ONE TOUCH Preventive & Social Medicine (PSM) For NEET PG/ FMGE/INI-CET/CMS Aspirants / Undergraduates [1 ed.] 9394525009, 9789394525009

Citation preview

First ever book designed

ed

for giving last-minute

touch to Community Medicine

o

ONE Touch Preventive & Social Medicine (PSM) For NEET PG/FMGE/INI-CET/CMS

Aspirants/Undergraduates

Special Features Compiled by the Leading Faculties &Subject Experts of Community Medicine Enriched with Latest Updates up to Jan 2023 Entire theorycovered in just 38 pages in Table and One-liner format Latest Demographic data included 100+ Important MCQs of Recent Exams covered up to 2023 (FMGE Jan 2023) PSM spotters table and formulas covered extensively

Written&

CBSPD CBS

Publishers & Distributors Pvt. Ltd.

Mukhmohit Singh Shveta Salnt

in he end

WE

ONLY regret

the CHANCE -

we

DIDN'T TAKE Be kind, be graceful. Everyone will make

it,

use this well. Good luck

si -Compiled by TB

Preface Dear

students,

is ur proud privilege to write this page for you. Ever since our medical college days, (and even after that) it PSM, Community Medicine has been a tough subject. Why this

book?

sas alwags our wish to provide Community Medicine in the simplest form, which is easily understood anistudent is able to revise in the shortest time. So, this book "One Touch PSM" is in line with the and is our effort to provide concise form of complete Community Medicine syllabus for UG, Pa ern trance and public students. it

ne

health

what is special in this book? Theory a concise form of text (in

1.

38 Pages) and most important points to remember for exams are given. The text is in accordance with the recent CBME and NEXT exam curriculum. 2. Latest demographic data (NFHS-5, SRS 2022) and recent updates are given as separate chapter. 2022 updates as new COVID, typhoid, cervical cancer, fiPV vaccines are highlighted in respective chapters for quick reference and long-term memory. 3. High Yield Tables most frequently asked points and clinical correlates are tabulated for easy learning and more visual impact for long-term memory. Images and logos are given along with description. They have been arranged as per the chapters. 5. Formula Page 30 formulas have been provided, for you to remember. These are frequently asked in entrance exams, UG exams. -

-

PYQs last 3 years Exam Question papers with solution, explanations and discussions are provided to have an idea about trend of questions and know about the recently asked topics. The answers are given

6.

with references from standard Do

2. 3.

We

I

resources.

really need this book?

Students who have completed Com.Med syllabus from any resource can use this books as revision text collection of pearls and high yield points. Students whose exams are round the corner and have not done Community Medicine can start prepGr ing firom this book. You have to remember most of the high yield text, tables and topics from the PYQs UG students, public health students can revise the text, study viva questions and prepare efficiently from this book. have

tried to make this book concise, revision oriented, clutter free and error free. IF you come across have any suggestions, please feel free to write at [email protected]. You

ny errors or if you

can also

Oinect to first author on Instagram @mukhmohitpsm

you think you can do it and get the best out of yourself, of course you are right..!

Best wishes for your preparation! Mukhmohit Singh

Shveta Saini

Abbreviations Per hundred women Abacavir

/HW

Drug of choice Directly observed treatment DOTS short course

National vector borne

DOC

NVBDCP

rate

DSTB

disease control program OPV Oral polio vaccine Odds ratio OR

Artemisinin based conbination therapy Also known as Aka ANC Ante natal care ANCDR Annual new case detection

FDC

A

Annual

ABER

blood examination

ACT

G2D

Grade 2 disability

HA

Health assistant

-

rate ANM

Auxiliary nurse midwife

API Annual parasite incidence ASHA Aceredited social health activist BPaL Bedaquiline, pretomanid, linezolid

C/1-Contraindication CBNAAT Cartridge-based nucleic acid amplification test Ce - Contraception CcOC Contraception of choice CHC Community health center CHO Community health officer -

CQ

-

Chloroquine

CRPSM

Conceptual review of preventive and social medicine CRS Civil registration system Cx Complication D Dolutegravir -

DG

Dgn

-

Demographic gap Diagnosis

Drug sensitive TB Fixed dose combination

-

IOC

Health and wellness center Investigation of choice

OC

Investigation of choice

HWC

Incubation period IPV inactivated polio vaceine IP

L

Lamivudine

LAV

Live

LHV

Lady health visitor

attenuated vaccine

Lpv/r Lopinavir and ritonavir boosted

M/c

Most common

Multi drug resistant TB MERM- Medicine event reminder MDR

management system Mode of action MOA MOT Mode of transmission MPW Multipurpose worker NFHS National family health Survey

NFPP

program NIS

National family planning

National immunization

schedule

-

Pearlsindex

P/I

Primary health center PLHIV Persons living with HIV PNC Post natal care POC Period of communicability PQ - Primaquine Px Prevention, prophylaxis QL Qualitative PHC

QN Quantitative

R

Raltegravir

mean square deviation Relative risk

RMSD RR

Root

Treatment S/E Side effects Rx

Si/Sy

Signs and symptoms

Source of infection

SOl

SRS

Slide positivity rate Sample registration system

T

Tenofovir

SPR

VIA VAPP polio Vx

Visual acuityy Vaccine associated paralytic

Vaccine

WRA

group XDR

Women of reproductive age Extensively drug resistant TB

Contents Preface

*********************************"*********"

**********************************************-***********

Abbreviatros.

***********

*******"******************

CHAPTER-WISE THEORY...

1-34

*******************************************************************************************************************saavuns

Demography

***************

*********************************************************

. India

Health Systcms in

4.

National Health Programs. Mother and Child Health.

s.

Vaccines, Immunization Schedule

6.

Communicable and Noncommunicable Diseases

7.

Nutrition

S.

Environment

9

Biostatistics and Scrcening of Disease

3.

***

******

******

****

17 *********

**********

*******

***

**************************************************************"****"******"***************************

26

Waste

and Biomedical

*

Epidemiology

11.

Infectious Disease: Epidenmiology, Concept of Disease, Control, Prevention, Health Management

12

Health Communication,

****

******************************************************************************

IMPORTANT TABLES AND IMAGES Important Tables

.

1

Demography

2.

Entomology.

*******a

*********r**********************************

*************************

34

35-37

***************************

39-71

******************************************************************************es**********

*************************************************************

Tools and Equipment

32

****************************

************************************

*******************************************

linportant Images and LogoS

30

*****

Disaster and Social Medicine

NEW SCHEMES AND RECENT UPDATES 2022.

28

*******************

****************

10.

**********************

*******************************************************************

***

****

*******************"***************************************

.

