Professional Documents
Culture Documents
Community
Community
Objectives
Morbidity
Achieved by
- Prevention of diseases by establishing maternal & child health serises, school health services. - Curative services By clinics, labs, 1st aid services
Occupational Health Occupational Health: is the science & art that aim at achieving optimum state of physical, mental & social wellbeing of workers.
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NaCl
C) Heat Pyrexia Exposure to extreme heat damage to the heat regulatory center
Treatment: immersion of the patient into ice cold water.
Prevention of Heat disorders A) Environmental measures Insulation of hot machines Prevention of steam leakage Proper ventilation Protective clothing Pre-employment examination Periodic medical examination Salts & fluids intake
B) Medical Measurements
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0105068372 B) Diseases caused by Noise A) Air conduction deafness exposure to noise > 150 decibels rupture of drum e.g. in military explosions. B) Nerve conduction deafness Prolonged exposure to noise level > 90 d.b. Prevention: 1. Environmental control: 2. Medical control: echo Proper maintenance of machines. Periodic examination Use of ear plugs
Dyspnia: decompression illness occurring in aeroplanes during rapid ascent to upper atmosphere Prevention of decompression illness A) Environmental measures Gradual decompression Inhalation of helium to avoid level of dissolved N2
B) Medical Measurements
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Treatment supportive Delayed effects lung cancer, Cataract, Premature aging, skin cancer, leukemia Prevention
environmental measures: - Isolation - use of radiation proof containers - Periodic medical examination - Health education - protective clothing Medical measures: - pre-employment examination
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Silicosis
A fibrotic lung disease produced by inhalation of dust containing Silicon dioxide.
Predisposing factors:
1. Duration of exposure (long period 5 10 years). 2. Size: Smaller dust particles are more injurious. 3. Concentration: the higher the conc. of dust the more injurious. 4. The presence of free silica in the dust. 5. Personal susceptibility.
Pathogenesis Silica particles are ingested by alveolar macrophages carry them to lung
tissue macrophages disintegrate stimulate fibroblast function & collagen formation, - Damaged macrophages attract others that ingest released silica particles
Pathology Silicosis nodular fibrosis, layers of collagen (ONION RING APPEARANCE) Clinical picture DYSNEA Complications: Tuberculosis.
Corpulmonale as a result of pulmonary hypertension, chronic bronchitis & emphysema
Diagnosis:
1. History of exposure 2. Radiological examination: Nodular shadow 3. Pulmonary function testing FVC, FEV1 below normal levels.
Prevention:
A) Environmental measures to reduce dust below TLV (Threshold Limit Value). 1. Substitution 4. Ventilation 6. Cleanliness B) Medical measures: 1. Pre-emp1oyment examination 2. Periodic medical examination Community Oct. Med. 5 3. Health education. 2. Segregation. 3. Enclose of machines releasing dust. 5. Wetting Water is sprayed to precipitate dust. 7. Protective clothes
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Asbestosis
Asbestos is a fibrous material obtained from mines; it has an insulating & fire protecting characters & can resist chemicals.
Hazards:
Cement Asbestos industry (used in roofs, buildings & pipes manufacture) During manufacture, fixation, or removal of car breaks.
Pathology Asbestos fibers can be found in the terminal bronchiols or penetrate lung tissue
irritation & injury of lung tissues - When coated with iron rich protieneanous material Asbestos Bodies (found in sputum)
Predisposing Factors:
1. Duration of exposure after 5-10 years. 2. Dose response relationship. 3. Smoking has synergistic effect in production of lung cancer & mesothelioma.
Clinical picture
Dysnea, cough & expectoration (Chest pain is an indication of involvement of pleura)
Complications:
1. Bronchogenic carcinoma. 2. Mesothelioma of pleura or peritoneum. 3. cor-pulmonale.
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B) Byssinosis
Tightness of the chest on the day following a holiday, (called MONDAY FEVER)
Predisposing Factors
1) Duration of exposure 5-10 years 3) Personal susceptibility. 2) Intensity of exposure
Pathogenesis
A) The allergic theory: On exposure to cotton dust antigen antibody reaction develops. B) The chemical theory: assumes presence of histamine releasing substance in cotton dust BRONCHOSPASM
Pathology:
NON SPECIFIC Mucous metaplasia in small airways, Mucious hyperplasia in larger bronchi
Clinical Picture:
STAGE 1/2: Tightness of chest occurring OCCASIONALLY in the day following holiday STAGE 1: Tightness of chest occurring on EACH DAY following holiday STAGE 2: Tightness of chest occurring on each day following holiday & EXTENDING FOR FEW DAYS AFTER.
