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Preventive and social medicine > Test 8 > Flashcards

Test 8 Flashcards

1
Q

factors affecting nutritional status of an individual

A
  1. quality
  2. quantity
  3. health of individual
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2
Q

nutritional status of the community

A

sum of nutritional status of individuals who form that community

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3
Q

objective of COMPREHENSIBLE nutritional surveys

A
  1. information about given community
    - PREVALENCE of nutritional problems (how many people have it)
    - geographical DISTRIBUTION of disease (where do people have it)
  2. information leads to identification:
    - at risk population (age group, sex group etc) who are at greatest need of assist
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4
Q

nutritional surveys - role

A
  1. collect information about nutritional disorders
  2. identify people who are at risk
  3. define the disorders and
  4. form the policies
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5
Q

purpose of nutritional assessment

A
  1. define needs of people
  2. develop a health care programme that meet those needs
  3. evaluate the progress
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6
Q

Nutritional surveys - SAMPLE that gives valid conclusions

A
  1. random
  2. representative
  3. cover all ages
  4. cover both sexes
  5. cover all socioeconomic classes
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7
Q

survey planning with aid of expert statistical advice

A

decisions are to be made (don’t just wing it man)

  1. duration
  2. type
  3. measurement techniques (standardized)
  4. instruments

finally -do extensive investigation on a sub sample about the nutritional status - if possible

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8
Q

nutritional survey

A
  1. role/ objectives - info (prevalence, distribution) - > disorders and risk groups = status assessment (define needs) -> policies formation (form programme that meet the needs and keep evaluating them)
  2. survey planning (duration, type, instruments, measurement kind, investigation)
  3. sample
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9
Q

types of surveys

A
  1. cross sectional

2. longitudinal

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10
Q

methods of nutritional assessment

A

evaluate - all disease stages (i.e. prepatho, patho, postpathogenesis) by under given COMPLEMENTARY methods:

  1. clinical examination (GPE)
  2. anthropometry (childhood data)
  3. biochemical evaluation (serum levels)
  4. functional assessment (bodily responses)
  5. assessment of dietary intake (food)
  6. vital and health statistics (rates, death births, marriages, divorces etc)
  7. ecological studies (environmental)
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11
Q

clinical examination

A

simplest
practical
look for physical signs (specific signs, non specific signs):
1. assess status of nutrition (of individual/ population)
i.e. if the person is nourished or has malnutrition:

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12
Q

nutritional surveys goals

A
  1. health vs food consumed
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13
Q

diagnosis of deficiency diseases

A

when two or more signs characteristic for a particular diseases are present simultaneously

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14
Q

classification of signs used in nutritional surveys (WHO expert committee)

A
  1. not related to nutrition
  2. need further investigation
  3. known of value
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15
Q

WHO classification of signs: not related to nutrition

A
  1. alopecia
  2. pyorrhea
    3 pterygium
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16
Q

WHO classification of signs:: that needs further investigation

A
  1. malar pigmentation
  2. corneal vascularisation
  3. geographical tongue
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17
Q

WHO classification of signs: known to be of value

A
  1. angular stomatitis (deficiency of riboflavin, iron
  2. bitot’s spots (vitamin A deficiency)
  3. calf tenderness
  4. absence of knee or ankle jerks (beri beri)
  5. enlargement of thyroid gland (endemic goitre)
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18
Q

drawbacks of clinical signs/ examination

A
  1. malnutrition cannot be quantified
  2. subjectivity or lack of specificity
  3. some diseases aren’t associated with signs
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19
Q

how to overcome subjective and objective errors

A
  1. cover all parts of body in the survey (standard survey forms)
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20
Q

anthropometric measurements in young children

A
  1. height
  2. weight
  3. chest circumference
  4. arm circumference
  5. head circumference
  6. skin fold thickness
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21
Q

anthropometric measurements

A
  1. height
  2. weight
  3. skin fold thickness
  4. arm circumference
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22
Q

anthropometric measurements

A
  1. can be done non medical - given enough training
  2. record over a period of time:
    - reflect pattern of growth
    - reflect pattern of development
    - reflects deviation from average values (of size, built and status) at various ages
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23
Q

natural history of disease

A
  1. prepathogenesis period

2. pathogenesis period

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24
Q

prepathogenesis period course

A
  1. diminishing reserves

2. reserves exhausted + physiological alteration

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25
Q

prepathogensis assessment methods

A
  1. food balance sheets

2. dietary surveys

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26
Q

pathogenesis course (+ assessment methods)