41-SO

S1-64 51

**

S8

*******************

4 Graphs and Charts.

**********************************

3,

14

******************

******"******************************************************************

Mother and Child Healthcare

FORMULA

LATEST QUESTION PAPERS

*****'****

****

70-71

73-120

DEMOGRAPHY 4 topics

-

Topic 1.1:

Demographic stages, Fertility rates, Survey indicators, Family planning

Demographic Stages

Birth rate

Name

Death rate

Phase

1

High stationary

High

High

Phase

2

Early expanding

High

Starts

declining

Remarks

Explosive growth DG

starts increasing

Maximunm DG toward late part of stage 2

High Phase

3

Phase 4

Late expanding

Starts declinin9

Slow decline

Low

Slow decline

Slow decline

Slow decline

Very low/ stable

stationary Phase

s

Declining

fertility rate

Increasing population, but growth rate is lovwer than stage 2 DG starts decreasing Demographic Gift, bonus Dependency ratio is lower ldeal stage, low liabilities, Developing countries Declining, dying population Minimum (negative) DG, demographic liability

Topic 1.2:

Fertility Rates

| GFR

Total number of children a female will bear during her reproductive years

TFR

Total number of children a female will bear during her reproductive years assuming the Current Age specific Fertility rates

GRR

Total number of daughters a female will bear during her reproductive years assuming the current Age specific Fertility rates

NRR

Total number of daughters a newborn girl child will bear during her entire tife assuming the Fixed age specific fertility rates and age specific death rates

Demographic Gifthigher number of reproductive age group population lower dependancy ratio Decause of higher birth rates in the previous demogrpahic phase seen from stage Il

onwards

Demographic liability .

igher number of older age group population higher dependancy ratio because of declining death rates seen typically in Stage 5

One Touch PSM by Dr Mukhmohit Singh and Dr Shveta Saini

Topic 1.3: Survey Rates

NFHS

SRS

CRS Ongoing system Births and deaths

registration also see important

data,

Table 1, pg 41

6monthly survey local level

at

Census

Every five years By institute of population sciences,

Annual estimates of CBR, CDR, IMR, Natural growth rate special bulletin release for MMR Done at national and subnational level dual system

Every 1O years

Under MoHA (home affairs) Demographic

Mumbai Under MoHFW Data for health status, literacy rates, immunization rates,

structure of population

FP use, Anemia,

malnutrition, tobacco/ alcohol use in India

-

Topic 1.4: Contraception Eligible couple: In which the Planned Family: Who has is in WRA. First child > 2 years of marriage female Gap between children > 3 years Not more than two children ASHA Incentives Social Marketing Scheme packet of OCP or 1 1. 1 for packet of 3 condoms and 75 for monthly 2. 3.

Target couple Who has completed family and has at least one live chila. Targets fo permanent sterilizations -

tablet

iPILL distribution

5O0 for delay of first child for 2 years after marriage child 75Oo for delay of second child, for 5 years after 1st

4.10OO/-

planning after 2nd child for adoption of permanent method of family

One liners:

Lowest failure rate

Implants (Nexplanon, Norplant)

Lowest failure rate among Cc under the NFPP

Combined OCPs

Most common S/e in 1UD

Bleeding

Most common S/e in OCP

Weight gain

CcOC for lactating female

POP (best), Chhaya

CcOC for delay in first child

Combined OCP

CcOC

for delayed in second child

Best method for failure rate

M/C method for failure rate

IUD

Life table analysis

70) Pearls index (pls see the formulas, pg

Demography Temporary methods Tirumala (cycle beads) Based on calendar method, for uneducated females

Barriers - Physical barrier Nirodh - latex, Fem. Condom (FC2)

Impair fertilization (primary) and implantation S/E- Bleeding (most common), Pain, PID, MOA

Perforation

MOA

polyurethane Cu

T 380 A

(A stands for "Copper on arms") 380 mm* of Cu2* on the lUD T-shape device, valid for 10 years White, polyurethane thread

Hypersensitivity S/EP/I 2-20 Chhaya: AKA

IUD

Centchroman tablets

Active chenmical

Ormiloxifene MOA Selective estrogen receptor modulator S/e Delayed periods (m/e) Dose: (30 mg tablets) Twice weekly for first 3 months, and then weekly

Cu 375 Multiload Device Cu on the lUD Stem (not on Arms)

P/I- 1-2

NOVA T has silver core, with 380 around the stem.

Inverted U shape, valid for Blue color, nylon thread -

3-5

years mm2 of Cu2

OCP

Ethinyl

estradiol O.03 mg

O.15 mg MALA N

+

Levonorgestrel

free supply, MALA D social marketing, home delivery on payment MOA - Interrupt ovulation S/E Metabolic DM, dyslipidemia, weight gain Cardiac thrombotic, CAD, stroke, raised liver enzymes Carcinogenic Promote Ca Cervix and Ca breast NOTE: Protects Ca Ovary, Ca endometriumM, benign breast disease, DUB DOse 2.1 hormonal pills and 7 iron tablets daily -

-

-

Note:

Can be inserted within 48 hours of delivery or after 6 weeks of delivery Ectopic pregnancy is NOT a C/1 Inserted uptill 5 days of unprotected intercourse

P/I- O.3-1.5

-

-

P/I O.3-7

spermicidal

-

nonoxynol-9

tnjectable (i/m) Medroxy progesterone acetate

-

Breastfeeding O.3 Nonbreastfeeding 09 -

Permanent methods: ubectomy_and vase.ctomy: Mechanical methods of inhibiting fertilization E-Operation related infection, pain. Note: For Vasectomy use alternate tor 8-9 weeks or 30 ejaculations. contraception -

-

150 mg i/m injection every three monthly Can be taken 2 weeks early and 4 weeks after the due date for injection

-

O.1

vaginal sponge.

Contains Antra:

P/I for Progestin only pills

P/I-

Today

Emergency ContraceptioniPILL, Ezy pill levonorgestrel 1.5 mg single dose, started ASAP but < 72 hours of unprotected intercourse P/1- 1-2 Other methods for Emergency Cc Yuzpe method (not used), mifepristone, IUD's -

HEALTH SYSTEMS IN INDIA CHC

Village level

ASHA, Subcenter 2 MPW

Specialist medical, surgical, ob/gy, pediatrics opthal, anesthesia, X-ray technician, OT- s, Assistants Functional X-ray, lab, OT Upgraded to FRU with 24 x 7 Blood bank facilit

Trained Dai

LHV'S,

(Male and

Upgraded to HwC

-

-

-

female) with post of CHO

District Hospital

PHC

incharge, AYUSH, Dental ANM HA (supervisory functions) services Best level of integrated health preventive, curative, rehabilitative) Medical officer

-

All

+

CinIcal specialities, nurses, specialized lahe Program officers for national health programs

Population norms, beds HWC (24 stafi) by center govt

maintained

-

PHC (Staff 13-14

basic,

20 desirable)

Health and wellness center Rural hilly 3000 Rural plain s000 15-20,000 Urban HWC populatiOn

Rural hilly 20,o00 Rural plain 30,000 PHC s0,000 Urban Urban polyclinic - 2.5-3 Lac

BEDS Type A SC: 1-2 beds TYpe B SC: 2-3 beds

BEDS

-

Drug Kit A, B,

C

-

-

TYpe A -4-6 beds TYpe B- 6-10 beds Drug Kit D

CHC (Staff 45 basic, SO desirable)