DIAGNOSIS
1. History of exposure 2. Clinical picture 3. Pulmonary function testing: FVC & FEV1 are reduced
Prevention
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Risk factors:
1. Host factors (Genetic factors) 2. Environmental factors:
Offsprings of parents with CHD have malformation rates ranging from 1.4% to 16.1%.
1. Maternal viral infections: Rubella accounts for 2% to 4% of all CHDs. 2. Maternal X-ray exposure: especially of pelvis incidence of Downs syndrome. 3. Teratogenic drugs as: - Thalidomide & folic acid antagonist - Lithium chloride. - Alcohol 4. Acute hypoxia 5. Cigarette smoking uterine vascular changes 6. Maternal metabolic defects: diabetes mellitus. 7. Obstetric problems association of advanced maternal age with Downs syndrome 8. Dietary deficiencies during pregnancy congenital malformation. - Anti-convulsion drugs. - Progesterone / estrogen: acting in the 1st trimester.
Preventio n
1. Genetic counseling of parents & families with CHD. 2. Rubella immunization programs through premarital care. 3. Avoidance of exposure to viral diseases during pregnancy 4. Physician should avoid Teratogenic drugs & radiological influence on the fetal & newborn heart during prenatal care. 5. Family planning services 6. Health education of mothers: to avoid cigarette smoking, alcohol consumption or any drugs without prescription.
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Hypertension
The elevation of arterial blood pressure over 140 / 90 in adults
Risk factors
a) Host factors
1. Genetic - Heredity interacting with the environmental role not all hypertensive patients have diseased offspring. - So children of hypertensive parents should be screened & advised to avoid environmental factors that aggravate hypertension (e.g. smoking, physical inactivity, and excess sodium) 2. Low birth weight Low birth weight due to fetal under- nutrition followed by B.P. later in life 3. The role of sodium salt in essential hypertension - sodium intake in diet B.P 4. Obesity: HTN is common among obese individuals risk of ischemic heart disease 5. Physical inactivity: Physical fitness prevent HTN 6. Alcohol intake 7. Smoke: Cigarette smoking B.P., through nicotine release of nor-epinephrin. 8. Hyperuricemia: Present in 25 - 50 % of individuals with untreated 1ry HTN. 9. Ethnic group: Adult blacks have HTN to higher rises of morbidity and mortality. 10. Sex: Before menopause, HTN is less common in women than in men, but after that HTN is equally common & dangerous in elderly males & females. 11. Age: At old age more HTN cases & age related atherosclerosis. 12. Diabetes mellitus: HTN & diabetes coexist commonly
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0105068372 Diabetics are susceptible to adverse effects of HTN therapy, because diuretics & blockers insulin resistance.
Environmental factors
Tension, anxiety & continuous exposure to external stress factors blood pressure in normo-tensives but high in hypertensives.
Prevention of Hypertension
1. Life style modification:
A) Weight reduction: - exercise B) Avoidance of tobacco C) Dietary Na restriction B) K supplementation: Patients should K depletion & dietary K intake E) Mg & Ca supplementation: B.P. F) Prevent alcohol consumption G) Physical exercise H) Relaxation exercises: stress & anxiety. - Use caloric supplement
Bronchial asthma
Asthma cannot be cured, but could be controlled.
CAUSES
1. Indoor allergens (e.g. domestic mites, carpets & furniture, cats) 2. Family history of asthma or allergy. 4. Exposure to chemicals in the workplace. 5. Drugs: aspirin & NSAIDs. Community Oct. Med. 6. Low birth weight & respiratory infection. 10 3. Tobacco smoke.
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0105068372 7. Weather (cold air) 8. Extreme emotional expression & physical exercise. 9. Urbanization.
Preventio n
1. Increase public awareness 2. Organize global epidemiological surveillance to monitor asthma 3. Develop & implement a strategy for its prevention 4. Stimulate research into the causes of asthma to develop new control strategies & treatment techniques.
