8
Community Medicine
1. How frequently should the well water in a village be chlorinated? (A) Dail Daily y (B) Once Once a week week (C) Every Every 3 months months (D) Every Every 6 months months 2. National National institute of occupational occupational health health is located at: (A) Jaip Jaipur ur (B) Ahmedab Ahmedabad ad (C) Mumb Mumbai ai (D) Luck Luckno now w 3. Penicillin injection is recommended every 3 weeks for diagnosed cases of rheumatic heart disease. This is an example of: (A) Health Health promot promotion ion (B) Specific Specific protectio protection n (C) Early diagnosis diagnosis and treatment treatment (D) (D ) Disability Disability limitation limitation 4. A five-year follow up study was done to determine, whether or not smokers, who had previous heart attacks, were at a risk of dying after 5 years, if they continued smoking or quit smoking. For this purpose a cohort of 156 patients of ischemic heart disease was taken. All of them were smokers till they experienced heart attack.
Community Medicine 81 75 patients continued smoking after heart attack and 81 patients quit smoking. Out of those who continued smoking 27 died and out of those who quit smoking 14 died. What is the risk ratio amongst those who continued smoking and those who quit smoking? Heart Attack Patients Statu s a fter
C on on t i n u e d
5 year s
sm ok ing
D ie d
27
14
41
Survived
48
67
115
Total
75
81
156
(A) (B) (B) (C) (C) (D) (D)
Q u i t sm o k i n g
T ot o t aall
0.17 0.17 1.1 2.1 3.1
5. The human genome project is an intervention which can be termed as an example of what type of prevention? (A) Primo Primord rdia iall (B) Prim Primar ary y (C) Second Secondary ary (D) Tert Tertia iary ry
6. In a village with a populatio population n of 5000, the infant mortality is 100 and the birth rate as 30/1000. Calculate the number of doses of measles vaccine required for the number of eligible children in the village, if the wastage factor of measles vaccine is two: (A) 135 (B) 150 (C) 270 (D) 300
82 MP–PPG 2010 7. Which of the following committees promoted the concept of urban primary health care? (A) Bhor Bhoree (B) Shriv Shrivas astav tav (C) Kartar Kartarsin singh gh (D) Krish Krishnan nan 8. As per the Central Births and Deaths Registration Act, 1969, what is the upper limit, in days for registering an event of birth? (A ) 7 (B) (B) 14 (C) (C) 21 (D) (D) 28 9. National Institute Institute of of Epidemiology Epidemiology is located at: (A) New Delh Delhii (B) Ahmedab Ahmedabad ad (C) Chen Chenna naii (D) Kolk Kolkat ataa 10. A new triage system was set up in an emergency unit of general hospital. To evaluate the new system, the waiting time of patients was measured and compared with the waiting time at a comparable nearby hospital for a period of 6 months. The type of study (research design) in above mentioned example is: (A) Cross-secti Cross-sectional onal study (B) Longitud Longitudinal inal study study (C) Case control control study (D) Clinical Clinical trial trial 11. With reference reference to the demographic demographic cycle, India is in which of the following phases? (A) Early Early expandin expanding g (B) Late Late expand expanding ing (C) Low statio stationar nary y (D) Decli Declini ning ng
Community Medicine 83 12. For one case of measles, the subclinical case/s expected in the community is/are: (A) (A) Zero Zero (B) (B) 10 (C) (C) 100 (D) 100 1000 13. Daily requirement requirement of water, in liters, per person, per day, for all purposes ideally is: (A) 40-5 40-50 0 (B) 50-1 50-100 00 (C) 100100-15 150 0 (D) 150150-20 200 0 14 . The approximate approximate calorific calorific value value of 2 slices of bread, in kilocalories, is: (A) (A) 70 (B) (B) 170 (C) (C) 270 (D) 370 15 . The (A) (B) (C) (D)
founder founder of epidemiology epidemiology is: Fracas Fracastor torius ius Edwin Edwin Chadwi Chadwick ck John John Snow Snow James James Lind Lind
84 MP–PPG 2010
ANSWERS 1. (A) (A) Dail Daily y (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, pages 627, 628) The question is definitely incomplete. The question should be like this “How frequently should the well water in a village be chlorinated during epidemics of cholera?” Park quotes that: “During epidemics of cholera, wells should be disinfected every day.” This clearly implies that while there is no epidemic, daily chlorination is not recommended. Provided with “Daily” as answer from VYAPAM, I suppose, the examiner missed the phrase “epidemics of cholera” in the question.