A
  1. non specific signs and symptoms (anthropometric measurements, clinical examination)
  2. illness (lab investigations etc)
  3. permanent damage (morbidity data)
  4. death (mortality data)
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27
Q

lab assessment

A
  1. blood (hemoglobin, rbc, hematocrit values)
  2. urine
  3. stool
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28
Q

hemoglobin assessment is the index of

A
  1. anemia

2. over all state of nutrition

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29
Q

stool testing is done for

A

intestinal parasites

Hx of infestation, diarrhea, dysentery = signify the nutritional status

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30
Q

urine examination is done for

A
  1. albumin

2. serum

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31
Q

biochemical examination - role

A
  1. precise
  2. detection of malnutrition in pre clinical stage by checking levels of individual nutrients or body molecules they affect
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32
Q

biochemical examination is done for

A
  1. vitamins in serum (retinol)
  2. minerals in serum (iron levels)
  3. enzymes for which vitamins are co factors (riboflavin is co enzyme of number of enzymes that are involved in energy metabolism eg. glutathione reductase)
  4. metabolites in urine (iodine)
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33
Q

normal iron levels of blood

A

0.8-1.8 mg/L

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34
Q

disadvantage of biochemical tests

A
  1. time consuming
  2. expensive
  3. cannot be applied on large scale (sub sample only)
  4. cross sectional findings
  5. only mild deficiencies detected
  6. confirmatory test for clinical assessment
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35
Q

currently advocated tests in nutritional surveys

A
  1. serum retinol
  2. TPP stimulation of RBC transketolase activity
  3. RBC glutathione reducatase activity stimulation by flavine adenine dinucleotide
  4. urine N-methyl nicotinamide
  5. serum folate, RBC folate
  6. serum B12 concentration
  7. leucocyte ascorbic acid
  8. prothrombin time
  9. serum albumin, serum transferrin, thyroid binding pre-albumin
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36
Q

biochemical tests - vitamin A

A

serum retinol - 20 mcg/dl

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37
Q

biochemical tests - thiamine

A

TPP stimulation of RBC transketolase activity - 1-1.23 ratio

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38
Q

biochemical tests - riboflavin

A

RBC glutathione reductase stimulation by flavine adenine dinucleotide - 1- 1.2 ratio

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39
Q

biochemical tests - niacin

A

urine N-methyl niicotinamide

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40
Q

biochemical tests - folate

A 
serum folate (6 mcg/ml)
rbc folate (160 mcg/ml)
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41
Q

biochemical tests - vitamin B12

A

serum B12 concentration (160 mg/ L)

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42
Q

biochemical tests - ascorbic acid

A

leucocyte ascorbic acid - 15 mcg/ 10^8 cells

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43
Q

biochemical tests - vitamin K

A

prothrombin time - 11-16 seconds

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44
Q

biochemical tests - protein

A

serum albumin - 35 g/L
serum transferrin - 20 g/L
thyroid binding pre albumin - 250 mg/L

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45
Q

functional indices of nutritional status / deficiencies

A
  1. structural integrity
  2. host defenses (P/E, Zn, Fe, Se)
  3. hemostasis
  4. reproduction
  5. nerve function
  6. work capacity
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46
Q

erythrocyte fragility indicates

A

vitamin E, selenium deficiencies

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47
Q

[functional indicator] state

A

indicates amt of deficiency

like, lesser the level of nutrient (say Se) associated with the said indicator (i.e erythrocyte fragility) is, worse is the state of that indicator (i.e. worse is the fragility)