- The high in rates of lung cancer is largely due to cigarette smoking. - Decline in rates of stomach cancer is unknown but may be related to dietary habits, (consumption of less preserved & more fresher foods) - Decline in mortality from uterine cancer is probably due to combination of 3 factors: 1. number of women who still have a uterus 2. cytological screening 3. Decline in the incidence of new cases
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0105068372 Initiators rearrangements in DNA expression of normal genes (ONCOGENES) Promotors rate of growth & number of stem & intermediate cells (targets for initiators) to enhance growth of tumor cells Estrogens proliferation of endometrium endometrial cancer
Risk factors
1. Tobacco
- Compared to non-smokers, risk in the average cigarette smoker is
- 10 fold lung cancer, - 8 folds laryngeal cancer - 4 folds mouth & pharynx - 3 folds esophageal cancer - 2 folds bladder, renal pelvis, ureter & pancreas - Risk is increased by about 30% in non-smoking members with a resident smoker.
2. Alcohol
- Risk of neoplasms is associated with alcohol consumption. - Hepatocellular carcinomas develop at rate in alcoholics with macro-nodular cirrhosis. - Risk for carcinomas of mouth (buccal cavity & pharynx) & esophagus
3. Industrial exposures
Specific exposure Arsenic & arsenic compounds Asbestos Benzene Site or tumor type Lung, skin
4. Drugs not an important cause of cancer (account for less than 1% of neoplasms) 5. Ionizing radiation
- Among the atomic bomb survivors in Japan there were - High in rates of carcinomas of thyroid & mammary glands & of leukemias - Lesser in rates of lymphomas & carcinomas of stomach, esophagus, & bladder - Risk of leukemia in early radiologists who took few precautions against radiation
6. Non-ionizing radiation
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0105068372 Sunlight cause squamous & basal cell carcinomas of skin (occur on exposed parts of body)
7. Exogenous hormones
- endometrial cancer in women receiving estrogens for menopausal conditions
8. Infectious agents:
EBV nasopharvnea1 carcinomas HBV Hepatocellular carcinoma (Hepatoma) HBV viral DNA cervical cancers Human immunodeficiency virus (HIV) AIDS An RNA virus Kaposi sarcoma & non Hodgkins lymphomas
9. Nutrition
Aflatoxins produced by fungi liver cancers it some parts of the world. Food additives May be carcinogenic, the evidence is weak - artificial sweeteners risk of bladder cancer - fat diet cancers of colon, breast & prostate Over-nutrition obesity associated with endometrial & postmenopausal breast cancers N.B. - Fibers in diet bulk of bowel contents & intraluminal carcinogens by contact of colonic mucosa with carcinogens. - Fresh fruits Diets & raw vegetables carcinomas risks in GIT & RT.
Preventio
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1. Precautions with blood donors:
1. Must be healthy & not addicts. 2. Must be free of infection: no history of recent disease, especially viral hepatitis & testing blood for any existing infection. 3. Blood grouping: ABO & Rh to be registered in the identity cards.
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0105068372 Infant mortality rate & congenital Abnormalities & pregnancy wastage, lethal sublethal. - Mother give better care nutritional, psychological, education & medical care for smaller number of children.
Outcome of Pregnancy:
1. Favorable: delivery of a healthy live born. 2. Unfavorable i.e. dead baby (called pregnancy wastage), It is of two types: Lethal i.e. abortion, miscarriage, stillbirth, neonatal death & postneonatal deaths Sublethal: e.g. congenital anomalies, mental retardation, cerebral palsy, Also prematurity.
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0105068372 6. Infection acquired by the foetus during labour 7. Social factor: Poor living conditions and lack of medical care
Maternal mortality
Maternal mortality: a biostatistical index which monitors the safety of the reproductive process through which mothers in the reproductive age might pass through. The interaction between the maternal fitness & environmental factors would determine the process of maternity and its outcome part of which is the maternal survival - Maternal mortality is death of women during performing their maternity function at pregnancy, delivery or puerperium. Maternal Mortality is one of the main indicators of the health status & welfare of a community.
Host
- Mothers who are intolerant to maternity stress might be due to: 1. Limited vital reserve due to constitutional factors 2. Incomplete recovery of their vital reserve due to previous maternity or other stressing factor (recovery needs 2 years at least). 3. Morbid condition whether limiting her vital reserve to the maternity process. Endocrine Balance: Pregnancy & delivery are the stresses to which mothers are exposed. Community Oct. Med. 16
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0105068372 Nutrition: Proper nutrition makes mother more tolerant to stress of maternity process. Age: Excess of deaths among older women & excess among women younger than 20. - Risk of maternal death was higher in mothers aged more than 40 years Parity: Maternal mortality is high among primipara then it drops & reincreases again among those who had five or more children.
