Public Health and Community Medicine Mnemonics

PUBLIC HEALTH / COMMUNITY MEDICINE

MNEMONICS 2014

DR SARAH T

Dr Sarah T – Public Health Mnemonics Page 1

The purpose of creating Mnemonics is to aid the undergraduate and postgraduate students of Community Medicine/Public health in memorizing the topics easily. All the notes and descriptions with MNEMONICS are taken from various sources(references are mentioned with the topic). DEDICATED TO MY MOTHER AND TEACHERS.

MNEMONICS EPIDEMIOLOGY STUDIES Criteria for judging causality(reference ; K PARK) Mnemonic TCS / BCS T – Temporal association C² – Consistency of association - Coherence of association S² – Strength of association - Specificity of association B- Biological plausibility

Classification of epidemiological studies (reference ; K PARK) 1.

Observational studies

a) Descriptional studies b) Analytical studies Mnemonic (C³E)

i. ii. iii. iv.

Cross-sectional / Prevalance Case control / Case reference Cohort / Followup Ecological / Correlational


2.

Experimental studies Intervention studies

Mnemonic (CRF) a) Community trials b) Randomised control trials / Clinical trials c) Field trial/Community intervention studies

CASE CONTROL STUDY (reference ; K PARK) 4 basic steps Mnemonic SAM² i. ii. iii. iv.

Selection of cases and controls Analysis and interpretation Matching Measurement of exposure

INVESTIGATION OF AN EPIDEMIC(reference ; K PARK) (ones in same colour are related to each other to help in remembering them – the last 2 are not in same order as in book) 1.

Verification of Diagnosis

2.

Confirmation of epidemic

3.

Population at risk

4.

Search for cases

5.

Data Analysis

6.

Formulation of hypothesis

7.

Testing of hypothesis

8.

Report writing

9.

Ecological factors evaluation

10.

Further investigation of population at risk



EASY EXAM NOTES

GENERATION TIME (reference ; K PARK) Interval of time Between Receipt of Infection by host  Max infectivity of that host

SECONDARY ATTACK RATE(reference ; K PARK) No of persons developing the disease within the range of the incubation period following exposure to the primary case SAR = No of exposed persons developing the disease Within range of incubation period/Total no of exposed , susceptible contacts X 100

HERD IMMUNITY (reference ; K PARK)    

level of resistance of a community or group of people to a particular disease Immunological barrier to spread of diseases in human herd Elements : Occurrence of clinical and subclinical infection in the herd , Immunization of herd , Herd structure Determined by serological surveys

RANDOMIZED CONTROLLED TRIAL(reference ; K PARK) Mnemonics – P²R MAF Basic steps – 1.

Drawing up a Protocol

2.

Selecting reference and experimental population

3.

Randomization


4.

Manipulation or intervention

5.

Assessment of outcome

6.

Follow up

SECULAR TRENDS(reference ; K PARK)   

Time distribution of descriptive study Changes in the occurrence of a disease i.e progressive increase or decrease over a long period of time generally several years or decades. E.g CHD have shown consistent upward trend in developed countries , followed by decline of diseases such as TB.

MIGRATION STUDIES(reference ; K PARK)  

Studies genetic and environmental factors in occurrence of disease Carried out in 2 ways

i. Comparison of disease and death rates for migrants with those of their kin who have stayed at home. It shows environmental affects in disease occurance ii. Comparison of migrants with local population of host country provides information on genetically different groups living in similar environment. It shows genetic factors affecting in disease occurance

COHORT STUDY(reference ; K PARK) Reasons for choosing : i.

Cohort study is type of analytical (observational) study which is undertaken to obtain additional evidence to refute or support the existence of an association between suspected cause and disease.

ii.

Cohort studies are undertaken when there is good evidence of an association between exposure and disease as derived from clinical observations and supported by descriptive and case control studies.


iii.

When attrition of study population can be minimized e.gfollowup is easy,cohort is stable,co-operative and easily accessible.

Main steps i.

Selection of study subjects

ii.

Obtaining data on exposure

iii.

Selection of comparison groups

iv.

Follow up

v.

Analysis

MNEMONIC FOR DIFFERENCES OF CASE CONTROL AND COHORT Definition + TEaR³S (mnemonis doesn’t cover all differences) T - Tests ? E – Expensive/Inexpensive R3 - Results (quick / delay) / Rare diseases/ Rates (RR etc) S - Subjects (fewer/larger) Reference ; K Park ) Case control study

Cohort study

Effect to cause

Cause to effect

Starts with disease

Starts with people exposed to risk factor or suspected cause

Tests whether the suspected cause occurs more frequently in those with the disease than among those without the disease First approach to testing of a hypothesis but also useful for exploratory studies Fewer no of subjects

Tests whether disease occurs more frequently in those exposed than in those not similarly exposed