Rural hily

-

80,0OO

Rural plain

1,20,c00 Non-metro city 2,50,O0O -

Metropolitan city population

5,00,

BEDS (FRU) bed CHC UCHC SO-100 (FRU) be

30-50

Drug

Kitt E, F, G, H

DIstrict Hospital: One bed per 1000 population is an 'Essential norm for every 1000 is a target they should aspire toward 'Desirable level:

district while two

beas

=

FunctionsS: ASHA worker

Home visits Health care of community Depot holder for essential drugs Care for mother and child

Integrated functions with Anganwadi, ANM, Village health sanitation and nutrition committee

MPW (male) Malaria stides, diagnosis,

treatment nsecticide spray, vector Control

Chlorination, water quality Records and registers Subcenter maintenance OPD and family survey

MPW (female) chul ANC, PNC, Mother and Care Conduct normal deliveries

emergency mother and child care Immunization contracepti0n Family planning, and family survey OPD

NATIONAL HEALTH PROGRAMS National Vector Borne Disease Control Program Malaria Denaue

Clean stagnant water, over-head tanks

Artificial collection of water

household containers, tires, tubes Dirty poluted water, paddy fields, long standing water collections Lakes, ponds, de-weeding

JE LF

-

Anti-larval Oils Physical methods Chemical methods Temephos, Paris green Biological methods Gambusia affinis Fish, Bacillus -

-

.

-

thuringiensis

Anti-Adut Measures Residual spray

DDT (amorphous powder, dosage 200 mg/sq ft), Malathion (brown liquid, dosage mg/sq t), Lindane 100-20O Spact spray (Fogging) - Pyrethrum extracts (dosage 1 oz/1000 cuft space) Ultra-low volume fogging Malathion, fenitrothion Bed

-

nets

Hole

1.2 mm (0.0475 inch) 200 holes (always < 285 holes) per square inch

size

150


10/100,000 10-14 yrs) x 6 months lesion(s) with dctunite sensory in high burden area) Rifampicin monthly, dcticit: 2. G2D per 10 lac supervised (600 mg involvcmcnt of the peripheral population-operational, 450 mg) neves with detinite thickcning with early case detection daily (100 mg, Dapsone loss of sensation with wcakncss/ 3. Cure rate SO mg) paralyss of the correspondngeyes; epidemiological indicator or muscles ot the hands, fect long MB (dosage adults, Children 4. Prevalence rate Demonstration of M. leprae in the term impact 10-14 yrs) x 12 months lcsions. Rifampicin monthly, Target: supervised (600 m9 Paucibacillary (PB): PR1/10,000 mg) 450 S or lcss lcsions or at district population Dapsone (100 mg, sO mg) No or one ncrve involvement level subnational daily No AFB smcar positive To reduce Grade lI monthly Clofazimine disability %20 hours/weck) SPARSH program to increase awareness SAPNA - NLEP Mascot UNICEF- WHO Mascot -

-

Clofazimine

is

daily dose for adults and alternate day dose for children age 10-14

As per the recent WH0 criteria, there

is

years

slight change in diagnostic criteria, this has, however,

not yet

included in the NLEP guidelines at National level. CARDINAL SIGNS FoR LEPROSY: 1.

2.

3.

Hypopigmented or reddish skin lesions with sensory deficit Involvement of peripheral nerves, as demonstrated by thickening WITH loss

Weakness of the muscles or the corresponding nerves Demonstration of M. leprae in the lesions

PB Case:

A case

of leprosy with

of sensation

D/

1-5 skin lesions and

without demonstration of bacilli in Skin s Case:A case of teprosy with 6 or more lesions, or with nerve involvement, or with demonstra in skin slit smear irrespective of number of MB

skin lesions

( baci

11

National Health Programs

National AlDS Control Program (NACP)

.

after

TB Preventive Therapy

HIV types

ruling out TB

1,group M, sub group C (m/c) .HIV 2 (more in African area) HIV

6months isoniazid

Diagnosis: at ICTC centers Screening tests triple test ELISA, Rapid Test, Spot test Diagnostic western blot, RT-PCR

.

OR

3 months Isoniazid+ Rifapentine (always add vit B6 with INH)

-

Treatment - Daily FDC tablets for: Adults Tenofovir Disoproxol fumarate + Lamivudine + Dolutegravir Children Zidovudine (or Abacavir) + Lamivudine + Dolutegravir Newborn Zidovudine + Lamivudine + Raltegravir (or Lopinavir/ritonavir)

Prophylaxis Post Exposure Prophylaxis TLD within 72 hours (best in 2 hours) of exposure for 28 days

.

Organization

at

ART, ART Plus centers

District Hospitals or medical colleges Link ART centers

subdistrict,

-

CHC level

voluntary workers at community level Link ART workers

-

Indicators HIV in ANC females (0.27) proxy for HIV burden in community

2. Pneumocystis jiroveci prevention

strength cotrimoxazole Start when CD4 350 cells/mm Stop when CD4 350 cells for more than Double

6

months

to find out burden of HIV in community HIV sentinel surveillance hijra/transgender, male having sex with male, IV 1. High risk groups - female sex workers,

drug users

population truck drivers, single male migrants 3. General population - ANC females groups for bridge population and high risk Sample size 400 among ANC females, 250 each

2. Bridge

National TB Elimination TB

definitions:

.

MDR TB

-

resistant to

Program (NTEP)

INH

and Rifampicin

moxifloxacin) Rif + any FQ (except levofloxacin and Pre A drugs* + XDR TB resistant to INH + Rif any FQ + any Group Delamanid uroup A drugs Linezolid, levofloxacin, moxifloxacin, Bedaquiline, a negatve sputum test report 6 Cured - person who has completed treatment and has sputum who has completed treatment but no documented negative XDR TB

resistant to

INH

-

reatment completed

-

eport or the sputum test report is not available report or SP even at sh month treatiment failure anytime SP after previous SN more than one month OSS to follow-up - with interruption of treatment for NeCurrent TB patient is sputum positive any time after completing T3 treatment -

B

person

test

One Touch PSM by Dr Mukhmohit Singh and Dr Shveta Saini

12

TB Epidemiology population All forms of TB 188/lac MDRTB4/lac population population TB mortality 37/lac

TB Preventive Therapy

to contacts, PLHIV months isoniazid OR 3 months Isoniazid + Rifapentine (always add Vit Bo with INH) .6