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48
Q

capillary fragility indicates

A

vitamin C deficiency

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49
Q

amt of tensile strength indicates

A

copper levels (i.e less strength= less copper levels)

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50
Q

normal leucocyte chemotaxis indicates

A

normal P/E and Zinc levels

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51
Q

normal leucocyte phagocytosis indicates

A

normal P/E and Fe levels

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52
Q

normal leucocyte bacteriocidal capacity indicates

A

normal P/E and Fe, Se levels

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53
Q

normal T cell blastogenesis indicates

A

normal P/E and Zn levels

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54
Q

delayed cutaneous hypersensitivit indicates

A

low P/E and Zn levels

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55
Q

increased prothrombin time indicates

A

vitamin K deficiency

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56
Q

sperm count levels indicates

A

energy and Zn levels

57
Q

nerve conduction capacity indicates

A

P/E, B1, B12 levels

58
Q

dark adaptation capacity indicates

A

vitamin A, Zn levels

59
Q

EEG indicates

A

P/E levels

60
Q

heart rate indicates

A

P/E, Fe levels

61
Q

vasopressor response indicates

A

vitamin C levels

62
Q

what are the indices of nutritional status

A

things that are influenced by the nutritional status

63
Q

direct assessment of food consumption is done by

A

food surveys

  1. household
  2. individual
64
Q

dietary survey methods

A
  1. weightment of raw food
  2. weightment of cooked food
  3. oral questionnaire
65
Q

dietary survey methods - weightment of raw food

A
  1. widely employed
  2. weigh all foood items
    - cooked and eaten
    - wasted, discarded
  3. ideal 7 days (one dietary cycle) recall (vary 1-21 days)
66
Q

dietary survey methods - weightment of cooked food

A
  1. not usually accepted
67
Q

dietary survey methods - oral questionnaire

A
  1. short time
  2. large number of people
  3. inquiries about
    - nature of food
    - quantity of food
    - dietary habits and practices
  4. duration 24- 48 hours
68
Q

dietary survey data is translated into

A
  1. mean food intake (gms) in terms of particular foods

2. mean nutrient intake per adult man (per consumption unit) by seeing the table of nutritive value of indian foods

69
Q

dietary survey provides information

A
  1. dietary patterns (quantity, variety, combination of foods)
  2. specific food consumed
  3. estimated nutrient intake
  4. estimated nutrient inadequacies (present standards)
70
Q

dietary survey - benefits

A
  1. help plan health education activities

2. assess the NEED of CHANGE in nature and extent of agricultural and food practices

71
Q

vital statistics - identify

A
  1. groups at high risk

2. extent of that risk in the community

72
Q

malnutrition (assessing risk by seeing the number of deaths in the given group and country)

A
  1. 1-4 years age - at risk group for mortality

2. more in developing countries (communities)

73
Q

vital statistics include

A
  1. mortality
  2. morbidity
  3. infant mortality rate
  4. second year mortality rate
  5. low birth weight
  6. life expectancy

(everything other than mortality rate provides good picture of the nutritional status of the community )

74
Q

data on morbidity is collected via

A

hospitals

community health centers and morbidity surveys

75
Q

morbidity data in relation to - (i.e data of the kinds and severities of the morbidity seen in following diseases)

A
  1. PEM
  2. anemia
  3. xerophthalmia
  4. vitamin deficiencies
  5. endemic goitre
  6. diarrhea
  7. measles
  8. parasitic infestation
76
Q

complete nutritional survey must include

A
  1. ecological survey
77
Q

study of ecological factors comprises of

A
  1. food balance sheet
  2. socio economic factors
  3. health and educational services
  4. conditioning influences
78
Q

conditioning influences

A
  1. precipitate malnutrition

2. eg. infections, infestations

79
Q

before putting effect measures for the prevention and control malnutrition

A

make ecological diagnosis of various factors influencing nutrition

80
Q

health and educational services

A
  1. health centers
  2. feeding
  3. immuniZation
81
Q

socioeconomic factors

A

food consumption factors varies with

  1. occupation
  2. family size
  3. income
  4. education
  5. customs
  6. cultural practices of feeding, mother and child
82
Q