Reserved for testing of precisely formulated hypothesis Larger no

Case control study

Cohort study

Quick results For rare diseases

Delayed results Inappropriate for rare disease

Yields RR

Yields Incidence rates,RR , AR

Cannot yield information about disease other than that selected for study Inexpensive

Can yield information about more than one disease outcome Expensive

EPIDEMIOLOGY SCENARIO QUESTIONS FOR PRACTICE (Reference ; UQs of MPH Final Exams ) Q1.The validity of a oral hypoglycemic agent has been questioned. What study will you carry out in such case and describe its steps. Ans.Randomized Control Trial Q2. In order to test his hypothesis a researcher selects 150 indviduals with oesophageal cancer and 300 indviduals without oesophageal cancer and obtain their history of alcohol consumption.Which is this study and why Ans.Case and control becauses both are given.

Q3.A study was conducted to verify the association of the effects of oral contraceptives on heart disease in women 40-44 years of age. what study design will you advise ? Ans.Cohort study

Q4.A school teacher needs advice to measure the extent of cigarette smoking among the students of all high schools in the city. What study desigh will you advice and why ? Dr Sarah T – Public Health Mnemonics Page 8

Ans.Cross sectional survey – to see Prevalance Because such study tells us about the distribution of a disease in population rather than its aetiology.

Q5.In a recent study on cot deaths (sudden infant death syndrome) it was reported that the odds ratio OR for cot death in infants of mothers who were heavy coffee drinkers during pregnancy 4 cups per day was 2.4 (95 percent confidence interval 1.2-6.0) Explain what OR = 2.4 indicates What does this tell u about the connection btw coffee drinking and cot death in light of the 95 percent confidence interval ? Ans. OR = 2.4 Odds ratio means strength of association in number of times between exposed and non exposed. OR more than 1 shows positive relationship . It shows that the mother who were heavy coffee drinkers during pregnancy had 2.4 times more chances of having cot deaths in infact as compared to ones who didn’t drink.


MNEMONICS Determinants of health(reference; K PARK) Mnemonic : B²AG²ES² B2 – Biological and behavioural A-Aging G2-Gender Genetics E-Environment S2-Socioeconomic and healthServices

Dimensions of health(reference; K PARK) Mnemonic ; VEMPS² V-Vocational dimension E-Emotional dimension M-Mental dimension P-Physical dimension S2- Spiritual social Others

INDICATORS OF HEALTH(reference; K PARK) Mnemonic – NO DIM²ES²H²UQ NO these DIMES don’t belong to HUQ 1. Nutritional status 2. Other indicators 3. Disability 4. Mortality 5. Morbidity 6. Environmental 7. Social and mental health 8. Socio economic 9. Health policy 10. Health care delivery Dr Sarah T – Public Health Mnemonics Page 10

11. Utilization 12. Quality of life

PRIMARY HEALTH CARE (reference ; notes and K PARK) Elements : (ones in same colour are related to each other so that way they can be learnt easily) 1. 2. 3. 4. 5. 6. 7. 8.

Education Proper nutrition Safe water Maternal and child health care Immunization Control of local endemic Treatment of common diseases Essential drugs

Priniciples of Primary Health Care :(reference; lecture notes) Mnemonic – MET C 1. 2. 3. 4.

Multisectoral coordination Equitable distribution Appropriate Technology Community participation


EASY NOTES GERM THEORY OF DISEASE (reference ; K PARK) One to one relationship between causal agent and disease. Disease agent  Man  Disease

WEB OF CAUSATION (reference; K PARK) For chronic disease where the disease agent is not known often but it is the outcome of interaction of multiple factors. Considers all predisposing factors of any type and their complex interrelationship with each other.

WHEELS CONCEPT OF CAUSATION OF DISEASE (reference;ILYAS ) 1. Genetic core 2. Host or human 3. Environment Relative sizes of different components of wheel depend upon disease . Hereditary disease – genetic core larger Measles – state of immunity of Host and environment

PHYSICAL QUALITY OF LIFE INDEX(reference; K PARK) o it consolidates 3 indicators Infant mortality Life expectancy at age one Literacy Performance placed on a scale of 0 to 100

HUMAN DEVELOPMENT INDEX(reference; K PARK) o o o o o

A consolidate index combining indicators representing 3 dimensions of life Life expectancy at birth Adult literacy rate and mean years of schooling GDP per capita Value ranges from 0 to 1


DISABILITY RATES (reference; K PARK) Sullivan;s index – expectation of life free of disability HALE–life expectancy at birth but includes an adjustment for time spent in poor health. DALY – years of life lost to premature death and years lived with disability adjusted for the severity of disease

LEVELS OF PREVENTION AND MODES OF INTERVENTION LEVELS :(reference; K PARK) 1. 2. 3. 4.