Also Know
• Most effective and cheapest method of • • • • • •
chlorination of wells is by bleaching powder. Chlorine demand of well water is estimated by Horrock’s Apparatus. Roughly 2.5 gms of bleaching powder is required to disinfect 1000 lit of water. This will give an approximate dose of 0.7 mg of applied chlorine per liter of water. A contact period of 1 hr. is allowed before the water is drawn for use. At the end of 1 hr., the residual chlorine is tested by “ORTHOTOLIDINE ARSENITE TEST”. If free residual chlorine level is less than 0.5 mg/litre, the chlorination procedure should be repeated before any water is drawn.
2. (B) Ahmeda Ahmedabad bad (Ref: http://icmr.nic.in/institute.htm#Permanent% 20Institutes/Centres)
Community Medicine 85 National ICMR and health institutes: Nationa Nationall Institu Institute te of Health Health and Family Family Welfare (NIHFW)
New New Delhi Delhi
Nati Nationa onall Instit Institut utee of Mala Malaria ria Resea Researc rch h (NIMR)
New New Delh Delhii
Nationa Nationall Instit Institute ute of Medical Medical Statis Statistic ticss (NIMS)
New New Delhi Delhi
N at at io io na na l I ns ns ti ti tu tu te te o f E pi pi de de mi mi ol ol og og y
C he he nn nn ai ai
Tube Tuberc rcul ulos osis is Rese Resear arch ch Cent Centre re (TRC (TRC))
Chenna Chennaii
National JALMA Institute Institute for Leprosy and Other Mycobacterial Diseases (NJILOMD)
Agra
National National Institute Institute of Occupati Occupational onal Health Health (NIOH)
Ahmeda Ahmedabad bad
N at at io io na na l I ns ns ti ti tu tu te te f or or R es es ea ea rc rc h i n Environmental Health (NIREH)
B ho ho pa pa l
Nation National al Instit Institute ute of Nutrit Nutrition ion (NIN) (NIN)
Hyde Hydera raba bad d
Nationa Nationall Centre Centre of Laborato Laboratory ry Sciences Sciences
Hydera Hyderabad bad
Food and Drug Toxicology Research Centre
Hyderabad
N at at io io na na l I ns ns ti ti tu tu te te o f C ho ho le le ra ra a nd nd Enteric Diseases (NICED)
K ol ol ka ka ta ta
Centre for Research in Medical Entomology (CRME)
Ma d u r a i
N at at io io na na l I ns ns ti ti tu tu te te f or or R es es ea ea rc rc h i n Reproductive Health (NIRRH)
M um um ba ba i
Na t io n a l I n s ti tu te te o f I m m u n o hematology (NIIH)
Mumbai
Vect or C on tr ol R esear ch Centre (VCRC)
Pu dd u ch er ry ( Po n d i ch e r r y )
Nati Nation onal al Inst Instit itut utee of Viro Virolo logy gy (NIV (NIV))
Pune
Nation National al AIDS AIDS Resear Research ch Instit Institute ute (NARI) (NARI)
Pune
3. (D) Disability Disability limitation limitation (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition) I would like to categorize this as a very tricky question. Page 331, Primary prevention: prevention : “Aim of primary prevention is to prevent the first attack of rheumatic fever, by identifying all patients with w ith streptococcal throat infection and treating them with penicillin” Secondary prevention of rheumatic fever: fever : Secondary prevention (i.e., the prevention of
86 MP–PPG 2010 recurrences of RF) is more practised approach, especially in developing countries. It consists in identifying those who have had RF and giving them one intramuscular injection of benzathine benzyl penicillin (1.2 million units in adults and 600,000 units in children) at intervals interva ls of 3 weeks. This must be continued for at least 5 years or until the child reaches 18 years whichever is later.” At first look it appears that the answer must be secondary prevention (or early diagnosis and treatment), however if we look into the question carefully, it is not about rheumatic fever but rheumatic heart disease so there is no point of secondary prevention. Page 329: “Rheumatic fever (RF) and rheumatic heart disease (RHD) cannot be separated epidemiological point of view. Rheumatic fever often leads to RHD which is a crippling disease”. That is after RHD only tertiary prevention (disability limitation) can be done. (See Table 8.1 on the next page) However there are no direct lines quoting such situation but as the question is about RHD not RF and the answer provided by VYAPAM is disability limitation, the explanation holds good. 4. (C) (C) 2.1 2.1 (Ref: Park, Textbook of Preventive and Social Medicine, 20th edition, page 69) Relative risk/Risk ratio = Incidence among exposed/Incidence among non-exposed = (27/75)/(14/81) = 2.082 or 2.1 5. (A) Primor Primordia diall (Ref: Textbook of Preventive and Social Medicine, 20th edition, page 39, Encyclopedia of Primary Prevention and Health Promotion, By Thomas P. Gullotta, Martin Bloom, page 316, 317
Table 8.1 Normal popu popula lati tion on
Streptococcal thro throat at infe infect ctio ion n
First attack of rheumatic fever →
Subsequent attacks of rheumatic fever →
Rheumatic heart disease →
Disability
Primordial prevention
Primary prevention
Secondary prevention
Secondary prevention
Te rti ary prevention
Te r t i a r y prevention
Individual and mass education
Specific pr protection
Early diagnosis and treatment
Early diagnosis and treatment
Disability limitation
Rehabilitation
ADULTS: Sing Single le IM 1.2 1.2 million units benzathine benz benzyl yl peni penici cill llin in
ADULTS: 1.2 1.2 mill millio ion n unit unitss benzat zathine benzyl zyl penicillin, IM/3wk For For 5 yrs yrs or till till 18 yrs, yrs, which whichev ever er is later
ADULTS: 1.2 mill millio ion n unit unitss benz benzat athi hine ne benz enzyl penicil cillin IM /3 wk For For 5 yrs yrs or till till 18 yrs, yrs, which whichev ever er is later
ADULTS: 1.2 mill millio ion n unit unitss benz benzat athi hine ne benz enzyl penic nicillin, IM/3wkLife long
CHILDREN: single IM, 600,000 unit unitss benz benzat athi hine ne benz benzyl yl peni penici cill llin in
CHILDREN: CHILDREN: CHILDREN: 600,000 units 600,000 units 600,000 units benz benzat athi hine ne benz benzyl yl benz benzat athi hine ne benz benzyl yl benz benzat athi hine ne benz benzyl yl peni penici cill llin in,I ,IM/ M/3w 3wk k peni penici cill llin in,, IM/3 IM/3wk wk peni penici cill llin in,, For 5 yrs or till till 18 For 5 yrs or till 18 yrs, yrs, IM/3wk IM/3wk Life Life long yrs, whichever whichever is later whichever whichever is later
→
88 MP–PPG 2010 PRIMARY PREVENTION OF CHRONIC DISEASES, OLDER ADULTHOOD: Strategies that Might Work “Another strategy that might work is gene therapy–the elimination or replacement of defective genes with normal genes. While this belongs to future, it is within the realm of possibility that gene therapy may result in slowing down the ageing process and a decrease in chronic conditions. The human genome project, a project of US government has uncovered the map of entire sequence of gene on human chromosome. In the near future, it is possible that gene therapy may result in cures for such age related chronic conditions and diseases like as Parkinson’s, Alzheimer’s and cancers.” Now coming to the definition of primordial prevention from Park which says primordial prevention is a type of primary prevention in its purest form. It must be clear to you that human genome project can be either primary of primordial prevention. To justify VYAPAM’s answer, I hereby give you a simple example. Primordial prevention is eliminating a risk factor, now if BRCA gene is a risk factor of breast carcinoma. Deletion or replacement of this
C o m m u n i t y M e d i c i n e 8 7