food balance sheet

A
  1. indirect
  2. assess food consumption
  3. supplies are related to census and then per capita supply availability is used to count the approx. food consumption
83
Q

advantages of balance sheet

A
  1. cheaper
  2. simpler
  3. gives general pattern for food consumption
84
Q

disadvantages of balance sheet

A
  1. conceals differences between regions, age, sex, economic groups
85
Q

nutritional surveillance

A

keeping watch
over nutrition
in order to improve nutrition
in a population

86
Q

objectives of nutritional surveillance

A
  1. aid in LONG TERM PLANNING in health and development
  2. to provide input for programme MANAGEMENT AND EVALUATION
  3. give timely WARNING and INTERVENTION to prevent short term food crisis
87
Q

growth monitoring - prepatho measure

A
  1. goal is to preserve normal growth
  2. approach is educational and motivational
  3. all infants are monitored
  4. starts before 6 months
  5. done monthly
  6. 10-20 people groups
  7. mothers weigh or record
  8. weight card is simple and its emphasis is on the growth
  9. emphasis is on maintaining nutrition rather than treating undernutrition
  10. in case of lacking growth, a child is given early home based interventions
  11. the early home based interventions are given for brief period, until normal growth is resumed
  12. interventions include primary health care, ORS, vaccines, vitamin A, deworming, contraceptives, chloroquine, other treatments
  13. in case of severe lack in growth - referral is to health system for check up and food supplements
88
Q

nutritional surveillance - patho measures

A
  1. strategy/ goal is to detect of undernutrition
  2. approach is diagnosis and inteventions
  3. representative samples are monitored
  4. representative ages are monitored 5. for long periods of time
  5. any size - mostly 50-100
  6. recording is done by trained workers
  7. weight card is very precise, include nutritional status
  8. emphasis is on treating undernutrition
  9. response include rehabilitation with supplements
  10. supplements are given for long periods, until there is good nutrition in community
  11. interventions include - food supplements to community, subsidy etc.
89
Q

growth monitoring

A
  1. individual child
  2. individual dynamic health
  3. normal nutrition
  4. promote growth and health
  5. enrollment by 6 months
  6. regular monthly participation
90
Q

nutritional surveillance

A
  1. representative sample
  2. over all health of community
    - bad or good
    - relative to other communities
    - improving or deteriorating
  3. help diagnose malnutrition
  4. impact of negative factors (drought)/ positive factors (interventions)
91
Q

nutritional status indicators - maternal

A
  1. birth weight
92
Q

overall nutritional status of infant/ preschool children

A
  1. proportion being breast fed
  2. proportion on weaning food (by age in months)
  3. mortality rates in children aged 1-4
  4. mortality rates of 2 year olds specially
  5. if age is known - height for age, weight for age
  6. if age is unknown - weight for height, arm circumference, clinical signs and symptoms
93
Q

school children nutritional status

A
  1. height for age (during admission, at 7 years)
  2. weight for age (during admission, at 7 years)
  3. clinical signs and symptoms
94
Q

nutritional status indicators - role

A
  1. measure quality of life

2. evaluate health and development programmes

95
Q

malnutrition

A
  1. pathological state
  2. resulting from relative or absolute
    - deficiency
    - excess
  3. of essential nutrient
96
Q

malnutrition - PATHOLOGICAL FORMS

A
  1. undernutrition
  2. overnutrition
  3. imbalance
  4. specific deficiency
97
Q

undernutrition (or in extreme cases - starvation) - pathological forms

A
  1. due to insufficient food intake over extended period of time
98
Q

overnutrition - pathological forms

A
  1. due to excessive food intake over extended period of time
  2. can cause, obesity, diabetes,
99
Q

imbalance of nutrients - pathological forms

A
  1. relative deficiency of any nutrient
    with or without absolute deficiency
  2. disproportion among different nutrients
100
Q