Primordial – risk factors Primary – prior to onset of disease Secondary – early diagnosis + treatment Tertiary – late pathogenesis phase

INTERVENTION(reference ; K PARK) 1. Health promotion Health education Env modification Nutritional interventions Lifestyle and behavioural changes 2. Specific protection Immunization , protection against occup hazards 3. Early diagnosis and treatment 4. Disability limitation 5. Rehabilitation Medical , Vocational , Social , Psyhcological


EPIDEMIOLOGY 50 TOPICS 1. Definition of epidemiology 2. Rate . Ratio, propotion I. Crude death rate II. Specific death rate III. Case Fatality rate IV. Propotional mortality rate V. Survival rate VI. Adjusted or standardized rates 3. Measurement of Morbidity – incidence 4. prevalence 5. Classification of Epidemiology 6. Descriptive Epidemiology 7. Analytical Epid – Case control 8. Cohort study 9. Differences of case control and cohort 10. Experimental Epidemiology – Randomised Control Trial 11. Non randomized trial 12. Association and causation 13. Uses of Epidemiology 14. Infectious disease Epidemiology – definitions 15. Dynamics of Disease Transmission 16. Modes of Transmission 17. Susceptible host I. Successful parasitism II. Incubation period III. Serial interval IV. Generation time V. Communicable period VI. Secondary attack rate 18. Host Defenses – Immunization I. Active Immunity II. Passive Immunity III. Herd Immunity IV. Vaccines V. Immunoglobulins VI. Anti toxins VII. Cold chains VIII. Adverse effects of immunization 19. Disease prevention and control 20. Surveillance 21. Health advise to travellers 22. Disinfection 23. Investigation of epidemic Dr Sarah T – Public Health Mnemonics Page 14

24. Screening definition , aims and objectives 25. Iceberg phenomenon 26. Difference between screening tests / and diagnostic tests / periodic health examination 27. Lead time 28. Uses of Screening 29. Types of screening 30. Criteria for screening 31. Screening test I. Acceptability II. Repeatability III. Validity 32. Evaluation of screening test I. Sensitivity II. Specificity III. Predictive accuracy IV. False negatives and positives 33. Yield 34. Combination of tests 35. Problem of the borderline 36. Evaluation of screening programmes 37. Communicable diseases a. Measles b. Mumps c. Rubella d. Chicken pox / Small pox e. Influenza f. Tuberculosis g. Meningococcal meningitis h. Diptheria i. Pertussis j. Poliomelitis k. Hepatitis A, B , C ,E l. Food poisoning m. Cholera n. Typhoid o. DIarrhoeal diseases p. Viral conjunctivitis q. Plague r. Yellow fever s. Dengue t. Malaria u. Leishmaniasis v. Tetanus Dr Sarah T – Public Health Mnemonics Page 15

w. Rabies x. AIDS y. CCHF 38. Non communicable diseases a. Obesity b. Hypertension / Heart diseases c. Diabetes d. Blindness e. Goitre 39. Definition of health 40. Dimensions and determinants of health I. PQLI II. HDI III. HPI 41. Spectrum of health 42. Indicators of health 43. Health care – characteristics and levels 44. Health for ALL – Primary health care 45. Causation – Germ theory of disease 46. Epidemiological triad 47. Multi factorial causation 48. Web of causation 49. Natural history of disease 50. Concepts of Control and Prevention


PUBLIC HEALTH PRACTICE PRINCIPLES OF HEALTH EDUCATION(Reference K Park)

Mnemonic : DR LIME went toFranKfurt PC² 1.

Learning by Doing

2.

Reinforcement

3.

Good human Relations

4.

Leader

5.

Interest

6.

Motivation

7.

Setting an Example

8.

Feedback

9.

Known to unknown


10.

Participation

11.

Credibility

12.

Comprehension

SMCR MODEL (Reference K Park) Sender  Message  Channel  Receiver Awareness/Interest/ Evaluation/Adoption •

Sender – Source Originator of message

•

Receiver – Audience

Types : Controlled and uncontrolled •

Message – Content

•

Channels – Medium 3 medias :

Interpersonal communication Mass media Traditional or folk media

•

Feedback – Effect Reaction of audience

TYPES OF COMMUNICATION (Reference K Park) (ones in same colour are related to each other so that way they can be learnt easily) 1.One way communication (Didactic Method) Mnemonic DO Lecture method in Classrooms 2.Two way communication (Socratic Method) ST Both the communicator and audience take part Dr Sarah T – Public Health Mnemonics Page 18

3.Verbalcommunication Direct – verbal Non direct - written 4.Non-verbal communication Without words, Bodily movements 5.Formal and informal communication Formal – lines of authority Informal – Gossip/circles 6.Visual communication Charts , groups , tables 7.Telecommunication and interest Radio TV internet

OCCUPATIONAL HAZARDS OF AGRICULTURAL WORKERS (Reference K Park) Mnemonic – TRAPZ 1.

Toxic hazards

By Fertilizers , insecticides , pesticides 2.

