from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.pdfgen import canvas
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import Paragraph
from reportlab.lib.enums import TA_CENTER, TA_LEFT
import textwrap

# --- COLOR PALETTE ---
DARK_BLUE   = colors.HexColor("#1A237E")
MED_BLUE    = colors.HexColor("#1565C0")
LIGHT_BLUE  = colors.HexColor("#E3F2FD")
TEAL        = colors.HexColor("#00796B")
TEAL_LIGHT  = colors.HexColor("#E0F2F1")
ORANGE      = colors.HexColor("#E65100")
ORANGE_LIGHT= colors.HexColor("#FFF3E0")
GREEN       = colors.HexColor("#2E7D32")
GREEN_LIGHT = colors.HexColor("#E8F5E9")
PURPLE      = colors.HexColor("#6A1B9A")
PURPLE_LIGHT= colors.HexColor("#F3E5F5")
RED         = colors.HexColor("#B71C1C")
RED_LIGHT   = colors.HexColor("#FFEBEE")
YELLOW      = colors.HexColor("#F57F17")
YELLOW_LIGHT= colors.HexColor("#FFFDE7")
GRAY_DARK   = colors.HexColor("#37474F")
GRAY_LIGHT  = colors.HexColor("#ECEFF1")
WHITE       = colors.white

# --- FLASHCARD DATA ---
# Format: (category, question/term, answer, color_header, color_bg)
flashcards = [

    # ── SECTION 1: KEY DEFINITIONS ──────────────────────────────────────────
    ("📖 Key Definitions", "Communicable Disease",
     "Illness due to a specific infectious agent or its toxic products, arising through transmission from infected person/animal/reservoir to susceptible host — directly or indirectly.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Epidemic",
     "Occurrence of cases of illness CLEARLY IN EXCESS of normal expectancy in a community/region within a specified time period.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Endemic",
     "CONSTANT PRESENCE of a disease/agent within a given geographic area without importation from outside. Example: common cold.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Pandemic",
     "Epidemic occurring over a VERY WIDE AREA, crossing international boundaries, affecting a large number of people. Examples: influenza, COVID-19, cholera.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Sporadic",
     "Cases occurring irregularly, haphazardly, widely separated in space and time, showing little/no connection. Examples: tetanus, herpes zoster, meningococcal meningitis.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Hyperendemic",
     "Disease constantly present at HIGH incidence, affecting ALL age groups equally.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Holoendemic",
     "High infection rate beginning early in life, mostly in children; adults less affected. Classic example: MALARIA.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Zoonosis",
     "Disease/infection naturally transmitted from vertebrate animals to man. Examples: rabies, plague, brucellosis, leptospirosis.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Nosocomial Infection",
     "Infection acquired IN HOSPITAL that was NOT present or incubating at time of admission. Examples: surgical wound infection, UTI, hepatitis B.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Opportunistic Infection",
     "Infection by normally innocuous organisms that become pathogenic when host immunity is compromised. Classic example: infections in AIDS.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Iatrogenic Disease",
     "'Doctor-generated' — adverse effects from medical interventions. Examples: penicillin reactions, aplastic anaemia from chloramphenicol, hepatitis B from blood transfusion.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Surveillance",
     "Continuous analysis, interpretation & feedback of systematically collected data to observe trends in time, place & person for appropriate action.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Eradication",
     "Termination of ALL transmission of infection WORLDWIDE by extermination of the agent. ONLY SMALLPOX has been eradicated (1980).",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Elimination",
     "Eradication of disease from a LARGE GEOGRAPHIC REGION (not worldwide). Example: India declared polio-free 2014.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Herd Immunity",
     "Indirect protection of susceptible individuals when a sufficiently large proportion of the population is immune. Threshold for measles: 92–95%.",
     MED_BLUE, LIGHT_BLUE),

    ("📖 Key Definitions", "Incubation Period vs Generation Time",
     "Incubation = time from INFECTION to FIRST SYMPTOM.\nGeneration time = time from infection to PEAK INFECTIVITY.",
     MED_BLUE, LIGHT_BLUE),