TB Case

detection

-

Active TB case finding - among higher risk

Diagnosis of TB

non-specific test Sputum screening test, sensitive test CXR

-

populations Intensified case finding patients attending health facilities with comorbidities. Passive case finding in TB Clinics

and high CBNATT - confirnmatory, High sensitivity diagnosis confirm to CBNAAT specificity, universal TB cases and to find the rifampicin status of Schemes: Liquid culture gold standard NIKSHAY software for TB notification for drug sensitivity test Line probe assay 99DOTS, MERM- for TB treatment compliance and surveillance Treatment of TB DSTB (2) HRZE +(4) HRE Incentives: INR SOO per month H-Mono DRTB (6) ZERO NIKSHAY Poshan Yojana regime BDQ shorter TB all oral MDR for nutritional supplements CHOBZEEt + (5) COZE Monthly food basked to T3 TB Mukt Bharat (4-6) patients C clofazimine, H high dose Isoniazid notification Bedaquiline .INR soo for TB Case O levofloxacin, B ethambutol SOOO for successful TB treatme t INR 10O0 Z pyrazinamide, E cOmpletion to treatment provider Et Ethionamide XDR TB all oral longer BDQ regime Organization TE L2C2B (8-20) Tuberculosis unit 2-s lac population for Iinezolid laboratory diagnostics, TB treatment and L Levofloxacin, LCycloserine C Supervisors C Clofazimine, for 10,00C DMC (aka TB diagnostic centers) B Bedaquiline 50,000 population -

-

-

-

-

-

-

-

-

-

-

-

-

-

Note:

(6) BPaL- under trial, yet to

be

implemented

Integrated Disease surveillance program: Three levels of weekly disease surveillance Syndromic Surveillance (6 syndromes)- by health workers: paralysis, unknown cause or aean $yndrome of fever, cough, jaundice, diarrhea, acute flaccid case surveillance (19 diseases) by medical officers Probable Laboratory surveillance (12 diseases) - by Labs

National Health Programs

National polio surveillance program Date of last case of Wild polio P1-13 January 2011, Howrah,

West Bengal

Aligarh,

October 1999 P2-24 Pradesh

Uttar P3 22 ctober 2010- Pakur,

Jharkhand

13

National Program for control of blindness and visual

impairment: Salient points from NPCBVI Survey 2019

Blindness

V/A

-


1% or bitot spots >o.5% in communit9 Corneal ulcers >o.017 in community

MOTHER AND CHILD HEALTH Target:

70 per lac

births live births < 12 per 1o00 live births 25 per 1o0o current values, data for (refer to demographic Tablc 1, pg 41) Classical definitions: 1. Neonate from birth till 28 days of lifelife 2. Early nconate birth till seven days of of life 3. Late nconate from sth day till 28 days Infant firom birth till one year of life Perinatal period - From 28 weeks of gestation till first 7 days of life Still birth classified as a fetal death which is a. more than 28 weeks of gestation b. more than 1000 g C. more than 35 Cm in crown rump length NOTE: AS per WHO, the perinatal period is from weeks till 7 days, but in India, we take it from 22 weeks onwards under the RCH program 28 Most common cause of death in: Neonatal mortality (and infant mortality) is low birth rate, prematurity (single best answer Infant mortality (as per Medical certificate cause of death - survey report 2020)- perinatal conditions as hypoxia, birth asphyxia and other respiratory conditions USMR Septicemia > Pneumonia > diarrhea Maternal mortality postpartum hemorrhage due to uterine atony due to multiple risk factors as traumatic delivery, prolonged delivery, anemia Points to remember Child mortality rate (under five mortality rate) death of children age under five years Child death rate (1-4 years death rate) death of children age 1 year to 4 years of age Perinatal mortality includes still births and early neonatal deaths Still birth rate is number of still births out of total births (still Live births) See formulas on page 70. MMR NNMR USMR

live

ANC Visits As per National health mission, India 4 visits. weeks, 14-26 weeks, 28-32 12 weeks, 36 wep -

term

till

As per WHO

trimester

1st

Total

-

1

8

visits

visit, 2/nd

and in 3rd trimester

-

5

trimester

-

2 visits

visits

-

-

-

.

ANC Screening:

Rural areas

-

test

Hb, Urine (protein,

Sugar), malari

Urban area Hb, urine, Malaria test VDRL+ GDM testing -

+ HIV+ He

+

-

Best indicator

Overall development of country and population health -

IMR

United Nations (UN) indicator for country development UsMR Quality of delivery services Health facilities availability MMR and service -

utilization indicator

Perinatal mortality rate

GDM screening guidelines:

two times < 12 weeks and 20-24 wecks criteria is one step testing 140 mg/dL is positive for GDM fasting is not required testing at 2 hours, post glucose load 75 -

anhydrous glucose trial with medical nutrition therapy (MNT 2 weeks to all positive GDM cases ANC Care Two doses of Td vaccine with gap of 4 we In case of complete immunization within three years, then only ONE booster to be Early pregnancy (OPV Most heat sensitive -reconstituted Measles/rubella Most freeze sensitive - Hep B> Penta, PCV, DPT sensitivve Rotavirus vaccine is both freeze and heat Vaccine vial monitor Vaccines which can be kept till 28 days, VVM is on the vial body Vaccine which DO NOT cOme under open vial| policy the VVM is on neck or cap of the vial about total heat exposure to vaccine

Tels

change in Inner square, compared to outer circle, discard point Same color

Color Measles

m

-

Diluents HepB

Lymphadenitis yr 24 hrs Prevents mother to child trans.

Penta

refrigerator

Top of

stored till 28 days of opening Measles, Rota, BCG, COVID, JE

OPV

IM, 0.S

Needs 8 hours electricity in 24 hours Placement of vaccines:

1

B

-

- IM, O.5 mL

Cold Chain

be

UtilSide effect/remars

Pentavalent (or DPT) Vaccine HepB

conjugate vacineO.5 mL, IM

(MERa ROTA BeChara COVID

to be

left side preferred

Pneumococcal

Open vial poliey

All vaccines can

mL

Antero-lateral thigh

Antero-lateral thigh right side preferred |

for vaccine 2°-8°C

Temperature

subcut, O S

(only 3" dose)

-

Vaccines

JE

till 1 month

0.05 nL)

FHPV-3- 1D, 0.1 mL

6

10 weeks

dropP

drops

Left upper arm BCG intradermal

Right upper arm

National innmunization schedule HepB Birth BCG, OPV, fiPv1, PCV1 weeks - Penta1, RVV1, OPV1,

5

Rotavirs

OPV-2

-

ntlucnza

H.

Edmonston Zagrcb

One Touch PSM by Dr Mukhmohit Singh and Dr Shveta Saini

18

Other vaccínes of use in public health: 1.

Typhoid Vaccine:

Typhoid conjugate vaccines (TCV)

Name

Tradename(s) (Manufacturer)

TY21a

Vi capsular polgsaceh vaccines (MCPS)

Typbar TCve (Bharat Biotech) Vivoyif (Paxvax) TYPHIBEV® (Biological E)

Typhim vi® (Sancfi Pasteur) Typherix

(GlaxoSmithkline)

Intramuscular injection

Administration

Age Number of doses Duration of protection

months of age 1 dose

6

Oral capsules 6 years of age 3-4 doses

Intramuscular injectic 2 years of age 1 dose with boosters every 2-3

2

years

7

years

2

years

years

Studies currently underway with Typbar TCV

Effectiveness

79-857

SO-807

SO-80

Data from TyVAC efficacy studies in Bangladesh, Malawi, and Nepal with Typbar TCV 2.