Respiratory diseases

Exposure to dust of grains, rice husks etc Byssinosis Begasssosis Farmer’s lung Occupational asthma 3.

Accidents

Agricultural machinery Insect and snake bites Dr Sarah T – Public Health Mnemonics Page 19

4.

Physical hazards

Extremes of climatic conditions Working in uncomfortable positions for long time 5.

Zoonotic diseases

Brucellosis Anthrax Leptospirosis Tetanus TB Q fever


HEALTH PROBLEMS DUE TO INDUSTRIALIZATION (Reference K Park) Mnemonic – DAMS - EF 1.Communicable Diseases TB , venereal diseases , food and water borne infections 2.Accidents Due to vehicular traffic , congestion. 3.Mental Health Failure of adjustment leads to mental illness 4.Morbidity and mortality High morbidity and mortality from certain diseases like Chronic bronchitis and lung cancer higher in industrialized areas. 5.Social Problems Like Alcoholism , Drug addictions 6.Environmental sanitation problem •

Housing

•

Water Pollution

•

Air pollution

•

Sewage disposal

7.Food sanitation Improper food sanitation causes food borne infections e.g typhoid fever and viral hepatitis.


WASTE DISPOSAL CLASSIFY HEALTH CARE WASTE (Reference K Park) Mnemonic : CRISP - GM 1.

Chemical waste

2.

Radioactive waste

3.

Infectious waste

4.

Sharps

5.

Pathological waste

6.

Pharmaceutical waste

7.

Pressurized containers

8.

Genotoxic waste

9.

Wastes with high content of heavy Metals

INCINERATION (Reference K Park) High temperature – dry oxidation process Organic and combustible waste Inorganic incombustible matter   

Resulting in significant reduction of waste-volume and weight. Selected to treat wastes that cannot be recycled , reused or disposed off in a land fill site Characteristic of waste suitable for incineration are

a)

Low heating volume – above 2000 kcal/kg for single chamber incinerator and above 3500 kcal/kg for pryolytic double chamber incinerator

b)

Content of combustible matter above 60 %.

c)

Content of non combustible solids below 5 %.

d)

Content of non-combustible fines below 20%

e)

Moisture content below 30 %.


Types of Incinerators(reference ; JE PARK) a)

Double chamber pryolytic incinerator

b)

Single chamber furnaces

c)

Rotary kilns

SEPTIC TANK (Reference K Park) Water tight masonry tank into which household sewage is admitted for treatment. It is a satisfactory means of disposing excreta and liquid wastes from individual dwellings , small groups of houses and institutions which have adequate water supplies but do not have access to a public sewerage system.

DESIGN FEATURES (reference K PARK) o

Single chambered or double chambered

o

Capacity : 20 – 30 gallons

o

Length – twice the breadth

o

Depth : 1.2 m (4 ft)

o

Air space : 30 cm

o

Bottom : slopping towards the inlet end.

o

Inlet and outlet pipe

o

Cover

o

Retention period


WORKING OF A SEPTIC TANK (reference K PARK) Solids settle down in the tank to form sludge while the lighter solids including grease and fat rise to the surface to form scum | Solids are attacked by anaerobic bacteria and fungi and are broken down into simpler chemical compunds First stage of purification called anaerobic digestion | Sludge is much reduced in volume by anaerobic digestion Stable and inoffensive | Portion of solids -> liquids and gases which rises to surface as bubbles | Liquid which passes out of the outlet pipe from time to time is Effluent Contains bacteriae,cysts , helminthic ova , organic matter Effluent allowed to percolate into subsoil. Its dispersed by perforated or open-jointed pipes laid in trenches 90cm And trenches are then covered with soil | Effluent percolates into the surrounding soil Millions of aerobic bacteria in the upper layers of soil attack organic matter in effluent Organic matter oxidized -Stable end products :nitrates CO2 water This stage of purification is called aerobic oxidation Summary 2 stages in purification of sewage Anaerobic digestion : Septic tank Aerobic oxidation : outside septic tank in sub-soil


Operation and Maintanance 1.

Use of soap water and disinfectant

2.

Contents bailed out atleast once a year

3.

Newly built should be filled with water first

NUTRITION ASSESSMENT OF NUTRITIONAL STATUS (Reference K Park) ASSESSMENT METHODS Mnemonic : ABCDEF – S 1.

Anthroprometry

2.

Biochemical evaluation

3.

Clinical examination

4.

Dietary intake

5.

Ecological studies

6.

Functional assessment

7.

Statistics – Vital and health

1.Clinical examination WHO classified signs used in nutritional survey into 3 categories a.

Non related to nutrition : Mnemonic PA

Pyorrhoea Pterygium Alopecia b.

That need further investigation :

Malar pigmentation Corneal vascularization Geographic tongue Dr Sarah T – Public Health Mnemonics Page 25

c.