1. Direct causes
These are the causes due to complications of pregnancy, delivery & puerperium & trials to manage the case during this maternity process including abortion. The three leading causes of maternal mortality in Egypt: haemorrhage, toxemia & sepsis. - Hemorrhage before & after delivery (43%of maternal death), with most hemorrhage deaths due to postpartum hemorrhage. - Other direct causes: hypertensive disease of pregnancy (22%), sepsis (8%), ruptured uterus (8%), cesarean section (7%) & obstructed labor (5%).
2. Indirect causes
- These are causes due to aggravation of pre-existing conditions as rheumatic heart during pregnancy, delivery & purperium. - Cardiac disease: the indirect cause of maternal deaths (13%) - Anemia was the second most important indirect cause of maternal death (11 %).
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0105068372 10. Community education must address traditional beliefs about pregnancy-related complications that are often blamed on a womans behavior, fate, evil influences & other factors beyond the reach of the health system. 11. Dialogue among communities, policy-makers, and health system staff is essential to identify ways of overcoming barriers to women seeking maternal care.
Child Health Care - MCH centers are responsible for care of under 5 years children (from birth to school age), & include infants & preschool children.
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II. Parasitic infections IV. Accidents. VI. Handicapping (disability).
I. Infectious diseases
- Infection is a health problem in developing countries. - It may be congenital or acquired.
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0105068372 - Many infectious diseases are endemic in the developing countries. - Susceptibility begins from the 6th month of infancy due to the fade out of maternally acquired immunity except for pertussis & T.B. in which there is no maternally acquired immunity. - Pertussis: Big molecule of immunoglobulin M, that can not pass through the placenta. - Tuberculosis: cell-mediated immunity. The risk of infection is aggravated by faulty breast feeding practices, malnutrition & faulty weaning practices. Infectious diseases occur in sporadic cases, epidemics or outbreaks.
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Ascaris lumbercoids, giardia lamblia, Hymenolepis nane, Entamoeba histolytica, Ancylostorna, Malaria
Impact of parasitic diseases on child health: a) Impairment in physical & mental development. b) Predispose to malnutrition.
IIIMalnutrition
About 50% -60% of under 5 years mortality is at attributed to or associated with malnutrition. Important forms of malnutrition: Iron deficiency anaemia, Protein-energy malnutrition Rickets, Vit A deficiency, Riboflavin deficiency, I2 deficiency (endemic goiter). The government compat vit A deficiency by its adminstration to pregnant females (600.000 iu) & to infants at the 9th month l00000 iu) also, iodinization of table salt to combat iodine deficiency
IVAccidents
Below-five-year children are exposed to Varity of injuries starting from birth injuries, home & road injuries.
V- Social disorders
Contributing factors
1) Big family size & low percapita income. 2) Poor housing & high crowdness index 3) Low socioeconomic standards 4) Separation of parents (loss of love & security) 5) Mothers Employment (lack of close with mother)
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a) Congenital handicapping
Examples: Mental retardation Microcephaly Hydrocephalus cleft lip or palate. Causes: 1. Genetic factor: Gene mutation & chronomosomal abrasion e.g downs syndrome. 2. Inutero Exposure to adverse condition: a. Maternal infection acquired during pregnancy e.g. toxoplasma gondii, hepatitis B infection, syphilis, measles, mumps, rubella. b. Live vaccines administered to pregnant mothers during or shortly before (less than 3 months) pregnancy. c. Teratogenic agents (drugs, heavy metals, radiation). d. Smoking: risk factor for low birth weight & prematurely. e. Air pollution & Malnutrition of the mother may play a role: Examples i. Iodine deficiency predispose to congenital cretinism. ii. Severe protein deficiency may predispose to LBW
Prevention: Congenital disability could be prevented through premarital, preconceptional & pre- natal care. 1. Premarital care a. Premarital counseling & examination for diagnosis & treatment of sexually transmitted diseases, genetic counseling to avoid hereditary diseases. b. Vaccination in non immune couples; females are vaccinated at least 3 months before pregnancy. c. Health education for healthy life & avoid any harmful practices that may affect pregnancy. 2. Prenatal care: to ensure healthy safe intrauterine growth & development & to avoid adverse intrauterine. 3. Health education: It is a continuous process to preparation of girls to be the future mothers. It is continued till child birth. Community Oct. Med. 23
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Control
- Case finding: It is better to be carried out at birth. - Management of case: Once diagnosed start medical, social & educational care & rehabilitation of the case physically, mentally, psychological & socially to lead independent life.