    # ── SECTION 2: EPIDEMIOLOGY MEASURES ────────────────────────────────────
    ("📊 Epi Measures", "Incidence Rate",
     "NEW cases / Population at risk × time × 1000\n• Measures RISK of getting disease\n• Best for ACUTE diseases",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Prevalence Rate",
     "ALL existing cases / Total population × 1000\n• Measures BURDEN of disease\n• Best for CHRONIC diseases\n• Formula: Prevalence = Incidence × Duration",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Attack Rate",
     "Cases during epidemic / Population exposed × 100\n• Used during OUTBREAKS\n• Secondary Attack Rate = spread within households",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Case Fatality Rate (CFR)",
     "Deaths from disease / Total cases of that disease × 100\n• Measures SEVERITY of disease\n• NOT a true rate (no time component)",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Infant Mortality Rate (IMR)",
     "Deaths <1 year / Live births × 1000\n• BEST single indicator of socioeconomic development\n• India IMR: ~28/1000 (2020)",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Maternal Mortality Rate (MMR)",
     "Maternal deaths / Live births × 100,000\n• India MMR: ~103/100,000 live births\n• Main causes: haemorrhage, hypertension, sepsis",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Neonatal Mortality Rate (NMR)",
     "Deaths <28 days / Live births × 1000\n• BEST indicator of quality of health services\n• Early NMR = <7 days; Late NMR = 7–28 days",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Total Fertility Rate (TFR)",
     "Average number of children born to a woman during her reproductive life (15–49 yrs).\n• India TFR: ~2.0 (2021)\n• Replacement level TFR = 2.1",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Sensitivity vs Specificity",
     "Sensitivity = TP/(TP+FN) — detects TRUE cases. Use for serious diseases (no miss).\nSpecificity = TN/(TN+FP) — excludes true negatives. Use to CONFIRM diagnosis.\nMnemonic: SeNsitivity → rule out with Negative (SnNout); SPecificity → rule in with Positive (SpPin)",
     TEAL, TEAL_LIGHT),

    ("📊 Epi Measures", "Odds Ratio vs Relative Risk",
     "Relative Risk (RR) = Cohort studies → Incidence in exposed / Incidence in unexposed\nOdds Ratio (OR) = Case-Control studies → approximate RR when disease is rare\nRR or OR = 1 → no association; >1 → positive association; <1 → protective",
     TEAL, TEAL_LIGHT),

    # ── SECTION 3: KEY NUMBERS ───────────────────────────────────────────────
    ("🔢 Key Numbers", "Health Infrastructure (India)",
     "Sub-centre: 5,000 (plains) / 3,000 (hilly)\nPHC: 30,000 (plains) / 20,000 (hilly) — 6 beds\nCHC: 80,000–1,20,000 — 30 beds\nPHCs in India (2017): 25,650",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "ASHA Worker",
     "1 ASHA per 1,000 rural population\n• Bridge between community & health system\n• Key roles: ANC registration, immunisation, institutional delivery, ORS distribution\n• Incentive-based, not salaried",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "Water Supply Requirements",
     "Urban: 135 litres/person/day\nRural (minimum): 40 litres/person/day\nResidual chlorine at tap: 0.2–0.5 mg/litre\nPermissible coliforms in drinking water: 0 per 100 mL",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "Tuberculosis Key Numbers",
     "1/3 of global population infected asymptomatically\n5–10% will develop clinical disease in lifetime\n1 case infects 10–15 persons/year\nIndia = 26% of global TB burden (highest)\nMDR-TB: 3.3% new cases; 18% previously treated",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "Nutrition (NFHS-4, India)",
     "Low birth weight: 18.5%\nUnderweight (<5 yrs): 35.7%\nStunted (<5 yrs): 38.4%\nWasted (<5 yrs): 21%\nAdult BMI <18.5: 33% men, 36% women",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "Caloric Requirements (ICMR)",
     "Sedentary adult man: ~2320 kcal/day\nSedentary adult woman: ~1900 kcal/day\nPregnant woman: +350 kcal/day\nLactating woman: +600 kcal/day\nIFA in pregnancy: 100 mg iron + 500 mcg folic acid daily",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "ANC Visits",
     "WHO recommends: 8 ANC visits (2016 guidelines)\nMinimum (older): 4 ANC visits\nFirst ANC: within first trimester (<12 weeks)\nTT doses: TT1 + TT2 (4 weeks apart) or Booster if previously immunised",
     ORANGE, ORANGE_LIGHT),