Known to be of value :Mnemonic ABCE

Angular stomatitis Absence of knee or ankle jerk Bitot’s spot Calf’s tenderness Enlargement of Thyroid Gland 2. Anthroprometry a.

Height

b.

Weight

c.

Skin fold thickness

d.

Arm circumference

e.

Head and chest circumference for child

3. Laboratory and Biochemical Assessment Laboratory tests : 1.

Haemoglobin

2.

Stool and urine

Biochemical tests 1.

Metabolites in urine

2.

Enzymes

3.

Nutrient concentration in body fluids

(Please See K Park for detailed table) Vitamin A

- Serum retinol

Folate - Serum folate Vitamin K

- Prothrombin time


4.Functional indicators (Please See K Park for detailed table) Work capacity •

Heart rate

-- P/E , Fe

Nerve function •

Nerve conduction -- P/E, VitB1 ,Vit B 12

5.Assessment of dietary intake i.

Weighment of raw food

ii.

Weighment of cooked food

iii.

Oral questionnaire method

6.Vital statistics 1.

Mortality and morbidity data

2.

Infant mortality rate

3.

Rate of low birth weight babies

4.

Life expectancy

7. Assessment of ecological factor a)

Food balance sheet

b)

Socioeconomic factors

c)

Health and educational services

d)

Conditioning influences (parasitic,bacterial,viral infections)


Vitamin A toxicity – Hypervitaminosis A (Reference K Park) Excess intake of retinol causes 1.

Nausea

2.

Vomiting

3.

Anorexia

4.

Sleep disorders

5.

Skin desquamation

6.

Enlarged liver

7.

Papillar edema

8.

Teratogenic effect

High intake of carotene may colour plasma and skin but do not appear to be dangerous

DIETARY FIBER (reference ; K PARK) •

Non starch polysaccharide

•

Found in vegetables,fruits,grains

•

Divided into cellulose and non cellulose polysaccharide

•

2 types of dietary fibers :

Insoluble fiber : cellulose , hemi cellulose , lignin Soluble fiber :pectins , gums and mucilages •

Functions ;

•

Reduces constipation

•

Cancer of stomach and colon have been linked directly to low fiber colon

•

Reduced incidence of coronary heart diseases

•

Reduces post prandial glucose level in blood.

•

Too much of fiber decreases absorption of valuable micronutrients

•

Dietary intake of 40 grams of dietary fiber is desirable.


DEMOGRAPHY MAJOR SOURCES OF POPULATION DATA (Reference Lecture notes) Four major source of population data in a country 1.Population censuses 2.National sample surveys 3.Registration system and administrative statistics including: •

Vital registration (birth, deaths and marriage)

•

Population registers

•

Service statistics (from health and family planning programs)

•

International migration statistics

4.Adhoc Demographic studies

CENSUS (Reference Lecture notes) Process of collecting, compiling and publishing demographic, economic and social data pertaining to a specific time from all persons in a country.

METHODS Enumerations Pre-enumeration Enumeration Post-enumeration •

Questionnaire

•

Combination of both

DE- FACTO: A person is at the place he or she is found at the time of counting DE- JURE: A person is counted at the place of his or her actual residence.


INFORMATION FROM CENSUS (Reference lecture notes) 1.

Population size

2.

Urban-rural distribution

3.

Marital status

4.

Literacy/ educational attainment

5.

Economic status

6.

Occupation

7.

Child population

8.

Migration

9.

Disability

POPULATION PYRAMID (Reference ; Lecture notes) •

Graphical representation of Age-Sex structural data is given as a histogram

•

Consists of two back-to-back bar graphs, with the population plotted on the Xaxis and age on the Y-axis, one showing the number of males and one showing females in a particular population in five-year age groups (also called cohorts).

•

Males are conventionally shown on the left and females on the right, and they may be measured by raw number or as a percentage of the total population

Features of a population pyramid (Reference ; Lecture notes) •

Population is divided into 5 year age groups.

•

The percentage of each age /sex group is given.

•

Each year a new cohort is born and appears at the bottom of the pyramid, while the cohorts above it move up.

•

As the cohorts age, they inevitably lose members because of death and may gain or lose members because of migration.

•

After age 45 the attrition process accelerates, causing the narrowing peak of all population pyramids.


Uses of Population pyramid (Reference ; Lecture notes) 1.

Age – sex distribution of population

2.

Male to female ratio

3.

Birth rate; Death rates

4.

Women in child bearing reproductive age

5.

Fertility level

6.

Past & future trends of population (Population momentum)

7.

Demographic transition

8.

Dependency ratios

9.

Median age of population by sex

10.

Mortality level by age & sex

11.

Migration trend (In and out migration)

12.

Calamities ( Natural& man made; earth quake, famine, epidemics, war)

13.

Health status of population

14.