b) Acquired handicapping
- It is disability acquired at any age of childhood, adolescence or geriatric age group. - Acquired disability during child hood is due to either or as complications for some infectious diseases. 1) Accidents: a. The 1st accident that might occur is birth injury that may lead to neurological damage. b. Home accidents e.g fall, swallowing of caustic materials that lead to permanent oesophageal fibrosis. c. Road accidents: traffic accidents. 2) Complications of infectious diseases: a) Streptococcal pharyngitis: improperly treated case may be complicated with: a. Impaired hearing & conductive deafness. b. Rheumatic heart disease. c. Glomerulonephritis. d. Conjunctivitis (purulent) is the most common cause of blindness in Egypt (corneal opacity as a result of corneal ulceration). - Corneal opacity has no treatment except corneal transplantation. e. Poliomyelitis: paralytic form lead to paralysis. f. Meningococcal meningitis: it is complicated by paralysis of cranial nerves subnormal mentality. h. Diphtheria. j. Tuberculosis i. Leprosy. k. Syphilis,
Forms of handicapping
- Impaired hearing, vision, blindness, paralysis, rheumatic heart disease, skeletal deformity & mental retardation.
Prevention
1- Primary prevention - Prevention of infections diseases by general or specific measures e.g. vaccination & chemoprophylaxis. Community Oct. Med. 24
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0105068372 2- Secondary prevention - Early case finding & management of infectious diseases through health appraisal. - 1st aid, emergency services for early management of infection & accidents. 3- Tertiary prevention: - Rehabilitation of cases suffering from any disability. - It is comprise of physical, mental social rehabilitation.
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0105068372 How Can we improve? - We must change: Change Improvement Quality 4. Management 5.
How change? 1. Cooperation 2. Involvement 3. Education Resources - The costumer: Expectation & rights & satisfaction, Measuring Quality? - Structure - Process - Outcome
Definitions: Definitely customer focused. Philosophy, concepts, tools & techniques focused. Emphasis in employee involvement. Continuous improvement and TQM a never ending journey. Organization wide-all departments function and level. Everyone responsible for quality. Involves process and culture change. The quality control proces 1. Evaluate actual operating performance. 2. Compare actual performance to goals. 3. Act on the difference.
TQM
Total Quality management is about improvement. Improvement requires change The change process requires consensus between all concerned. Education & training may assist the process of change but it is not sufficient by itself changes in the organizations policies, structures & technical systems are also likely to be necessary.
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0105068372 Quality Improvement in Health Care Quality council Team work Information system Reducing deficiency in the services Adding new services Better care under limited budgets Attract new customer Lower the cost of services Customer satisfaction Internal (health team provider). External (population & patients)
Quality control: establish standard for structure and process, measure actual performance & corn pare to standard & regulate the process.
Family Medicine
1. Continuity of care
Family practice is defined as the medical specialty that provides continuity and comprehensive health care for the individual & the family.
2. Comprehensive care
Family practitioners can provide independent care for 85 90% of problems encountered in daily practice. - Comprehensive care may be synonymous with personal medicine. - Personal medicine is a process of providing broad-based health care which both physician & patient recognize that the relationship extends beyond that of provider and client. - When providing personal medicine, the physician may act as advisor, advocate, confidant or healer. Community Oct. Med. 27
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0105068372 - The specialty of family physician including adolescent health care, sports medicine, addiction medicine and geriatrics.
3. Coordinated care
- Family physician have traditionally served as the patients first contact and point of entry into the health care system. - Hence, care is provided for all problems. - This physician serves as the patients or familys advocate in all health-related matters, including the appropriate use of consultants and community resources. - His training and experience qualify him to practice in the several fields of medicine & surgery.