specific deficiency - pathological forms

A
  1. relative or absolute deficiency

2. of specific nutrient

101
Q

five principle nutritional deficiency diseases

A
  1. stunting
  2. wasting
  3. xerophthalmia
  4. nutritional anemia
  5. endemic goitre
102
Q

effects of malnutrition in a community

A
  1. direct

2. indirect

103
Q

direct effects of malnutrition

A
  1. frank nutritional deficiencies

2. subclinical nutritional deficiencies

104
Q

nutritional deficiencies include

A
  1. kwashiorkor
  2. marasmus
  3. vitamin and mineral deficiencies
105
Q

indirect effects of malnutrition

A
  1. high mortality and morbidity in young children
    - predisposal to infections (tb, gastro disorders)
    - developing country 50% deaths are that of preschool children (in developed countries that % is 5)
  2. retarded physical and mental growth
  3. lower vitality
  4. lower productivity
  5. lower life expectancy
  6. maternal mortality
  7. stillbirth
  8. low birth weight
106
Q

hazards of over nutrition

A
  1. obesity
  2. cardiovascular diseases
  3. diabetes
  4. hypertension
  5. liver and gall bladder disorders
107
Q

ecology of malnutrition

A
  1. man made disease
  2. begins in womb
  3. ends in grave
108
Q

ecological factors related to malnutrition as listed by jeliffee

A
  1. conditioning factors
  2. cultural influences
  3. socioeconomic factors
  4. food production
  5. health and other services
109
Q

conditioning factors associated with malnutrition

A
  1. infectious diseases (esp in smol children) causes malnutrition and malnutrition predisposes children to infections
    - example measles, whooping cough, parasites (intestinal), malaria, tb
  2. in poor environmental conditions half the first 3 years of one’s life could be spent sick
110
Q

cultural influences

A
  1. food habits
  2. customs
  3. beliefs
  4. attitudes
  5. religion
  6. food fads
  7. cooking practices
  8. child rearing
  9. men eating first, alcoholism
111
Q

cultural influences - food habits

A
  1. psychological roots
  2. entrenched deeply
  3. associated with love, affection, warmth, self image, prestige
  4. shaped by family - passed to generations
112
Q

cultural influences - customs and beliefs

A
  1. apply to vulnerable groups
113
Q

cultural influences

A
  • people may refuse to eat food that is against their culture even if it is present in plenty . eg. wheat during ww in south india, anti beri beri food by that one dumbass (respek) phillipine student who knew to prevent it but didn’t because of the stupid culture fuck u look what u caused, papaya by pregnant woman, dals, leaf greens, rice and fruits by lactating gujrati woman
  • belief = if woman eat more- baby big, will rip vag apart apparently
  • harmful food for children
  • hot cold, light heavy foods
114
Q

cultural influences - religion

A
  1. influence food habits (food taboos)
    - hindus don’t eat beef, fish eggs, onions
    - muslims don’t eat pork
115
Q

cultural influences - food fads

A
  1. personal dislikes and likes

2. can pose a nutritional problem when we are trying to correct deficiencies

116
Q

cultural influences - cooking practices

A
  1. cooking influence nutritive values of food
    - peeling vegetables
    - throwing rice water
    - prolonged boiling in open pans
117
Q

cultural influences - child rearing practices

A

1 . influence nutritional status of infants and children

  1. practices include
    - premature weaning
    - bottle feeding - commercially refined food
118
Q

socioeconomic factors / political structures (national, international)