88 MP–PPG 2010 PRIMARY PREVENTION OF CHRONIC DISEASES, OLDER ADULTHOOD: Strategies that Might Work “Another strategy that might work is gene therapy–the elimination or replacement of defective genes with normal genes. While this belongs to future, it is within the realm of possibility that gene therapy may result in slowing down the ageing process and a decrease in chronic conditions. The human genome project, a project of US government has uncovered the map of entire sequence of gene on human chromosome. In the near future, it is possible that gene therapy may result in cures for such age related chronic conditions and diseases like as Parkinson’s, Alzheimer’s and cancers.” Now coming to the definition of primordial prevention from Park which says primordial prevention is a type of primary prevention in its purest form. It must be clear to you that human genome project can be either primary of primordial prevention. To justify VYAPAM’s answer, I hereby give you a simple example. Primordial prevention is eliminating a risk factor, now if BRCA gene is a risk factor of breast carcinoma. Deletion or replacement of this BRCA gene by virtue of gene therapy in that particular individual is primary prevention but this act of repairing the gene will further act as a primordial prevention for all the future family tree as it will prevent even the risk factor (BRCA gene) to occur further. 6. (C) (C) 270 270 (Ref: Textbook of Preventive and Social Medicine, 20th edition, page 488, http:// www.who.int/immunization_delivery/ vaccine_management_logistics/logistics/ expected_wastage/en/index.html)
Community Medicine 89 “In the practice of immunization, the number of vaccine doses consumed (used) is always higher than the number of persons immunized. The excess number of doses represents doses loosed” In the question birth rate = 30/1000 So total number of births in a population of 5000 = 5000 × 30/1000 = 150 Infant mortality rate is 100 per thousand live births So total infants deaths would be = 150 × 100/ 1000 = 15 So total number of vaccine needed will be = (total births – infant death) × wastage factor = (150 – 15) × 2 = 270 7. (D) Krish Krishnan nan (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, pages 776, 777, http://nihfw.org/NDC/Docum http://nihfw.org/NDC/Documentation entation Services/Committee_and_commission.html, http://www.ihmp.org/urban_health.html) Krishnan Committee has not been described in Park but has been asked several times in MPPPG. The last health planning committee that Park mentioned was up till 1977 (Shrivastava committee) (See Table 8.2 on the next page) 8. (B) (B) 14 (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, page 743) If you think Park cannot commit mistakes, then I must tell you that park has not corrected/updated itself on this point for a very long time. As Pre Park “The time limit for registering the event of births is 14 days and for deaths is 7 days” which in fact was true at the time of framing the act, but the act has not mentioned any time frame by itself and has provided the powers to the registrar general of India to direct state governments and union territories on this matter. The time frame
Table 8.2 BHOR E COMMITTEE
1 9 46 46
B efore 1st five year plan
I n t e g r a t i o n o f p r e v en en ti tiv e a n d c u r at at i v e se r v ic ice s Primary Health Centre (s h o rt t er m p la n -1 PHC/40,000 population and long-term plan aka3 million plan) plan ) Social physician
M UD UD AL AL IA IA R C OM OM MI MI TT TT EE EE
1962
B y t he he e nd nd of 2 nd nd f iv iv e y ea ear p la la n ( 19 19 56 56 -1 -1 96 96 1) 1)
A ls ls o k no no wn wn a s “ He He al al th th s ur ur ve ve y a nd nd p la la nn nn in in g c om om mi mi tt tt ee ee ” All India health services like Indian admin istrative services 1 PHC/40,000 population