COVID Vaccines: 1.

Viral vector vaccines: .Covishield - using CHAD-ox1 strain, with chimpanzee adenovirus human adenovirus vaccine Sputnik . Janssen - viral vectored vaccine by Johnson & Johnson -

INCOVACC (2022) 2.

BBV154 nase

Killed vaccine

Covaxin using BBV-152 strain, killed inactivated vaccine .Sinovac/CoronaVac - inactivated COVID-19 vaccine 3. Protein subunit vaccine Novavax Subunit Protein Vaccine Corbevax - BECOV2D protein subunit strain with Alum adjuvant 4. mRNA vaccines

Pfizer Moderna Corbevax (2021): version of the receptor binding domain (RBD) Recombinant subunit vaccine For 12-14 years O.5mL, lM, 2 doses with >4 weeks gap INCOVACC (2022)-

Recombinant replication deficient adenovirus vectored vaccine with a prefusion stabilized spike p For age more than 18 years, 2 dose schedule with gap of 4 weeks It is the first approved nasal vaccine, produced from India (Bharat Biotech) Source: BB newsletter, September 2022

cOMMUNICABLE AND NONCOMMUNICABLE DISEASES Chicken Ppox: case

pox

of chicken 1-2 before and

.SOlPOC

Onset

AFTER onset of 4-5 dayS

rash -10

Outbreak measures 7 days after rash Isolation

MCV within 2

Cxposure Measles vaccine (MV-o) dose in outbreaks to 6mo 8 months age chl This is extra dose, give MR-1 On time

days

-21 IP(14-16 days)

MOT airborne < M/c in Age 10

years . Si/Sy -Plcomorphic, Symmetrical, vesicular rash, starting from trunk Scabs on rash are NOT

Rubella SOl

-

OKA

strain, LAV

-

case and subclinical cases POC - 4-6 days before and 7 days after onset of rash weeks IP 2-4 -

droplet MOT .M/c in Age 5-9 years Si/Sy

30-40% cases are subclinical ear ache, parotitis m/c Cx Orchitis (in adult -

.Mild, self-limiting

infective Pneumonia related to deaths Dgn clinical or VZV RTPCR Vx

days of

Mumps SOl

clinical or subclinical

-

children), meningitis, ovaritis Lynn, LAV VxJeryl

cases Shows iceberg phenomenon

2

doses

Vaccine within 5 days VZIG - within 72 hours of exposure

PEPMeasles SOl

case of measles, no

carrier

days before and after onset of rash POC 4

IP 10-14 days

MOT airborne M/C in Age 6 months

-

3 years

Si/Sy kolpik spots, morbillitorm rash starting from face (behind ears)

.

days before/after POC 7 Onset of rash IP 14-21 days droplet. MOT M/C in winter, spring and epidemiC 4-9 years M/C age of involvement Developing countries 3-10 years Developed countries 15 years Si/Sy rash from face, mild illness, 3-day fever cong. Rubella syndrome Cx in early pregnancy infections

. LAV, RA27/3 winstar associated feature diarrhea, malnutrition Avoid pregnancy X 1 month Severe in case of malnutrition after taking Rubella vaccine MICcomplication titis Influenza: media Epidemics by A. B serotype M/C cause of death Pneumonia H, N Antigens related to Long term, rare shifts/drifts SSPE POC 1-2 days before/after V-Measlesvaccine, LAV onset. IP - 1-3 days Measles lmmunoglobulinWithin 3-4 days of exposure, MOT droplet, airborne followed by vaccine DOC oseltamivir

M/C

-

-

-

8-12 weeks later

Pneumonia Guidelines Age < 2 months No feeding, convulsions, severe chest indrawing, RR>60/min -classity as PSBI, very severe disease

Treatment oral amoxy IM genta + Check vitals and refer -

urgently to hospital Age 2 months -5 years Danger signs/chest indrawing -

Severe pneumonia

-

give

oral amoxy/IM Gent, checkk vitals and refer Fast breathing > 50/min (2-11 months) or 40

(12-59 months) Classify pneumonia oral amoxycillin No signs of pneumonia home -

-

-

care for cough or cold

Singh and Dr Shveta Saini Mukhmohit Dr PSM by Touch One

20 Diphtheria M/C in Age 1 MOT IP 26

Rabies Class 1-

5 years droplet, healthy carriers -

licks, touch on skin

-

wound

management

days case, subclinical case, carrier stage SO Rx for cases - Diphtheria antitoxin,

Erythromycinpenicilin 10 days of oral Rx for carrier stage

Class 2- laceratiOns, abraSionswound My. ARV Class 3- deep wOund, licks on mucosa, bleed: edine wound Mx + ARV + RIG

Delayed, Loose sutures, wash 10-15 mins. Soap + water erythromycin Managenment for contacts Post exposure prophylaxis Essen regime - Day O, 3, 7, 14, 28 Ifcomplete vaccine within 5 years no- vaccine one If more than 5 years ago, full 3 dose Intramuscular, 5 visits and 5 doses -

-

-

booster

than 3 dose or unknown - complete o Thai regime - - Day O, 3, 7, 28 primary doses Intradermal, 4 visits and 8 doses Isolation till 2 negative throat culture, 24 hrs Pre exposure prophylaxis apart Day O, 7 and 21 or 28 3 doses 1 site, intramuscular or intradermal Plague Agent: Yersinia pestis, Reservoir Tatera indica Re-exposure prophylaxis Day o, 3 - 2 visits, 2 doses Vector Xenopsyla cheopis - carry up to sooo plague bacilli in O.5 cu mm of blood -1 site, lntramuscular or intradermal Seasonal- Sept May To be given to all pre-exposure and post e Cheopis index number of rat flea/rat is outbreak more than 3 months ago If less

-

indicator Death of Rats is first indictor for outbreak

Rabies Immunoglobuli SOI rats/Flea Human RIG 20 IU/kg. Equine RIG: 40O IP 2-7 days for septicemic, bubonic plague Maximum to be infiltrated in wound, rer in nearest IM site 1-3 days for pneumonic plague Dgn Not given in Pre-exposure or Re-exposure Wayson staining, blood culture (gold rcin standard) -

-

Yellow Fever

KX-Isolation (especially for pneumonic Plaque) Streptomycin (DOC), tetracycline (alternate, prophylaxis) Flea index to be 'ZERO' within 48 hrs of outbreak reporting Vx

2 doses, Haffkine-sokhey before exposure.

vaccine, 1 week

Favivirus, reservoir monkey and human urban) Vector Aedes aegypti, once infected is intecti -

all life POC 1st 3-4 days of illness, IP 3-6 days Vx- 17 D vaccine, LAV. It is contraindicates -

-Egg allergy, pregnant but traveling to Y -Give gap of > 3 weeks with cholera vaccine Vaccine valid after 10

days, for lifetimne

21

Communicable and Noncommunicable Diseases

Syndromic Kits

Content of the kit

Color Use indications

Kit

Grey

Urethral, anorectal discharge

Tab. Azithromycin

Green

Vaginal discharge

Tab. Secnidazole 2 g

Kit 2 Kit 3

With

Nonherpetic genital ulcer

Penicillin (2.4M Units)+ Tab azithromycin 1 9 +10 mL Syringe, 21G needle + 10 mL Distilled water

Kit 1

nj.