Family is part of family physician and family practice is integral to their definitions. - is a people oriented specialty physicians today choose family practice because they wish to be people doctors not doctors for organs, machines or age groups. General guidelines for family medicine 1. Provide personal care for individual & family 2. Manage acute & chronic medical problems in the community. 3. Provide anticipatory (predicted) health care using education, risk reduction, & health enhancement strategies. 4. Provide continuous health care, not limited by a specific disease 5. Provide comprehensive care of complex and sever problems. 6. Establish physician-patient relationships by using interpersonal communication skills to provide quality health care. Five Star Doctor - The concept of the five-star doctor is an ideal profile of a doctor possessing a mix of aptitudes to carry out the range of services that health settings must deliver to meet the requirements, quality, cost-effectiveness & equity in health. - The five sets of attributes of the five-star doctor are summarized as follows: - Care provider - Community leader - Decision-maker - Manager - Communicator
1. Care-provider
- Besides giving individual treatment five- star Doctors must take into account the total (physical, mental & social) needs of the patient. - They must ensure that a full range of treatment curative, preventive will be dispensed in ways that are complementary, integrated & continuous. - And they must ensure that the treatment is of the highest quality.
2. Decision-maker
Five-star doctors have to take justified & efficient decisions. 28 Community Oct. Med.
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0105068372 - In treating a given health condition, the one that seems most appropriate in the given situation must be chosen.
3. Communicator
- The doctors of tomorrow must be excellent communicators in order to persuade individuals, families & the communities in their charge to adopt healthy lifestyles & become partner in the health effort.
4. Community leader
The needs and problems of the whole community- in a suburb or a district must not be forgotten. By understanding the determinants of health inherent in the physical and social environment five-star doctors will not simply be treating individuals who seek help but will also take a positive interest in community health activities which will benefit large numbers of people.
5. Manager
- To carry out all these functions, it will be essential for five-star doctors to acquire managerial skills. - This will enable them to initiate exchanges of information in order to make better decisions.
Vaccination Schedule
Vaccine or Toxoid
First 3 months BCG for tuberculosis, Sabin (poliomyelitis). Hepatitis B vaccine. Quadruple vaccine (OPT + polio salk) Sabin (poliomyelitis). Hepatitis B vaccine. OPT.
Dose
0.1 ml intradermally in deltoid region (without tuberculin test). - 3 drops on tongue - 0.5 ml IM - 0.5 ml IM or deep subcutaneous. - 3 drops on tongue. - 0.5 ml IM. - 0.5 ml IM or deep subcutaneous.
2nd month
4th month
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0105068372 6th month 9tb month 18 to 24th month Sabin (polio). Hepatitis B vaccine. OPT. Measles. DPT. MMR (measles, mumps, Rubella) Sabin (polio). - 3 drops on tongue. - 0.5 ml IM. - 0.5 ml IM or deep subcutaneous. - 0.5 ml subcutaneous. - 0.5 ml IM. 0.5 ml subcutaneous. - 3 drops on tongue.
1. Have a written breast feeding policy communicated to all health care staff 2. Train all health care staff necessary to implement the policy. 3. Inform all pregnant women about the benefits and management of breast feeding. 4. Help mothers initiate beast feeding within a half-hour of birth. 5. Show mothers how to breast feed 6. Give new born babies no food or drink other than breast milk unless medically indicated. 7. Practice rooming in-allow mothers and babies to remain together-24 hrs a day. 8. Encourage breast feeding on demand. 9. Give no artificial teats. 10. Establishment of breast feeding support groups.
newborn should be offered the breast as soon after delivery as possible, preferably within one hour of birth. Nothing, nothing all except breast milk, should be given to a young infant. Early initiation stimulates breast milk production. Community Oct. Med. 30
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0105068372 - It fosters motherschild bonding and serves the babys first immunization with antibodies present in colostrums (the 1st milk). For the mother Early suckling promotes the release of a hormone that reducing the risk of mothers haemorrhage after labor. - It helps the uterus to shrink back to normal size. - The suckling action can help expel the placenta & reduce postpartum hemorrhage. Establishment of emotional bond between mother and child. For the child It is important to receive the colostrums which contains antibodies that protect infant against illnesses & enhances the babys immune system. - Early & frequent feeding may bring in mothers milk more quickly. - The infant will immediately benefit from the protective effect of the concentrated amounts of antibodies present in colostrum. The colostrums is like a first immunization.