    ("🔢 Key Numbers", "Noise Limits",
     "Permissible noise level at workplace: 90 dB for 8 hrs\nNoise-induced hearing loss threshold: >85 dB sustained\nResidential area day: 55 dB; night: 45 dB\nSilent zone (hospitals/schools): 50 dB day; 40 dB night",
     ORANGE, ORANGE_LIGHT),

    # ── SECTION 4: NATIONAL PROGRAMMES ──────────────────────────────────────
    ("🏥 National Programmes", "Milestones to Remember",
     "NHM launched: 2005 (NRHM + NUHM merged 2013)\nICDS started: 1975\nPulse Polio: 1995 → India polio-free: 2014\nUIP started: 1985\nAyushman Bharat: 2018\nNACR (HIV): 1992\nNMHP (Mental Health): 1982",
     PURPLE, PURPLE_LIGHT),

    ("🏥 National Programmes", "END TB Strategy Targets",
     "Target period: 2015–2030\n• 90% reduction in TB deaths\n• 80% reduction in new TB cases\n• Zero catastrophic costs for TB families\nIndia target: Eliminate TB by 2025\nUN targets (2018–2022): 40 million treated; 30 million preventive treatment; USD 13 billion/year",
     PURPLE, PURPLE_LIGHT),

    ("🏥 National Programmes", "DOTS — 5 Components",
     "1. Political commitment\n2. Case detection by sputum smear microscopy\n3. Standardized short-course chemotherapy under direct observation\n4. Uninterrupted drug supply\n5. Systematic monitoring & accountability (recording & reporting)",
     PURPLE, PURPLE_LIGHT),

    ("🏥 National Programmes", "UIP Vaccine Schedule (Key)",
     "Birth: BCG, OPV-0, HepB-1\n6 wks: DPT-1, OPV-1, HepB-2, IPV-1, Hib-1, Rota-1, PCV-1\n10 wks: DPT-2, OPV-2, Hib-2, Rota-2, PCV-2\n14 wks: DPT-3, OPV-3, IPV-2, Hib-3, Rota-3, PCV-3\n9–12 mo: MR-1, HepB-3, JE (endemic)\n16–24 mo: DPT booster, OPV booster, MR-2",
     PURPLE, PURPLE_LIGHT),

    ("🏥 National Programmes", "Cold Chain Rules",
     "Storage temperature: 2–8°C (most vaccines)\nOPV (long-term): stored at –15 to –25°C\nMost HEAT-sensitive: OPV > Measles\nMost FREEZE-sensitive: DPT, TT, Hepatitis B, IPV\nVVM (Vaccine Vial Monitor): changes colour if heat exposure exceeded",
     PURPLE, PURPLE_LIGHT),

    ("🏥 National Programmes", "Key Committees & Declarations",
     "Bhore Committee (1946): PHC concept, 3-tier system\nMudaliar (1962): Strengthen PHCs, 40,000 pop/PHC\nShrivastav (1975): Community health workers\nAlma-Ata (1978): 'Health for All by 2000 AD'\nOttawa Charter (1986): 5 health promotion action areas\nAyushman Bharat (2018): HWCs + PMJAY insurance",
     PURPLE, PURPLE_LIGHT),

    # ── SECTION 5: DISEASE PREVENTION ───────────────────────────────────────
    ("🛡️ Prevention", "Levels of Prevention",
     "PRIMORDIAL: Before risk factors develop (socioeconomic development)\nPRIMARY: Before disease (vaccination, safe water, condoms)\nSECONDARY: Early disease/screen (screening, early Dx + Rx)\nTERTIARY: Established disease (rehab, disability limitation)\nLeavell & Clark's 5 levels: Health promotion → Specific protection → Early Dx/Rx → Disability limitation → Rehabilitation",
     GREEN, GREEN_LIGHT),