C HA HA DA DAH C O MM MM I TT TT E E
1963
T o stu dy dy m ai ain te te na na nc nc e p ha hase of m al al ar ar ia ia e ra ra di di ca ca ti ti on on p ro ro gr gr am am me me
Basic health workers to work as Multipurpose health workers (1/10,000 p op op ul ul at at io io n, n, c om om bi bi ne ne f or or m al al ar ar ia ia a nd nd f am am il il y p la la nn nn in in g) g)
MU KE KE RJ RJI COMMITTEE (1st and 2nd)
1 st st –1 –1 9 65 65
To r ev eview strategies of f a mi ly p la n n in g
Separ at ate staf f fo r fam il ily p la lann in ing De l i n k f a m i l y p l a n n i n g a n d m a l a r i a
2nd–1966 2nd–1966
To exam examin inee nati nation onal al heal health th programmes
Basi Basicc heal health th serv servic ices es
JUNG JUNGAL ALWA WALL LLA A COMMITTEE
1967
Commi Committ ttee ee on inte integra grati tion on of h ea lth se r vi ces
Unif Unifie ied d cadr cadre, e, comm common on seni senior orit ity, y, Integrated health services No private practice. Equal pay for equal work, special pay for special work. Recognition of extra qualification
KARTA KARTAR R SING SINGH H COMMITTEE
197 3
Accepted Accepted for 5th five year year plan, plan, c o m m it t e e o n m u l t i p u r p o se workers under health health and and family p la la nn nn in in g
Single Single cadre cadre of multipu multipurpos rposee workers workers,, i.e., i.e., MPW (Femal (Female)e)-Female health workers (in place of nurse/midwifes) and MPW (Male) Male health workers (in place of family planning assistant)1 PHC/50,000 po pu pu la lati on on div id id ed ed i nt nto 16 sub ce cen tr tre s ( on one f or or 30 00 00 to 35 00 00 p op op ul ul at atio n) n)
SRIVASTAVA COMMITTEE COMMITTEE
1 97 97 5
6 th f iv e- ye ar p lan “ Gr ou p o n Medi Medica call Educ Educat atio ion n and and Supp Suppor ortt M an an po po we we r” r”
“Referral Services Complex” Medical and health education comm commis issi sion on ROME ROME sche scheme me (reo (reori rien enta tati tion on of medi medica call educ educat atio ion) n) A cc cc ep ep ta ta nc nc e o f t he he r ec ec om om me me nd nd at at io io ns ns o f t he he S hr hr iv iv as as ta ta va va C om om mi mi tt tt ee ee l ed ed t o “Rural Health Service”
KRIS KRISHN HNAN AN COMMITTEE
1982
To addr addres esss the the prob proble lems ms of urban health
Heal Health th post post run run by a doct doctor or,, a Publ Public ic Heal Health th Nurs Nurse, e, 4 Auxi Auxili liar ary y Nurs Nursee Midwives, 4 multipurpose workers and 25 Community Health Workers for a population of 50,000.
9 0 M P – P P G 2 0 1 0
Contd.
Contd.
BAJAJ COMMITTEE
1986
Nation al medical and health ed ucation policy Edu cational commission for h ealth sciences (ECHS) like UGC Health science universities, Vocationalization of education health manpower cells at Centre and states
C o m m u n i t y M e d i c i n e 9 1
Contd. SRIVASTAVA COMMITTEE COMMITTEE
1 97 97 5
6 th f iv e- ye ar p lan “ Gr ou p o n Medi Medica call Educ Educat atio ion n and and Supp Suppor ortt M an an po po we we r” r”
“Referral Services Complex” Medical and health education comm commis issi sion on ROME ROME sche scheme me (reo (reori rien enta tati tion on of medi medica call educ educat atio ion) n) A cc cc ep ep ta ta nc nc e o f t he he r ec ec om om me me nd nd at at io io ns ns o f t he he S hr hr iv iv as as ta ta va va C om om mi mi tt tt ee ee l ed ed t o “Rural Health Service”
KRIS KRISHN HNAN AN COMMITTEE
1982
To addr addres esss the the prob proble lems ms of urban health
Heal Health th post post run run by a doct doctor or,, a Publ Public ic Heal Health th Nurs Nurse, e, 4 Auxi Auxili liar ary y Nurs Nursee Midwives, 4 multipurpose workers and 25 Community Health Workers for a population of 50,000.