19 +

Tab fluconazole 150mg

B.

1 vial

-

Kit 4

Bluc

Nonherpetic genital ulcer, allergic to penicillin

Tab Doxycycline (100 mg BD x 14 days) Azithrowmycin 1 9

Kit 5

Red

Herpetic genital ulcers

Tb Acyclovir, 400 mg TDS x 7 days

Yellow

Lower abdominal pain, PID

TB Cefixime 400 mg Tab. Metronidazole 400 mg BD x 14 days Tab Doxyeycline 1 g BD x 14 days

3ag

Inguinal bubos

Tab Doxycycline 1 g BD x 21 days Tab Azithromycin 1 g

Kit

6

Kit 7

+

Tab

Rickettsia

Rickettsia prowazekii Rickettsia

typhi

Onentia tsutsugamushi

Rickettsia conori

Large, EPIC

is

Epidemic typhus Louse

iPhone Pro

Endemic typhus

Flea

Typhoid Fle(a)s like Endemic

Scrub typhuus

Mite

Go

Indian tick typhus

TICk

Tick tock

burnetii

Tetanus

(Clostridium tetani)

Q

No

fever

Coxiclla

*Spore bearing, potent exotoxin Reservoir and source soil MOT inoculation direct

corner

vector Special -no rash, no vector (Q is special alphabet)

tetanospasmin

-

for Tsu-Tsu in Shrubs (serubs)

tetanolysin

-

Category

Clean woundd and k6 hours

Patient immune status

4egory

A

Full immunization 5 years

Cgory

B

Full immunization within

within

|

Contamirated wound or

Only wound care

Only wound care

TT single dose

TT single dose

TT single dose

TT single dose Tetanus immunoglobulin

TT/Td two doses

TT/Td two doses immunoglobulin

>6

5-10 years

egory C egory D

Full immunization than 10 years agoo

more

Unknown immunization status, no vaccine

oSe

r

letanus Immunoglobulin is

-

250-500

IU

(1-2 ml in vials)

+

Tetanus

hours

Mukhmohit Singh and Dr Shveta Saini One Touch PSM by Dr

22

National Cancer registry data (202 Males Lung cancer Females - Breast cancer Cancer Prevention and Control: A. Primary Prevention: As per

Noncommunicable Diseases Prevention of Rheumatic fever Refer to page

85

Prevention of Hypertension prevention 1. Primary (and/or primordial)

Tobacco, alcohol control, Personal Hug cancer educationn mmunization (h 2. Specific prevention for liver cancer, HPV for cervical cancer RE lesions 3. Treatment of precancerous 4. Legislation (control environment pollE sale of tobacco, alcohol) 1.

Population strategy: lifestyle modification, i. Health education low (fat, dairy, sSugar), Physical exercise Dietary approach to stop ii. DASH Diet hypertension B. Secondary Prevention: b. High risk strategy: Tracking of blood pressures populat| are tracked for 1. Cancer Registration (hoSpital and the blood pressures group, -IF to identify based registries) children to adolescent age detection in hypertension prevent persons at risk and 2. Cancer screening, early treatment later life. case detection Early 2. Secondary prevention Screening test of choice: Ch and treatment 5% act with inspection Visual cancer Cervix Management of prevention 3. Tertiary acid solution is done at peripheral units stroke nephropathy, hypertensive retinopathy, cancer mammography is most: nstprE Breast of half Only 1s Rule of halves in Hypertension: and specitic screening tool. condition, of the aware are population hypertensive 2 only out of which only half are treated, out of which Cervical Cancer (HPV) Vaccine half are adequately treated. AV Bivalent Cervarix vaccine - 16, 18B Obesity Indicators: Quadrivalent Gardasil - 6, 11, 16, 18 Nonvalent Gardasil - 6, 11, 16, 18 Weight (in kgs) 45, $2, s8 Body mass index Height (in mtrs) Ma Cervarix is ONLY recommended in fer age Height (in cms) more than 9 years till reproductive Ponderal index HPV4 or HPV9 vaccine is recommende Body weight (in kgs) prevention of anogenital warts, penile ed 1000 Broca's index = Height (in cms) cancer, perineal intraepithelial neoplaVi associated cancers and may be given Actual weight (in kgs) = Corpulence index also. Desirable weight (in kgs) New vaccine Cervavac a.

-

-

-

-

-

Cancer

Target strains (2020) cancer in males Lip/oral

.MC

MC cancer in females

cervix and uteri

Lung

Breast

-

Uteri ovary MC cancer (any gender)

>

stomach

11,

C

Ca

Cases

Li VLP Vaccine type 9-26 years, in females .Age Dose: 2 doses 6 months apart (

FO

-

cervix

and

-

-

16, 18

ot 16 and 18 contribute to 70%

HPV

As per Globocan Data

6,

Breast> Lip/oral

Immun0compromised)

doses

ta

NUTRITION male/Female: years, Reference body Age 19-34 weight- Male 65 kg, female s5 kg

Reference

(+30kg-pregnancy)

percentile; 95 kg/m*

Height

BMI

range of

22.9

18.S

Recomended Dietay allowance: (kcal/day) Energy: Adult

Male 2,110

1,660

Moderate

2,700

2,130

Heavy

3,470

2,720

85 kcal/day

70

280 kcal/day

2rd TM 230 3dTM 390 Average is

47O kcal/day

37S kcal/day

310

6-12 months

kcal/day +520 kcal/day

+60O

-

2.3

lodine mcg/day

150

250

280

Calcium mg/day

1,000

1,000

1,200

Vit A meg/day

850

900

950

220

S70

330

Fat intake

Female

25,

30,

40 g/day

20, 25,

-

DIetary fiber Carbs

-

30 g/day

40 g/2,000

?325

mg/day

Limiting amino acids Cereals

Threonine

Lysine

Maize

Tryptophan

Lysine

Pulses

Methionine

Cysteine

DHAP-TLC

Foremilk- Fluidy (watery) First Milk Hindmilk- later on milk, Heavy (Fatty) -

kcal

130 g/day; Pregnancy- 175 g/day,

Lactation

ro4uality: oroducts tand

200 g/ aay

FSSAI

-

LOO

DHA, A-arachidonic, PUFA, Taurine Lactose, Vit C,| Cysteine | Iron is adequate to meet demand of child till 6 months f age.

g/kg/day DIAAS- best indicator Male

3,500

285,

Net Protein Utilization formula: Amount of Nitrogen reatined for body mass x Amount of protein ingested