    ("🛡️ Prevention", "First Line Anti-TB Drugs (RIPE)",
     "R — Rifampicin: orange urine, hepatotoxicity, drug interactions\nI — Isoniazid (INH): peripheral neuropathy, hepatotoxicity\nP — Pyrazinamide: hyperuricaemia (gout), hepatotoxicity\nE — Ethambutol: OPTIC NEURITIS (check colour vision!)\nMnemonic: RIPE or SHREP",
     GREEN, GREEN_LIGHT),

    ("🛡️ Prevention", "Vaccine Types",
     "Live attenuated: BCG, OPV, MMR, Yellow fever, Varicella\nKilled/Inactivated: Pertussis (whole cell), IPV, Cholera, Rabies (HDCV)\nToxoid: Diphtheria (DT), Tetanus (TT)\nRecombinant: Hepatitis B, HPV\nPolysaccharide: Typhim Vi, Meningococcal",
     GREEN, GREEN_LIGHT),

    ("🛡️ Prevention", "Fecal-Oral Diseases (TCHAP)",
     "T — Typhoid\nC — Cholera\nH — Hepatitis A & E\nA — Amoebiasis / Ascariasis\nP — Polio\nAlso: Rotavirus diarrhoea, Giardiasis\nPrevention: safe water, sanitation, hand hygiene",
     GREEN, GREEN_LIGHT),

    ("🛡️ Prevention", "Airborne Diseases (CAVTM)",
     "C — Chickenpox (varicella)\nA — Aspergillosis\nV — (also Varicella)\nT — Tuberculosis\nM — Measles\nAll require AIRBORNE precautions (N95 mask, negative pressure room)",
     GREEN, GREEN_LIGHT),

    ("🛡️ Prevention", "Vector-Borne Diseases",
     "Malaria → Anopheles (female)\nDengue / Chikungunya → Aedes aegypti\nFilariasis → Culex quinquefasciatus\nKala-azar → Phlebotomus (sandfly)\nPlague → Rat flea (Xenopsylla cheopis)\nJapanese Encephalitis → Culex tritaeniorhynchus\nRocky Mountain SF → Tick",
     GREEN, GREEN_LIGHT),

    # ── SECTION 6: NUTRITION ─────────────────────────────────────────────────
    ("🥗 Nutrition", "PEM — Kwashiorkor vs Marasmus",
     "KWASHIORKOR: protein deficiency, EDEMA (hallmark), moon face, pot belly, skin changes, flag sign in hair. Age: 1–3 yrs (post-weaning)\nMARASMUS: total calorie deficiency, NO edema, wasted 'old man' face, severely underweight. Age: <1 yr\nMarasmic Kwashiorkor = both features (most severe)",
     YELLOW, YELLOW_LIGHT),

    ("🥗 Nutrition", "IAP Grading of Malnutrition",
     "Normal: >80% of expected weight for age\nGrade I: 71–80%\nGrade II: 61–70%\nGrade III: 51–60%\nGrade IV: <50% (severe malnutrition)\n\nWHO MUAC cut-offs (<5 yrs):\n<11.5 cm = Severe Acute Malnutrition\n11.5–12.5 cm = Moderate Acute Malnutrition",
     YELLOW, YELLOW_LIGHT),

    ("🥗 Nutrition", "Micronutrient Deficiency Diseases",
     "Vit A → Xerophthalmia, night blindness, Bitot's spots\nVit D → Rickets (child), Osteomalacia (adult)\nVit C → Scurvy (bleeding gums, perifollicular haemorrhage)\nVit B1 → Beriberi (wet=cardiac, dry=neuro)\nVit B3 → Pellagra (3Ds: Dermatitis, Diarrhoea, Dementia)\nIron → Microcytic hypochromic anaemia\nIodine → Goitre, Cretinism\nZinc → Growth retardation",
     YELLOW, YELLOW_LIGHT),

    ("🥗 Nutrition", "ICDS Programme",
     "Integrated Child Development Services — started 1975\nTarget: Children <6 yrs + pregnant & lactating mothers\n6 services: (1) Supplementary nutrition (2) Immunisation (3) Health check-up (4) Referral services (5) Pre-school education (6) Health & nutrition education\nWorld's LARGEST integrated child development programme",
     YELLOW, YELLOW_LIGHT),