Economic stability of a country

DEMOGRAPHIC TRANSITION (Reference Lecture notes) Moving from a stage of high birth rate to a low birth rate. Theory of Demographic transition refers to 5 stages during which a slowly growing or stagnant population growth gives way to a period of rapid population growth & then reverts to slow & stagnant growth going on to a negative growth rate.

STAGES OF DEMOGRAPHIC TRANSITION Stage 1 - High Stationary Birth Rate and Death rate are both high. Population growth is slow and fluctuating. Dr Sarah T – Public Health Mnemonics Page 31

Stage 2 - Early Expanding Birth Rate remains high. Death Rate is falling. Population begins to rise steadily. Stage 3 - Late Expanding Birth Rate starts to fall. Death Rate continues to fall. Population rising. Stage 4 - Low Stationary Birth Rate and Death Rate both low. STAGE 5- DECLINING Birth rate lower than death rate. Population on the decline.

ENVIRONMENT METHODS WHICH ARE AVAILABLE FOR PURIFYING WATER ON SMALL SCALE (Reference K Park) (1)HOUSEHOLD PURIFICATION OF WATER a)

Boiling

For effective boiling water must be brought to a rolling boil for 10 to 20 minutes

b)

Chemical Disinfection

1)

Bleaching powder

2)

Chlorine solution

3)

Hight test hypochlorite

4)

Chlorine test

5)

High test hypochlorite

6)

Chloring tablets


7)

Iodine

8)

Potassium permanganate

c)

Filtration

(2)DISINFECTION OF WELLS STEPS IN WELL DISINFECTION 1)

Find the volume of water in a well

2)

Find the amount of bleaching powder required for disinfection

3)

Dissolve bleaching powder in water

4)

Delivery of chlorine solution into the well

5)

Contact period

6)

Orthotolidinearsenite test

Double Pot Method

BIOLOGICAL EFFECTS OF RADIATIONS(Reference K Park) 1.Somatic Effect 

Immediate

•

Radiation sickness

•

Acute radiation syndrome



Delayed

•

Leukemia

•

Carcinogenesis

•

Foetal development abnormalities

•

Shortening of life


2.Genetic 

Chromosome mutation



Point mutation

AUDITORY AND NON-AUDITORY EFFECTS OF NOISE EXPOSURE (Reference K Park) Auditory effects 1.

Auditory fatigue

2.

Deafness

Non Auditory effects 1.

Interference with speech

2.

Annoyance

3.

Efficiency : decreases

4.

Physiological changes

5.

Economic loses : linked to health loss

MNCH PERINATAL MORTALITY RATE (Reference K Park) WHO Definition PMR = Late foetal deaths ( 28 weeks gestation and more) + Early neonatal deaths (first week)in one year / Live births in same year


X 1000

International comparisons : PMR = Late foetal and early neonatal deaths weighing over 1000 g at birth / Total live births weighing over 1000g

X 1000

at birth

WHY PERINATAL RATE (Reference K Park) 1.

Two types of death rate – stillbirths and deaths under the first week of life are combined in PMR because the factors responsible for these 2 types of deaths are similar – being those operating before and around the time of birth

2.

A propotion of deaths which occur after births are incorrectly registered as still births , thereby inflating the stillbirth rate and lowering the neonatal death rate. PMR being a combination of stillbirths and early neonatal deaths is not influenced by this error.

3.

It’s a good indicator of the extent of pregnancy wastage as well as the quality and quantity of health care available to the mother and newborn.

It reflects the results of maternity care more clearly than the neonatal death rate

PREVENTIVE AND SOCIAL MEASURES (Reference K Park) Mnemonic – BP / GP / SP - EF 1)

Breast feeding

2)

Prenatal nutrition

3)

Prevention of infection

4)

Provision of primary health care

5)

Growth monitoring

6)

Sanitation

7)

Socio-economic development

8)

Education

9)

Family planning


USES OF GROWTH CHART (Reference K Park) Mnemonic – MD ATE Pasta 1)

Growth Monitoring

2)

Diagnostic tool

3)

Tool for Action

4)

Tool for teaching

5)

Educational tool

6)

Planning and policy making

Weaning (Reference K Park) •

Gradual process starting around the age of 6 months because mother’s milk alone is not sufficient to sustain growth beyong 6 months.

•

It should be supplemented by food rich in proteints and other nutrients called

•

Supplementary food ;

1.

cow’s milk ,

2.

fruit juice

3.

soft cooked rice

4.

dhal

5.

vegetables

•

During weaning children are exposed to deleterious synergistic interaction of malnutrition and infection

•

If not done properly its followed by diarrhea and months of growth failure leading to kwashiokar marasmus and immunodeficiency marked by recurrent and persistant infections which may be fatal.

•

At the age of one year children should receive solid foods.


MANAGEMENT OBJECTIVES OF HEALTH INFORMATION SYSTEM (Reference K Park) •

To provide (Mnemonic RᶾAT-U)

1.

reliable,

2.

relevant,

3.