BAJAJ COMMITTEE
1986
Nation al medical and health ed ucation policy Edu cational commission for h ealth sciences (ECHS) like UGC Health science universities, Vocationalization of education health manpower cells at Centre and states
92 MP–PPG 2010 has been changed long time back to 21 days for all registrations. There is innumerable government of India/state government/municipal corporation websites which clearly says 21 days as cut off day for registration of both birth and death. (http://www.tnhealth.org/dphbd.htm, http://cbmorar.org/birth_death.html, http://www.bhopalmunicipal.co http://www.bhopalmunicipal.com/Hindiversio m/Hindiversion/ n/ how1.html, http://119.226.51.104/rbd/detail.php?and var=R2UMSLYwhx127wyGKtWpTQ) Moral of the story; mark 21 days as AIPG never commits mistakes like this and after being dragged to High Court of MP, even VYAPM is i s not going to commit same mistake again. Hallelujah!!!! 9. (C) Chenna Chennai, i, (Ref: Q 2 of PSM) 10 . (D) Clinical trial trial (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, pages 79, 80) “For the most part, “clinical trials” have been concerned with evaluating therapeutic agents, mainly drugs.” “Nevertheless, they are powerful tool and should
C o m m u n i t y M e d i c i n e 9 1
92 MP–PPG 2010 has been changed long time back to 21 days for all registrations. There is innumerable government of India/state government/municipal corporation websites which clearly says 21 days as cut off day for registration of both birth and death. (http://www.tnhealth.org/dphbd.htm, http://cbmorar.org/birth_death.html, http://www.bhopalmunicipal.co http://www.bhopalmunicipal.com/Hindiversio m/Hindiversion/ n/ how1.html, http://119.226.51.104/rbd/detail.php?and var=R2UMSLYwhx127wyGKtWpTQ) Moral of the story; mark 21 days as AIPG never commits mistakes like this and after being dragged to High Court of MP, even VYAPM is i s not going to commit same mistake again. Hallelujah!!!! 9. (C) Chenna Chennai, i, (Ref: Q 2 of PSM) 10 . (D) Clinical trial trial (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, pages 79, 80) “For the most part, “clinical trials” have been concerned with evaluating therapeutic agents, mainly drugs.” “Nevertheless, they are powerful tool and should be carried out before any new therapy, procedure or service is introduced.” Clearly in the question we are talking about a new triage system and before implementing it has to be tested first with a clinical trial. 11. (B) Late expanding (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, page 411, Exploring environmental issues: An Integrated Approach, David D. Kemp, page 120, http://en.wikipedia.org/wiki/Demographic transition)
Community Medicine 93 High stationary stationary n o ti a l u p o P 0 0 0 1 / s h t a e D / s h t r i B
Early Early expanding expanding Late expanding Low stationary stationary Daclining Daclining
Birth Rate
Death Rate
Total Population Time
(See Table 8.3 on the next page) Park has wrongly placed China and Singapore in late expanding. They are now low stationary (updates from Wikipedia). Theoretically, when the TFR = 2, each pair of parents just replaces itself. Actually it takes a TFR of 2.1 or 2.2 to replace each generation — this number is called the replacement rate — because some children will die before they grow up to have their own two children. 12. (A) Zero (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, page 137, http://www.cdc.gov/measles/about/ complications.html) This has been asked innumerable times. However this time they have changed the language a bit. What they want to ask is about subclinical cases or carriers. “The only source of infection is a case of measles. Carriers are not known to occur.”
Also Know
•
WHO’s measles elimination strategy comprises a three part vaccination strategy, i.e., catch-up, keep-up and follow-up.