    # ── SECTION 7: ENVIRONMENT ───────────────────────────────────────────────
    ("🌿 Environment", "Water Purification Steps",
     "1. Storage & Sedimentation\n2. Coagulation/Flocculation (Alum)\n3. Filtration:\n   • Slow Sand Filter: 0.1–0.4 m/hr, no coagulant, Schmutzdecke layer removes bacteria\n   • Rapid Sand Filter: 5–15 m/hr, needs coagulant, backwashing\n4. Disinfection (Chlorination)\nBreak-point chlorination: all chlorine demand satisfied, residual appears",
     RED, RED_LIGHT),

    ("🌿 Environment", "Occupational Lung Diseases",
     "Silicosis (most common): silica dust → mining, quarrying\nCoal workers' pneumoconiosis: coal dust\nAsbestosis: asbestos → shipbuilding (risk of mesothelioma!)\nByssinosis: cotton/flax dust → textile workers\nBagassosis: sugarcane bagasse → sugar industry\nFarmer's lung: mouldy hay (thermophilic actinomycetes)",
     RED, RED_LIGHT),

    ("🌿 Environment", "Air Pollutants & Effects",
     "CO: combines with Hb → carboxyHb → tissue hypoxia\nSO₂: respiratory irritation, acid rain\nNO₂: lung damage, brown haze\nPM₂.₅ / PM₁₀: deep lung penetration, cancer risk\nOzone (O₃): secondary pollutant, respiratory irritation\nLead: neurotoxicity (esp. children)",
     RED, RED_LIGHT),

    ("🌿 Environment", "Biomedical Waste Categories",
     "Yellow bag: anatomical waste, cytotoxic, chemical waste, expired medicines\nRed bag: contaminated recyclable waste (IV tubes, syringes without needles)\nWhite/Translucent: sharps (needles, blades, glass)\nBlue bag: glassware, metallic implants\nDisposal: Incineration (most effective), autoclaving, chemical treatment",
     RED, RED_LIGHT),

    # ── SECTION 8: MUST-KNOW MNEMONICS ──────────────────────────────────────
    ("💡 Mnemonics", "Epidemiological Triad",
     "     AGENT\n       |\nHOST — — ENVIRONMENT\n\nAgent factors: infectivity, pathogenicity, virulence, toxigenicity\nHost factors: age, sex, immunity, nutrition, genetics\nEnv. factors: physical, biological, social",
     GRAY_DARK, GRAY_LIGHT),

    ("💡 Mnemonics", "Ottawa Charter — 5 Action Areas",
     "1. Build healthy PUBLIC POLICY\n2. Create SUPPORTIVE ENVIRONMENTS\n3. Strengthen COMMUNITY ACTION\n4. Develop PERSONAL SKILLS\n5. REORIENT health services\n\nMnemonic: 'Build Create Strengthen Develop Reorient'\nYear: 1986 | Goal: Health Promotion",
     GRAY_DARK, GRAY_LIGHT),

    ("💡 Mnemonics", "Alma-Ata 8 Elements of PHC",
     "Mnemonic: 'SEEDS ME'\nS — Safe water & basic sanitation\nE — Education about health\nE — Endemic disease control\nD — Drug supply (essential drugs)\nS — Sound maternal & child health\nM — Mental health\nE — Expanded immunisation\n(+) Nutrition & Treatment of common diseases",
     GRAY_DARK, GRAY_LIGHT),

    ("💡 Mnemonics", "Wilson & Jungner Screening Criteria (10)",
     "IMPORTANT health problem\nACCEPTABLE treatment exists\nFACILITIES for Dx & Rx available\nRECOGNIZABLE latent/early stage\nSUITABLE test available\nACCEPTABLE test to population\nNATURAL HISTORY understood\nAGREED policy on who to treat\nCOST balanced economically\nCONTINUING process",
     GRAY_DARK, GRAY_LIGHT),
]

# ── PDF GENERATION ────────────────────────────────────────────────────────────
OUTPUT = "/home/daytona/workspace/psm-flashcards/PSM_Flashcards.pdf"
PAGE_W, PAGE_H = A4          # 210 x 297 mm
MARGIN = 14 * mm
COLS = 2
ROWS = 2
CARDS_PER_PAGE = COLS * ROWS