A
  1. population growth
  2. poverty
  3. ignorance
  4. education lack
  5. lack of knowledge about nutrition
119
Q

food production

A
  1. increased food production = increased food consumption
  2. indian average per capita land 0.6 hectare (5.8 in developed countries)
  3. average per capita arable land 0.3 hectares
  4. indian average yield per hectare 1/4th of devolped countries
120
Q

problems associated with food production

A
  1. even though food production can be increased several folds, the main problem in uneven distribution of foods between countries and within countries
121
Q

health and other services needs

A

it needs to be
1. properly organised
2. given resources
to combat malnutrition

122
Q

malnutrition remedial actions that should be taken by health sectors

A
  1. nutritional surveillance
  2. nutritional rehabilitation
  3. nutritional supplementation (mothers and children - stop gap measure)
  4. health education - programmes
123
Q

nutritional surveillance

A 
continuous monitoring 
in a community or an area
of factors or conditions 
which indicate, relate to or impinge
nutritional status of
individuals or groups
124
Q

nutritional rehablitation

A
  1. malnoruished subject detected
  2. immediate measures put into action
    eg PEM child - hospitalisation, domiciliary or rehab centers depending on the degree of malnourishment
  3. supplementation can be given as a stop gap measure
125
Q

levels of preventing malnutrition

A
  1. family (principle target)
  2. community
  3. national
  4. international
126
Q

coordinated approach for malnutrition treatment by which disciplines

A
  1. nutrition
  2. food technology
  3. health administration
  4. health education
  5. marketing
127
Q

action at the family level to prevent malnutrition

A

key position for imparting education - community health workers, multipurpose workers

  1. nutritional education (programmes) of especially husband and wife
    - right kind of local food
    - nutritionally adequate
    - promote breast feeding
    - improve infant and child feeding practices
    - counter misleading commercials about baby foods
    - food taboos and dietary prejudices can be identified and corrected
    - focus on expecting, lactating mothers
    - kitchen garden, poultry keeping
  2. mother child health
  3. family planning
  4. immunisation
128
Q

action at community level to prevent malnutrition

A
  1. analysis of nutritional problem /deficiency
    - extent
    - distribution
    - type
  2. at risk population identification
  3. dietary/ non dietary factors contributing to malnutrition
  4. surveys - samples - methods - compare
  5. feasible approach to combat malnutrition with local available resources
129
Q

action at national level to prevent malnutrition

A
  1. rural development (raise living standard, purchasing power - by broad based rural development programme)
  2. increasing agricultural production
  3. stabilisation of population ( spacing, small fam norm)
  4. nutritional intervention programmes (NIDDCP, control of anemia, blindness control, supplementary feeding programme)
  5. nutrition related health activities (malaria eradication, , immunisation , sanitisation, family planning, food and nutrtional planning)
130
Q

action at international level to prevent malnutrition

A
  1. international cooperation during floods, drought
  2. multilateral world food programme 1963 - stimulate social and economic growth
    - enough safe food for those who need
    - aid to victims of emergency
131
Q

international agencies helping national government to combat malnutrition

A

FAO, UNICEF, WORLD BANK, WHO, CARE

132
Q

approaches to combat malnutrition at community level - temporary

A

palliative, partial , temporary solution

  1. mid day meal programme
  2. supplementary feeding
  3. vitamin A prophylaxis
133
Q

approaches to combat malnutrition at community level - - permanent

A
  1. increasing food quality
  2. increasing food quantity
  3. making sure at risk people obtain it
  4. programme like applied nutrition programmes, ICDS
  5. improving overall living conditions like water supply, education health, controlling infectious disease, socioeconomic development
134
Q

ICDS - acitvity

A
  1. provide nutritional education to mother
  2. informal education to pre school children
  3. supplements
  4. immunisation
  5. health check up

beneficiaries - children upto 6 years, preganant, lactating women, 15-44 years old women

135
Q

indian population living in rural areas

136
Q

how to increase food production (programmes should include)

A
  1. better farming practices
  2. expansion of cultivation area
  3. fertilisers
  4. better seeds
  5. effective distribution
  6. irrigation +pest control
137
Q

anemia prevention

A
  1. ifa ot pregnant and lactating females

2. fortification with iron in common foods

138
Q

NIDDCP

A

iodised salt

139
Q

nutritional blindless control

A

large doses of vitamin A
2 lac retinol palmitate 12 months to 6 years - 6 monthly
1 lac - 6 months to 1 year

Preventive and social medicine (13 decks)

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