HIGH

Macronutrients: Proteins 0.83

Visible

d

Human milk: Energy 65 kcal/100 mL Low NaCl (Na-sodium, Cl-calcium)

Lactation: O-6 months

40

Potassium

Pregnancy (extra calories to be added)

TM

29

-

kcal/day 1,700 kcal/day 3,300 kcal/day 2,200

-

Iron mg/day

Magnesium (mg/day) Sodium 2,000 mg/day

infants 5sO-670 Children 1,000

Adolescent

Pregnant Lactating

Adult

Folate mcg/day

Female

Sedentary

Micronutrients, Vitamins:

Food safety and

standard authority of India

for raw food, grains quality: Codex Alimentarius

quality of food and other food

for international food quality and

24

One Touch PSM by Dr Mukhmohit Singh and Dr Shveta Saini

Food Intoxications

Neurolathyrism:

Epidemic dropsy

Toxin Beta-oxalylaminoalanne Food Khesari daal Si/Sy -kncc, anklec, hip join

Aflatoxicois Ergotism Toxin: Aflatoxin Toxin: Sanguinarinc (in Toxin. Ero Argemone mexicana) Food: Ground Alkaloid oil Food: nuts, Mustard cereal, Food: Si/Sy: Glaucoma, Dyspnea, congestive cardiac failure, pedal edema, diarrhea Px: Check mustard oil for argemone

Involvemcnt Px vit C prophylaxis,

parboiling of daal

Endemic ascites Toxin

Contamination by nitric acid chromatography test

Pyrrolizidine in cirotalaria secd Food Millets

maize Si/Sy: Liver

Sorghum,

rye, Bajra Si/Sy

invoívement Px: Proper

Diarrhea,c

storage,

cOmplaint

Improve

Px: Float

ventilation and reduce humidity

plant in 20 salt solutior

Si/Sy Liver involvement Px: Filtration, sieving Fats:

Fatty

acidd

Omega

TOpe

Richest Source

FA, Oleic acid

Monounsaturated fatty acids

Olive, Peanut, Canola, Avocad Mustard oil

Omega 3 FA, Alpha linolenic acid Omega 6 FA, Linoleic acid

Polyunsaturated Fatty acids Polyunsaturated Fatty acids

Flaxseed oil

Safflower, Grapeseed, Cottor Walnut

e

Egg:

605

60 kcal, 6 g protein, 6 g fat, 30 mg calciumm Highest NPU, rich in cholesterol, PUFA, DHA

(maximum in breast milk)

Raw egg has avidin which may cause biotin deficiency

Malnutrition Acute malnutrition

-

low weight for height

Chronic malnutrition: low height for age General malnutrition (acute on chronic) low weight for age -

Severe acute malnutrition (SAM)

Age independent marker for malnutritioncircumference (MUAC), by Shakir's tape < Mid upper arm 11.S severe malnutrition L1 .5 12.5moderate malnutrition,> -

12.5 cm- no malnourishment ICDS growth charts: based on MGRS standards, 3 zones: 1. Between +2SD and -2SD normal, green zone 2. Between -2SD and -3sD yellow zone, mild/moderate maln 3. Below -3SD red zone, severe malnutrition (refer to image pa -

-

Nutritional rehabilitation centers (for management .Stabilization phase: starter (aka F75 diet), no of SAM children 75 criteria lron supplement 099 protein/100 mL diet Weight for height < Transition phase: catch-up diet -3SD (aka F100 diet) 100 cal, 2.1 gprote P 100 mL diet Bilateral pedal edema. Maintenance phase home -based Cony MUAC diet, when child is able w 11.5cm 10% of feed and no danger signs or edema -

-

Nutrition

25

Food poisoning: Salmonella

Staph aureus Botulism Glostridiun botuliruns

Farm animal and poultry Milk, milk products, Cream,

salads,

12-24 hours 1-8

hours

Custard Home canned vegctables, Pickled fish, cheese, low acid food

Clostridium pertringens

Meat, poultry

Bacillus cereus

Raw, dried and processed foods, cooked rice

18-36 hours

enteritis and colitis, fever Profuse watery diarrhea

Acute

Preformed toxin (intradietetic toxin) Vomiting, cramps are main features Diarrhea maybe associated with or without blood Found in soil, dust intestinal tract of animals Preformed toxin (intradietetic toxin) under anacrobic conditions Dysphagia, diplopia, ptosis, dysarthria, blurring of VISIon, muscle weakness Treatment - Botulism antitoxin, Guanidine hydrochloride in feces, soil, water

6-24

Found

hours

abdominal cramps Diarrhea, Vomiting and nausea are rare, rapid recovery Food cooked and stored for more than 24 hours, cool at room temperature and heated prior to serving Two enterotoxins - emetic (1-6 hours) form and diarrheal (12-24 hours) form Preformed toxin, rapid recovery

between Cow Milk and Human Milk however. The mature milk grossly resembles a cow milk in terms of energy, nutrients and fat content, milk. Human milk has only one-third of the protein concentration compared to cow is digested easily, and it is low Human milk contains a lipase enzyme because of which human milk fat

Difference

*

sodium milk. provides an easily Human milk has almost double the amount of lactose compared to cow milk. Lactose growing nerve tissue of digestible source of energy. High lactose content helps in myelination in the intestine, which prevents growth of in the baby. Also, part of lactose is converted to lactic acid the undesirable bacteria in the intestine. Bifidus factor iss Human milk contains the bifidus factor, which is a nitrogen-containing carbohydrate.

ecessary for the growth of Lactobacillus bifidus, which converts lactose to lactic acid. A, which is not man milk, especially the colostrum, contains large amountsasofE.immunoglobulin coln ) and Viruses. aDsorbed but acts in the intestine against certain bacteria (Such several thousand times that of cow O2yme, an enzyme, is present in human milk in concentrations viruses. wk. Lysozyme breaks down certain harmful bacteria and also protects against various

ENVIRONMENT AND BIOMEDICAL WASTE Corrected Effective air

Air Air pollution Primary air pollutants CO, Co. NO. SO. CH, Ozone Sccondary air pollutants Smoke and dust Most iyportant Primary air pollutant as marker for -

industrial development

so,

Greenhouse, climate change-

CO smoke Grit index measures Dust Soiling index

-

Air Quality

Index Includes 8 air pollutants:

namcly particulate matter (PM) 10, PM2.5, Ozone

(O,), Sulphur dioxide (SO,), nitrogen dioxide (NO), carbon monoxide (CO), lead (Pb) and ammonia (NH,). AQI of < sO = Good 100 = Satisfactory

300

=

400

=

Poor Severe

thermometer Humidity psychrometer and -

hygrometer thermometer

-

globe

Biological Quality Fecal contamination coliformM

test McCarth rtneu chart, MPN method

Chemical Quality Chlorine > 0.5 ppm Outbreaks O.7 ppm Swimming pool > 1 ppm

Contact time

1

hour -

Chlorine demand Horrock's apparatus - amount of bleaching powder for 45SL of H,O

Orthotoulidine test is for free and combined residual chlorine OT-Arsenate test will test free and combined chlorine separately Hardness 1-3 mEg Temporary hardness is Ca/Mg bicarbonates Permanent hardness is Ca/Mg non-carbonates and is not removed by boiling