CARD_W = (PAGE_W - 2 * MARGIN - 4 * mm) / COLS
CARD_H = (PAGE_H - 2 * MARGIN - 4 * mm) / ROWS

c = canvas.Canvas(OUTPUT, pagesize=A4)
c.setTitle("PSM Flashcards — Key Definitions & Numbers")

def draw_cover(c):
    c.setFillColor(DARK_BLUE)
    c.rect(0, 0, PAGE_W, PAGE_H, fill=1, stroke=0)
    # decorative circles
    c.setFillColor(colors.HexColor("#283593"))
    c.circle(PAGE_W - 30*mm, PAGE_H - 30*mm, 60*mm, fill=1, stroke=0)
    c.setFillColor(colors.HexColor("#1A237E"))
    c.circle(30*mm, 30*mm, 45*mm, fill=1, stroke=0)

    c.setFillColor(WHITE)
    c.setFont("Helvetica-Bold", 32)
    c.drawCentredString(PAGE_W/2, PAGE_H * 0.72, "PSM FLASHCARDS")
    c.setFont("Helvetica-Bold", 18)
    c.drawCentredString(PAGE_W/2, PAGE_H * 0.63, "Preventive & Social Medicine")
    c.setFont("Helvetica", 13)
    c.drawCentredString(PAGE_W/2, PAGE_H * 0.56, "Key Definitions, Numbers & Mnemonics")

    # divider
    c.setStrokeColor(colors.HexColor("#FFC107"))
    c.setLineWidth(2)
    c.line(MARGIN*2, PAGE_H*0.52, PAGE_W - MARGIN*2, PAGE_H*0.52)

    c.setFont("Helvetica", 11)
    sections = [
        "📖  Key Definitions (16 cards)",
        "📊  Epidemiology Measures (10 cards)",
        "🔢  Key Numbers (8 cards)",
        "🏥  National Programmes (6 cards)",
        "🛡️   Disease Prevention (6 cards)",
        "🥗  Nutrition (4 cards)",
        "🌿  Environment & Occupational Health (4 cards)",
        "💡  Mnemonics (4 cards)",
    ]
    y = PAGE_H * 0.47
    for s in sections:
        c.drawCentredString(PAGE_W/2, y, s)
        y -= 18

    c.setFont("Helvetica-Bold", 10)
    c.setFillColor(colors.HexColor("#FFC107"))
    c.drawCentredString(PAGE_W/2, MARGIN * 1.5, "Based on Park's Textbook of Preventive & Social Medicine")
    c.showPage()

def wrap_text_lines(text, font, font_size, max_width, c_obj):
    """Split text into lines that fit within max_width."""
    from reportlab.pdfbase.pdfmetrics import stringWidth
    lines_out = []
    for paragraph in text.split('\n'):
        if stringWidth(paragraph, font, font_size) <= max_width:
            lines_out.append(paragraph)
        else:
            words = paragraph.split(' ')
            current = ''
            for word in words:
                test = (current + ' ' + word).strip()
                if stringWidth(test, font, font_size) <= max_width:
                    current = test
                else:
                    if current:
                        lines_out.append(current)
                    current = word
            if current:
                lines_out.append(current)
    return lines_out

def draw_card(c, x, y, w, h, category, question, answer, hdr_color, bg_color):
    RADIUS = 6
    HEADER_H = 22

    # Shadow
    c.setFillColor(colors.HexColor("#BDBDBD"))
    c.roundRect(x + 2, y - 2, w, h, RADIUS, fill=1, stroke=0)

    # Card background
    c.setFillColor(bg_color)
    c.roundRect(x, y, w, h, RADIUS, fill=1, stroke=0)

    # Header bar
    c.setFillColor(hdr_color)
    c.roundRect(x, y + h - HEADER_H, w, HEADER_H, RADIUS, fill=1, stroke=0)
    # Fill bottom half of header to look like a straight bottom
    c.rect(x, y + h - HEADER_H, w, HEADER_H/2, fill=1, stroke=0)

    # Category text in header
    c.setFillColor(WHITE)
    c.setFont("Helvetica-Bold", 7.5)
    c.drawString(x + 8, y + h - 14, category.upper())