Reasonably complete information

4.

adequate

5.

Timely

6.

Up to date

For all health managers at all levels and at the sharing of technical and scientific information by all health personnel participating in the health services of a country •

To provide at periodic levels data that will show the general performance of the health services

•

To assist planners in studying their current functioning and trends in demand and work load

REQUIREMENT OF HEALTH INFORMATION SYSTEM (Reference K Park) According to WHO ------Mnemonic ( P²AF – TB ) System should be 1.

Population based

2.

Problem oriented

3.

Avoid unnecessary Agglomeration of data

4.

Make provision for the Feedback of data

5.

Employ functional and operational Terms (e.g episodes of illness)


6.

Express information Briefly and imaginatively ( e.g tables)

SOURCES OF HEALTH INFORMATION(Reference K Park) Mnemonic ;CVS n RᶾESP 1.

Census

2.

Vital events

3.

Health manager statistics

4.

Notification of diseases

5.

Record linkage

6.

Hospital records

7.

Disease registers

8.

Environmental health data

9.

Epidemiological surveillance

10.

Population surveys

EVLAUATION METHODS OF EVALUATION( Reference ; old lecture notes) Mnemonic ; CLAP³ – IF 1.

CBA cost benefit analysis , CEA cost effective analysis and CPM critical path method

2.

Logical framework approach

3.

Rapid Appraisal methods

4.

Participatory method

5.

Public expenditure tracking surveys

6.

PERT

7.

Impact evaluation

8.

Formal surveys


HOSPITAL PLANNING STEPS INVOLVED IN ESTABLISHING A NEW HOSPITAL FACILITY (reference ; old lecture notes) Mnemonic : BC- EFᶾ 1. 2. 3. 4. 5.

Planning the hospital Building Commissioning Equipment planning Functional planning Financial planning

PLANNING DEFINITION OF PLANNING (Reference ;lecture notes ) Planning is decision making about the future for efficient use of resources to achieve explicit objectives.

STEPS OF PLANNING CYCLE (Reference: Planning of health services at the district by AA Keilmann , R M Ngolo , S.Siddiqi)

Mnemonic – PG – SR – IO – RM B P M PG became SR In Opthalmology and Registered Medical Practitioner in BaseMent 1.

Plan the planning

2.

Review of Policy Guidelines

3.

Situational analysis

4.

Review of Resource Availability


5.

Developing Interventions

6.

Setting plan Objectives And Targets

7.

Determination of Resource Requirement

8.

Adjusting the M and O systems

9.

Preparing the Budget

10.

Developing the Plan Of Objectives

11.

Planning for Monitoring And Evaluation

COST BENEFIT ANALYSIS – CBA (reference ; lecture notes) o

Determines how well or how poorly a planned action will turn out

o

All inputs are measured in monetary terms

o

Formalized way of comparing the advantages – benefit and disadvantages – costs of undertaking a project

o

Systematic comparison in financial or monetary terms of all the costs and benefits of the proposed alternative schemes

BASIC HEALTH UNIT– BHU(reference ; lecture notes) Each union council has a Basic Health Unit which has 2 beds and serves as catchment population of about 25000.It has a dispensary Functions 1.

All Primary Health Care activities

2.

OPD

3.

In patient facility

4.

Referral support

5.

Reproductive health services

6.

Pharmacy

7.

Training services


8.

Facility records and HMIS

9.

Linen and sterilization

10.

Facility waste , environment and estate management

BHU Staffing 1.

Medical officer

2.

Medical assistant / MHT

3.

Lady Health Visitor

4.

Dispenser

5.

Midwife

6.

Other support staff

OUT REACH STAFF Sanitary inspector Communicable Disease Control Supervisor EPI vaccinator Lady Health Worker of National program for Primary Health Care and Family Planning

PERT - PROGRAM EVALUATION AND REVIEW TECHNIQUE (reference ; lecture notes)   

Program evaluation and review technique is a management technique which makes possible detailed planning and comprehensive supervision. It is represented by arrow diagram The diagram represents logical sequence in which events must take place and we can calculate the time by which each activity must be completed and to identify those activities that are critical.

ROEMERS MODEL(reference ; lecture notes) 1. 2. 3. 4. 5. 6.

Resources Organization Management Economic support Service delivery Health needs


7. Health Results

PERFORMANCE INDICATORS OF RURAL HEALTH CENTRES (reference ; lecture notes) 1.

Number of staff posted out of planned staff in one year

2.

Number of medical equipments available out of equipment list for RHC

3.

Number of days in which ambulance service was operational during one month.

4.

Percentage of essential drugs available out of equipment list for RHC.

5.

Percentage of functional equipment available out of equipment list for RHC.

6.

Percentage of days in which electricity connection was active during one month

7.

Percentage of days in which water connection was active during one month

8.