Table 8.3 High stationary stage
Earl y e xpanding st age
L at e expanding st age
Low stationary stage
D e c li n i ng
B irt h r ate h igh
B irth r ate h igh (rem ain s u nc ha ng e d)
Birth rate begins to fall
Birth r ate lo w
Birth rate lower than d e at h r at e
De ath r at e h ig h
Death rate f allin g
Dea th r ate fal ling (declines further)
Death rate low
Po pu pu la lation gr ow owth slo w
Po pu pu la lat io io n i nc ncr ea eas in in g
P op op ul ula ti tio n in cr cr ea ea si si ng ng , but less rapidly
Po pu pu la la ti ti on on s ta ta bl bl e (T o tal Fe rt ili ty R at e < 2 . 5 )
Po pu pu la la ti ti on on g ro ro wt wt h negative (subr ep l a ce m e n t fertility<2.1)
I nd nd ia ia t il il l 1 92 92 0 ( pr pr ee- in in du du st st ri ri al al s oc oc ie ie ty ty )
A fg fg ha ha ni ni st st an an , P al al es es ti ti ni ni an an , B hu hu ta ta n, n, La os os, Su bb- Sa Sa ha har an an Afr iicca (ex ce cep t Sou th th Afr iicca)
( De De ve ve lo lo pi pi ng ng c ou ou nt nt ri ri es es ) I nd nd ia ia, So ut uth A fr fr ic ic a, a, Asi a ( ex ex ce ce pt pt C hi hi na na )
( In In du du st st ri ri al al iz iz ed ed n at at io io ns ns ) E ur ur op op e, e, U SA SA , Canada, Ch in in a, a, Singapore, Australia, New Zealand, Brazil, South Korea, Turkey, Mauritius
G er er ma ma ny ny , H un un ga ga ry ry , Russia
Community Medicine 95
•
•
•
•
• • •
• •
The period of communicability is approximately 4 days before and 5 days after the appearance of rash. WHO defines elimination of measles as absence of endemic measles for a period of >/= 12 months in presence of adequate surveillance. The most effective age of immunization of measles vaccine is as close to 9 months as possible. The age can be lowered to 6 months if there is measles outbreak. In this case a second dose after the age of 9 months would be needed. One dose of vaccine appears to give 95% protection. Pneumonia, is the most common life threatening complication of measles. Ear infections (otitis media) is the most common complication of measles, occurring in about 1 in 10 measles cases and permanent loss of hearing can result. Diarrhea is reported in about 8% of measles cases. SSPE (subacute sclerosing panencephalitis) is a very rare/least common complication, but fatal degenerative disease of the central
9 4 M P – P P G 2 0 1 0
Community Medicine 95
•
•
•
•
• • •
• •
•
The period of communicability is approximately 4 days before and 5 days after the appearance of rash. WHO defines elimination of measles as absence of endemic measles for a period of >/= 12 months in presence of adequate surveillance. The most effective age of immunization of measles vaccine is as close to 9 months as possible. The age can be lowered to 6 months if there is measles outbreak. In this case a second dose after the age of 9 months would be needed. One dose of vaccine appears to give 95% protection. Pneumonia, is the most common life threatening complication of measles. Ear infections (otitis media) is the most common complication of measles, occurring in about 1 in 10 measles cases and permanent loss of hearing can result. Diarrhea is reported in about 8% of measles cases. SSPE (subacute sclerosing panencephalitis) is a very rare/least common complication, but fatal degenerative disease of the central nervous system that results from a measles virus infection acquired earlier in life. It is believed that measles, like smallpox, is amenable to eradication. It requires achieving immunization coverage of at least 96% of children less than one year of age.
13. (D)150-200 However in my opinion it should be (a) 40-50. Decision of High Court of Madhya Pradesh on this matter is awaited. Hallelujah!!!!