    # Question
    PAD = 7
    q_area_top = y + h - HEADER_H - PAD
    c.setFillColor(hdr_color)
    c.setFont("Helvetica-Bold", 9.5)
    q_lines = wrap_text_lines(question, "Helvetica-Bold", 9.5, w - 2*PAD, c)
    q_line_h = 13
    q_y = q_area_top - q_line_h
    for line in q_lines[:3]:
        c.drawString(x + PAD, q_y, line)
        q_y -= q_line_h

    # Divider
    div_y = q_y - 2
    c.setStrokeColor(hdr_color)
    c.setLineWidth(0.5)
    c.line(x + PAD, div_y, x + w - PAD, div_y)

    # Answer
    c.setFillColor(GRAY_DARK)
    c.setFont("Helvetica", 8)
    ans_lines = wrap_text_lines(answer, "Helvetica", 8, w - 2*PAD, c)
    a_line_h = 11
    a_y = div_y - 2 - a_line_h
    for line in ans_lines:
        if a_y < y + PAD:
            break
        c.drawString(x + PAD, a_y, line)
        a_y -= a_line_h

    # Card border
    c.setStrokeColor(hdr_color)
    c.setLineWidth(1)
    c.roundRect(x, y, w, h, RADIUS, fill=0, stroke=1)

# ── DRAW COVER ────────────────────────────────────────────────────────────────
draw_cover(c)

# ── DRAW SECTION TITLE PAGES + CARDS ─────────────────────────────────────────
GAP = 4 * mm

for page_start in range(0, len(flashcards), CARDS_PER_PAGE):
    batch = flashcards[page_start:page_start + CARDS_PER_PAGE]

    for idx, (category, question, answer, hdr_color, bg_color) in enumerate(batch):
        col = idx % COLS
        row = idx // COLS
        x = MARGIN + col * (CARD_W + GAP)
        y = PAGE_H - MARGIN - (row + 1) * CARD_H - row * GAP
        draw_card(c, x, y, CARD_W, CARD_H, category, question, answer, hdr_color, bg_color)

    c.showPage()

c.save()
print(f"PDF created: {OUTPUT}")
print(f"Total flashcards: {len(flashcards)}")

"""
PSM Flashcards PDF - v2
Uses reportlab PLATYPUS for maximum compatibility with all PDF viewers.
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    PageBreak, HRFlowable, KeepTogether
)
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont
import os

OUTPUT = "/home/daytona/workspace/psm-flashcards/PSM_Flashcards.pdf"

# ── COLORS ────────────────────────────────────────────────────────────────────
C = {
    "blue":      colors.HexColor("#1565C0"),
    "blue_bg":   colors.HexColor("#E3F2FD"),
    "teal":      colors.HexColor("#00796B"),
    "teal_bg":   colors.HexColor("#E0F2F1"),
    "orange":    colors.HexColor("#E65100"),
    "orange_bg": colors.HexColor("#FFF3E0"),
    "purple":    colors.HexColor("#6A1B9A"),
    "purple_bg": colors.HexColor("#F3E5F5"),
    "green":     colors.HexColor("#2E7D32"),
    "green_bg":  colors.HexColor("#E8F5E9"),
    "yellow":    colors.HexColor("#F57F17"),
    "yellow_bg": colors.HexColor("#FFFDE7"),
    "red":       colors.HexColor("#B71C1C"),
    "red_bg":    colors.HexColor("#FFEBEE"),
    "gray":      colors.HexColor("#37474F"),
    "gray_bg":   colors.HexColor("#ECEFF1"),
    "white":     colors.white,
    "navy":      colors.HexColor("#1A237E"),
    "gold":      colors.HexColor("#FFC107"),
    "dark_gray": colors.HexColor("#263238"),
    "light_gray":colors.HexColor("#B0BEC5"),
}