Percentage of days in which telephone connection was active during one month

POLICY MAKING FORCES INVOLVED IN HEALTH POLICY MAKING PROCESS (reference ; lecture notes ) 1.

Individual citizen

2.

Political parties

3.

Media

4.

Pressure groups like sectional interest groups

5.

Legislature

6.

Executive (PM office and cabinet)

7.

Special institutions

National security council Planning commission and National reconstruction bureau 8.

Bereaucracy


9.

Judiciary

HEALTH POLICY PROCESS IN PAKISTAN (reference ; lecture notes) 1.

Setting up working group for the purpose

2.

Mid term evaluation of previous policy

3.

Preparation of reports in priority areas by special sub-committees

4.

Preparation of a draft of the subsequent policy

5.

Concurrence approval of provinces on the draft policy

6.

Health policy formulation :

•

Traditionally policy formulation has been the sole function of the ministry of health

•

To institutionalize the proves a national health policy unit eastablished which has made the process ongoing

•

Private partners coming forward for influencing the proves – think tanks

Research and advocacy centre for health policy (REACH) Lahore Pakistan health policy forum , Islamabad.

PROBLEMS IN POLICY MAKING ( Reference ; lecture Notes) 1.

Good policy documents not matched by effective implementation

2.

Policy and planning not based on evidence

3.

Different stake holders have varying influences

PLANNING BODIES (Reference ; lecture notes) Federal 1.

NEC National Economic Council

2.

ENEC Executive committee of national economic council

3.

CDWP Central development working party


4.

DDWP Departmental development working party

Provincial 1.

PDWP Provincial development working party

2.

DDSC District development Sub Committee

District DDC District development Committee


DATA AND INFORMATION (Reference ; K PARK) DATA Discrete observations of attributes or events that carry little meaning when considered alone

Information Data needs to be transformed into information by reducing Summarising Adjusting for variations Such as age and sex composition of the population so that comparisons over time and place are possible Data as collected from operating health Transformation of information through care systems or institutions are inadequate intergration and processing with for planning experience and perceptions based on social and political values that produces intelligence

JOB DESCRIPTION AND JOB SPECIFICATION (Reference ; lecture notes) Job description A list of job’s o duties o responsibilities o reporting relationships o working conditions o supervisory responsibilities. It is an outcome of job analysis.

Job specification Its list of o skills o Knowledge and attitudes o Required by the individual o To carry out duties involved in job It is another outcome of job analysis

Population surveys(Reference ; K PARK) Health surveys ; surveys relating to any aspect of health – morbidity,mortality,,nutritional status etc. 4 Types Mnemoic - RIQE 1. 2. 3. 4.

Health records survey Health interview survey Mailed questionnaire survey Health examination survey

5. Dr Sarah T – Public Health Mnemonics Page 45

(Reference ; K Park ) RECORDS Collection of data from health services records

Advantages Cheapest method of collection of data

Disadvantages 1. Estimates obtained are not population based 2. Reliability questionnab le 3. Lack of uniform procedures and standardizat ion of data

INTERVIEW Measuring subjective phenomena such as perceived 1. Morbidity 2. Disability 3. Impairement 4. Economic loss due to illness 5. Expenditure on medical care 6. Behavioural characteristic

QUESTIONNAIRE EXAMINATION Without interviewer 1. More valid info then interview 2. Carried out by  Dr  Technicians  Interviewers

1.Population based data 2.Provides country wide data on general morbidity , Family planning , Vital events , Morbidity

1. Simpler 2. Cheaper Can be done by mail to persons sampled from given target population

Not reliable

See detail from K Park


1. Cerain level of education or skill expected 2. Increased rate of nonresponse

1. Expensive 2. Not for extensive scale 3. Requires consideration of providing treatment to people found suffering from certain diseases.

MANAGEMENT 40 TOPICS 1.Health planning , planning cycle 2.Health promotion planning 3.Brain storming 4.Health process, Health need 5.Equity 6.Factors affecting utilization of health services 7.Community participation 8.Health planning in Pakistan 9.Hospital planning 10.Policy 11.National health policy 12.Decentralization 13.Organization reforms 14.Management 15.MBO 16.Organization 17.Decision making 18.Job description,job analysis , job specification 19.Duties of drawing and disbursing officer 20.Training need assessment 21.Training and development 22.Performance appraisal 23.Performance indicators 24.Monitoring and Evaluation 25.Health care system 26.Service delivery at primary health care leve 27.Performance indicators for rural health centres 28.Quality of care 29.Total Quality management 30.Human resource planning 31.Introduction to human resource in health 32.Motivation 33.Motivation processes 34.Leadership skills 35.Health economics 36.Health financing 37.Demography 38.Fertility 39.Source of demography Dr Sarah T – Public Health Mnemonics Page 47

39.Population census 40.Census planning


Public Health and Community Medicine Mnemonics

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