96 MP–PPG 2010 (Ref: http://www.un.org/eco http://www.un.org/ecosocdev/geninfo/ socdev/geninfo/ sustdev/waterrep.htm, EARTH SUMMIT +5, UN Assessment of Freshwater Resources “High-intensity use in urban and industrial areas may place severe stress on fresh water resources in surrounding localities. The Assessment reports an estimated household consumption in industrial countries of 150 to 200 litres of water per day, with an additional 150 to 200 litres litre s per person per day going for various municipal services. Additional conservation measures could reduce the per capita amount of usage. But in the developing countries, it can be anticipated that current per capita usage, which is about 50 litres/ person/day in many urban areas, is sure to increase in the coming years. This will necessitate additional water-treatment capacity and improved water management capacity.” (Ref:http://ddws.nic.in/popups/Rural DrinkingWater 2ndApril.pdf Rajiv Gandhi National Drinking Water Mission) National Rural DrinkingWater Programme; Annexure 1, A. Norms for Providing Potable Drinking Water in Rural Areas “40 litres per capita per day (lpcd) for humans to meet the following requirements based on basic minimum need as defined under the ARWSP guideline.” P ur po se Quantity (lpcd) Drinking 3 Cooking 5 Bathing 15 Washing utensils 7 House ablution 10 Total 40 (Ref: Guidelines for drinking water quality, 2nd edition, volume 3, Surveillance and control of community supplies, World Health Organization Geneva, page 74) “Measurements of the volume of water collected or supplied for domestic purposes may be used
Community Medicine 97 as a basic hygiene indicator. Some authorities’ use a guideline value of 50 litres per capita per day, but this is based on the assumption that personal washing and laundry are carried out in the home; where this is not the case, lower figures may be acceptable.” Ref: http://www.bvsde.paho.org/bvsacd/ cd17/basic_wate.pdf Basic Water Requirements for Human Activities: Meeting Basic Needs By Peter H. Gleick, M. IWRA, Pacific Institute for Studies in Development, Environment and Security 1204 Preservation Park Way, OAKLAND CA 94612, U.S.A. “I recommend that international organizations, national and local governments, and water providers adopt a basic water requirement standard for human needs of 50 liters per person per day (l/p/d) and guarantee access to it independently of an individual’s economic, social or political status.” 14. (B) 170 The question seems to be incomplete, it is important to mention the size and type of bread. There are white bread (made from wheat flour from which the bran and the germ have been removed through milling) and brown bread (whole wheat bread). Also there are different sizes of breads available. (Ref: O.P. Ghai: Textbook of Pediatrics, page 112 Table 5.11) “100 gms of white bread contains 245 calories, and one slice contains around 25 gms.” So two slices of white bread = 50 gms = 245/2 Calories = 122.5 Calories (1 Calorie = 1 kilo calorie, note the difference between capital C and small c). Ref: American Diabetic Association Complete Food and Nutrition Guide, 3rd edition, page 63
98 MP–PPG 2010 “2 slices of bread contains 130 Calories.” Ref:http://www.dietbites.com/calories/ calories-in-bread.html “Calories in bread based on a one-ounce serving unless noted (1 ounce = 28 grams).” 170 is the closest option if I have to choose one, otherwise the question deserves cancellation. Hallelujah!!!! 15. (A) Fracastorius (Ref: Park: Textbook of Preventive and Social Medicine, 20th edition, page 4) Fracastorius (1483-1553), an Italian physician enunciated the “theory of contagion”. He envisaged the transfer of infection via minute invisible particles and explained the cause of epidemics. Fracastorius recognized that syphilis was transmitted from person to person during sexual relations. He became the founder of epidemiology. However, foreign authors invariably consider John Snow as father/founder of epidemiology. Park states John Snow as father of modern epidemiology. Ref: The Medical Detective: John Snow and the Mystery of Cholera, Sandra Hempel, Granta Books, London, 2006, ISBN-13: 9781-86207-842-0, http://www.ncbi.nlm.nih. http://www.ncbi.nlm.nih.gov/ gov/ pmc/articles/PMC1463927/ “John Snow is perhaps the only doctor ever to be considered the founder of two medical disciplines: epidemiology and anesthesiology.”