Why young infants should suckle frequently? An infant should suckle frequentlr, both day and night. Frequent feeds are needed because: An infants stomach is small and can only take in a limited quantity of breast mild at any one time. The small stomach needs to be refilled often. Breast milk is perfectly adapted to the baby. - This means Ms more easily and quickly digested than other foods, and the infant will need to feed often. Since the supply of breast milk is dependent on demand, frequent feeds are needed to keep up a mother s milk supply. Frequent suckling maximizes the contraceptive benefit to mothers and helps delay the return of menses. N.B. An infant should be put to the breast 8-12 times per 24 hours, for about 10-20 minutes on each breast. - Infant should sleep with the mother so that it can feed on demand. Reproductive health A state of complete physical, mental, & social wellbeing & not merely the absence of disease or infirmity ( ,)in all matters related to the reproductive system & to its function & processes. Components of Reproductive Health I. Health promotion of females, from birth, childhood, adolescence & childbearing period. II. Safe motherhood. III. Family planning service. IV. Prevention & management of: Complicated abortion. Community Oct. Med. 31
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0105068372 Infections of reproductive system, including STDs. Noninfectious hazards of reproductive system. Infertility. Management of menopause. V. Elimination of harmful practices for girls & women. VI. Care of the Newborn Basic Requirements for Safe Motherhood 1. Preconceptional Care: 1- Health promotion Proper nutrition Prevention of infectious diseases Health education 2- Premarital guidance Education includes: Family life Family planning Child bearing 3- Premarital immunization Mumps for males and females not affected before German measles for females not affected before. 4- Premarital examination Includes: Complete family and medical history Systematic medical examination Investigations X-ray of chest, RH factor & Wasserman reaction 2. Obstetric Care A. Prenatal care for safe childbirth a) Early, regular, & good antenatal care including: 1. Nutrition 2. Screening for high risk 3. 1ry & 2ry prevention of certain conditions as anemia. 4. Health education: to make women understand nature of maternity process, how to care for themselves, the service resources available around & how to benefit of it. 5. Treatment of mild diseases if occur 6. Immunization: against tetanus to prevent tetanus of child & post partum tetanus of mother. b. Recognition of & early care seeking for danger signs. c. Birth preparedness d. Plan for emergencies e. Immunization against Tetanus With Tetanus Toxoid. Immunization of Pregnant Women Against Tetanus With Tetanus Toxoid (TT) - Tetanus Toxoid protects all women of child-bearing age, including pregnant women during & after labour. Child must be vaccinated with the 1st dose of DPT at 2 months of age. The reasons underlying the female malpractice: 1. Psychosexual reason reduction or elimination of the sensitive tissue of the outer genitalia, particularly the clitoris, in order to attenuate sexual desire in the female. 2. Sociological reason identification with the culture heritage, initiation of girls into womanhood. 3. Hygiene reason the external female genitalia are considered dirty & unsightly and should be removed to promote hygiene. 4. Religious reason there is no substantive evidence that it is a religious requirement. 5. Myths ()enhancement of fertility & promotion of child survival. Community Oct. Med. 32
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0105068372 Levels & Trend of the Problem in Egypt - Maternal Mortality is measured through the maternal mortality ratio = = no. of mothers who died due to pregnancy, delivery and puerperium 1000 live Births at the Same Period & Locality - There is a definite drop of maternal mortality rate. National Maternal Mortality in Egypt during 1992-93, determined the mortality to be 174/100.000 live births). - In the 2000, National Maternal Mortality Study of maternal death carried out in Egypt, maternal mortality decreases to 84/100,000 live births. - This direct reduction of more than 50% is a remarkable achievement Egypts efforts to improve the quality of obstetric care, access to family planning, & educate women about see medical care.