-

Recent contamination Fecal streptococci Remote/distant ContamInation

Clostridium pertringens

units

Hydrometer measures specific gravity or density of water Color < 15 true color units

-

count

Coliform

Water Physical quality parameters Turbidity< 5 nephelometric

-

Cooling power of air and Low air velocity Kata

Radiant heat

temperature includes radiant heat and ET -Effective temperature (ET includes temperature, humidity and air velocity) -

Rapid sand filter: bed

Sand

Includes

main filtratioa preliminary b is

storage of water Less space, faster Sand size: O.4-0.7 mm rate 5 m/hr Filter

Slow sand filter: . Schmutzdecke layer or biological layer- is main functioning part More space, slow rate

RE

Sand size: O.2-0.3 m Filter rate: O.15 m/hi

Water

diseases:

W

Fa

."washed' scabies, shigella, trachoma "based" -schistosomiasis, dracunculiasis cholera, "borne"

|

-

gastroenteritis

"related- mosquito-born, -

malaria

Em

Environment and Biomedical Waste

Ventilation Mixed Ventilation includes exhaust and plenum ventilation. lux in room for living Light >100 candela o Brightness of light source lumens or flux o Flow of light -

-

-

-

Light reaching surface, illumination lux Lambert's o Brightness (light re-emitted by surface) Noise 85 dB House- area 11O sq t for 2 persons and 40 sq t/person after this Doors and window to be >2/sth of floor area -

o

Biomedical Waste Management ellow -

category

Human anatomical Animal waste

-

fetus, organ, tissue

cotton, gauze, bandage, dressings, casts, plaster, fUD Expired drugs, cytotoxic waste (special symbol, lBQS section, page 51) - Chemical waste -Fluids X-ray developer fluid, disinfectants, Body secretions pus, sputum, feces, CSF - Gown, linen, bedding, blankets, mattress 1 Microbiological wastes, culture plates, live vaccine vials, vacutainer with blood, blood bags, BT sets, blood and blood products Red Gloves, syringes, vacutainer without blood, urine bags, catheter, Eye goggles, Soiled waste

-

-

Nhite

Sharps and other metals

actories Act Article 24

(1948) no child (< 14 years) employment

appropriate work for children of tender age (15-19 years) More than s00 cu.ft. space per worker Creche facility: >30 workers Canteen facility: »25O workers Welfare officer: >50O workers Satety officer >1,000 workers Article 39

ployee State Insurance (ESI) Scheme ESI day-24 February; Under Ministry of Labor Benefits:

Direct (via ESI clinics) ndirect benefit (via empanelled hospitals) Financial

contribution

Employee Employer

O.757 of wage 3.25% of the wage Sickr benefit - up to 91 Days, and up to 70% wage tended sickness benet - up to 2 years, and up to 80% wage Maternity benefit 26 weeks for deliver Funeral expense 15,000 INK -

-

-

27 Blue

Orthopedic

metallic body implants, and broken glass

Pretreatment

is

done

f, g, h and red, blue, white

for yellow

category wherever indicated.

BIOSTATISTICS AND SCREENING OF DISEASE Quantitative Data continuous, mean can be calculated Qualitative data - discrete, countable, proportions may be calculated -

Standard deviation Remember:

XN

K

Root Mean Squared Deviations (RMSD) Mean - average, best measure Median central value, after arranging in ascending order. Least affected by extreme values Mode most frequent value -

Normal distribution curve Bell shaped,

symmetrical Mean median = mode: coincide 1SD 687%; 2SD 957; 3SD = 99% Ends never touch the baseline

Test of significance:

Chi square test:

Spot map location on a map Box and Whisker Data distribution. Each whisker is 25% of values, box shows interquartile range is values, difference of Q3 and Q1and sot -

chart - always in circle, with age Venn diagram overlapping QL data Pictogram symbolic presentation Scatter plot used for correlations, alwaus between 2 variables Pie

-

-

-

Correlation

r = Minus rr Plus

Negative correlation positive correlation

1

1

Als

no correlation. Regression - involves predicting one value, w en another value is known logistic regression -QL, non-parametric Linear regression QN, parametric dato latl O =

Qualitative data Sampling methods: single group, QN data Probability methods (better) Unpaired t-test: two groups, QN data Stratified random dividing population C ANOVA test 3 or more groups, QN third variable data P value < O.0s significant result, effect is found Systematic every nth unit is selected Graphs: See IMAGES, page 6o. Non-probability methods (non-random) Histogram - joined Column chart, QN data Convenient, Quota, purposive, snowball Bar chart distantly placed columns, QL data sampling Frequency polygon joining of mid points of histogram Probability Rules Line diagram- time trend chart Rule of addition events are mutually Choropleth frequency, exclusive or equation uses "OR" intensity on a map .Rule of multiplication - equation uses "AND Research Hypothesis Alternate hypothesis this is the "real" thing we are trying to find in the "opposite" of alternate hypothesis the study. The null hypothe Null hypothesis: It is an assumption, that there is no effect no effect of the intervention or no difference between groups, or thert the Alpha Error Chance of REJECTING null hypothesis, which was TRUE in REALITY Observing (or finding) an EFFECT, which was NoT there in REALITY Example - YoU SAY Drug A is better than Drug B, but REALITY is A = B Beta Error Chance of ACCEPTING null hypothesis, which was FALSE in REALITY Saying NO Effect is found (or no difference), even when there IS AN effect REALITY EXample YOU SAY Drug in A = Drug B, but the REALITY IS Drug A is better or worse (but No" than drug B

Pairedt-test:

-

-

-

-

-

-

-

-

-

-

-

Biostatistics and Screening of Disease

29

p-Value

the probability of rejecting (or accepting) the Null hypothesis. fp-value Median> Mode

Means

in LEFT skew

Sereening

for Disease

Pls see forwmula,

page

70.

Sensitivity - Probability of having test positive out of total diseased Specificity Probability of having test negative out of total healthy Positive predictive value Probability of having disease out of tested positive. Negative predictive value - Probability of having disease out of tested negative. Keceiver operator characteristic curve Between Sensitivity and 1 - Specificity Test in series Increase in Sensitivity -

-

Screening

time Time

between first possible point of diagnosis and critical time of diagnosis Lead time Time between first possible point of | diagnosis and usual point of diagnosis Validity, accuracy, Precision Validity- Test measures what it iS supposed to| measure Accuracy- Nearness to the true or actual value Precision- Reproducibility, repeatability getting same results on repeat measurements -

EPIDEMIOLOGY see page 70. All cases within OR, RR, AR, PAR Common source, point exposure risC fall. and scen or with rapid Onc IP. Single waves If OR RR 1 Positive association poisoning. Food Eg, Or RR