Non-human resources (to decrease maternal mortality) 1. Transportation & communication 2. Drugs 3. Blood & plasma expanders 4. Hospital & maternity homers 5. Reproduction regulators 6. Training facilities & resources 7. Research facilities & funds 8. Health education resources Main Avoidable Factors contributing to maternal Death 1. Health Provider Factors General practitioners contributed disproportionately to maternal deaths, due to delays in referral of woman with obstetric complications & misuse of drugs used to speed up labor. 2. Woman & Family Factors Failure by the woman or her family to recognize danger signs and consequently delay in seeking care, was the second most 3. Health Facility Factors Shortage of blood was the most frequent health facility factors, contributing to 16% of maternal deaths. 4. Main Medical Care of Maternal Death Medical causes of death were classified in direct causes and indirect causes. Community Oct. Med. 33
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0105068372 - Direct causes were responsible for 77% of maternal deaths - Indirect causes for 20% of maternal deaths. For 3% it Health record It is a file initiated at birth of any child & follows him (her) to school & through the whole life, for registration of all concerning health & morbidity. Contents of health record 1. Birth data (date, weight, length, head circumference and any detected abnormality. 2. Results of health appraisal at the periodic visits to the MCH center as. a- General health status & body built. b- Growth monitoring by anthropometric measurements plotted on growth chart for early detection of any deviation from normal to be managed. c- Criteria of developmental milestones according to age. 3. Vaccinations given, by date & age. 4. Curative services provided on morbidity & referral if any value of health record. Value of health record 1. Follow-up and growth monitoring. 2. a data for statistical analysis for comparison between countries, current & past states. Health hazards of smoking Health hazards 1. Malignancy: Cancer lung & other parts of the body (mouth, larynx, Pharynx, esophagus) 2. Cardiovascular disease: - CHD & Cerebrovascular disease. - stroke. * Peripheral vascular disease. 3. Respiratory hazards other than cancer: - Bronchitis, emphysema, Asthma. 5. Unfavorable outcome of pregnancy: risk of abortion, & Congenital Hazards. 4. Peptic ulcer. 6. Others, e.g. gingivitis, heart burn, and indigestion. Particular hazards to which females smokers are exposed 1. Unfavorable outcome of pregnancy. 2. Cardiovascular hazards in contraceptive pill users. 3. Increased incidence of CHD and lung cancer. Control of smoking 1. Extensive education program. 2. Management of smokers, and helping them to give up. 2. Restriction of manufacture, sale and advertising of Cigarettes
Mortality Statistics
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Death: It is the postnatal cessation of vital function without capability of resuscitation. Crude Death rate C.D.R. =
Specific Death Rates: rates calculated by taking in consideration one or more of characteristics of population like age, sex, occupation, religion Specific Death Rate =
Infant mortality rate IMR: The infant is the baby in his first year
Causes of infant deaths A) Biological: Congenital malformation Prematurity Rh factor Birth injuries and birth complication. B) Environmental Respiratory infection Gastroenteritis Malnutrition Accidents C) General Factors: Ignorance Low income Big family Leading causes of infant mortality in Egypt Bronchitis, pneumonia and bronchopneurnonia, gastroenteritis, prematurely constitutes (90%) of death. Other causes constitutes (10%) of deaths. Causes of death (other cause 10%) of infant in the first year of life are. Tetanus, Pertussis, Measles, Diphtheria, T.B., Poliomyelitis, Meningitis, PEM and accidents Neonatal Mortality Rate = Post-neonatal mortality rate =
Morbidity Statistics Incidence Rate = Prevalence Rate = Measures of fertility Community Oct. Med. 35
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2- General fertility rate (G F R)= 3- Age specific fertility rate (ASFR) = Basic Hospital Medical Records a. Diagnostic summary index: listing of admissions with dates, diagnosis and operations. b. Admission and discharge records. c. History and physical examination. d. Progress notes. e. Discharge summary. f. Physicians orders. h. Nurses note. i. Vital signs record Temp, pulse, respiration, blood pressure, state of consciousness. Uses of Medical Records 1. Document the course of the patients illness and medical treatmentt inpatient or an outpatient. 2. Serves as a basis for planning individual patient care. 3. Provide continuity of patient care on subsequent admission of the patient. 4. Review, study and evaluate patient care by hospital or medical staff committees. 5. Provide data for fluid parties concerned with the patient e.g. governmental agencies. 6. Communicates between the physician and other professionals contributing to patient care.
FEV1: Forced Expiratory Volume in the first second. The volume of air that can be forced out in one second after taking a deep breath, an important measure of pulmonary function.
Fibroblasts cells of connective tissue play a critical role in wound healing.
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Forced vital capacity (FVC) measures lung volume which will be reduced if the lungs are stiffened by scar. Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum).
Appraisal: Asepsis: infrequent Prevalent:
Percapita: each person Microcephaly: the condition of having a small head or having reduced space for the brain in the skull, often associated with learning difficulties Hydrocephalus: an increase of cerebrospinal fluid around the brain, resulting in an enlargement of the head in infants, because the bones of the skull are still unfused. The fluid is blocked by a congenital condition or a disease, and can be drained into the abdominal cavity. Mumps: an acute contagious disease, usually affecting children, that causes a fever with swelling of the salivary glands and sometimes also affects the pancreas and ovaries or testes. It is caused by a virus and can be prevented through vaccination. It may cause sterility if contracted by a man. Rubella: a highly contagious viral disease, especially affecting children, that causes swelling of the lymph glands and a reddish pink rash on the skin. It can be harmful to the unborn baby of a pregnant woman who contracts it.
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