# ── STYLES ────────────────────────────────────────────────────────────────────
def make_styles():
    return {
        "section": ParagraphStyle(
            "section", fontName="Helvetica-Bold", fontSize=7,
            textColor=C["white"], leading=9, spaceAfter=0
        ),
        "question": ParagraphStyle(
            "question", fontName="Helvetica-Bold", fontSize=10,
            textColor=C["dark_gray"], leading=13, spaceBefore=4, spaceAfter=3
        ),
        "answer": ParagraphStyle(
            "answer", fontName="Helvetica", fontSize=8.5,
            textColor=C["dark_gray"], leading=12, spaceBefore=0
        ),
        "cover_title": ParagraphStyle(
            "cover_title", fontName="Helvetica-Bold", fontSize=34,
            textColor=C["white"], leading=40, alignment=TA_CENTER
        ),
        "cover_sub": ParagraphStyle(
            "cover_sub", fontName="Helvetica-Bold", fontSize=16,
            textColor=C["gold"], leading=22, alignment=TA_CENTER
        ),
        "cover_body": ParagraphStyle(
            "cover_body", fontName="Helvetica", fontSize=11,
            textColor=C["white"], leading=16, alignment=TA_CENTER
        ),
        "page_heading": ParagraphStyle(
            "page_heading", fontName="Helvetica-Bold", fontSize=13,
            textColor=C["white"], leading=16, alignment=TA_CENTER
        ),
        "hint": ParagraphStyle(
            "hint", fontName="Helvetica-Oblique", fontSize=7,
            textColor=C["light_gray"], leading=9, alignment=TA_CENTER
        ),
    }

S = make_styles()

# ── FLASHCARD DATA ─────────────────────────────────────────────────────────────
# (section_label, color_key, question, answer)
CARDS = [

    # ── KEY DEFINITIONS ──────────────────────────────────────────────────────
    ("KEY DEFINITIONS", "blue",
     "Communicable Disease",
     "Illness due to a specific infectious agent or its toxic products, arising through <b>transmission</b> from an infected person, animal or reservoir to a <b>susceptible host</b> — directly or indirectly through a vector, intermediate host or the inanimate environment."),

    ("KEY DEFINITIONS", "blue",
     "Epidemic",
     "Occurrence of cases of illness <b>clearly in excess of normal expectancy</b> in a community/region within a specified time period.\n\u2022 Even 2 cases of a rare disease in time &amp; place can constitute an epidemic."),

    ("KEY DEFINITIONS", "blue",
     "Endemic",
     "<b>Constant presence</b> of a disease/agent within a given geographic area without importation from outside.\n\u2022 Example: common cold.\n\u2022 Hyperendemic = high incidence, all age groups equally affected.\n\u2022 Holoendemic = high infection early in life, mainly children (e.g. malaria)."),

    ("KEY DEFINITIONS", "blue",
     "Pandemic",
     "Epidemic occurring over a <b>very wide area, crossing international boundaries</b>, affecting a large number of people.\n\u2022 Examples: Influenza pandemics, COVID-19, Cholera pandemics."),

    ("KEY DEFINITIONS", "blue",
     "Sporadic",
     "Cases occurring <b>irregularly, haphazardly</b>, widely separated in space and time, with little or no connection to each other.\n\u2022 Examples: Tetanus, Herpes zoster, Meningococcal meningitis."),

    ("KEY DEFINITIONS", "blue",
     "Zoonosis",
     "Disease/infection <b>naturally transmitted from vertebrate animals to man</b>.\n\u2022 Examples: Rabies, Plague, Brucellosis, Leptospirosis, Anthrax.\n\u2022 Anthropozoonosis = animal \u2192 man; Zooanthroponosis = man \u2192 animal."),

    ("KEY DEFINITIONS", "blue",
     "Nosocomial (Hospital-Acquired) Infection",
     "Infection acquired <b>in hospital, NOT present or incubating at time of admission</b>.\n\u2022 Includes infections appearing after discharge.\n\u2022 Examples: Surgical wound infection, UTI (catheter-related), Hepatitis B, MRSA."),

    ("KEY DEFINITIONS", "blue",
     "Opportunistic Infection",
     "Infection by normally innocuous organisms that become pathogenic when <b>host immunity is compromised</b>.\n\u2022 Classic example: PCP, CMV, Cryptococcus in AIDS patients."),

    ("KEY DEFINITIONS", "blue",
     "Iatrogenic Disease",
     "<b>'Doctor-generated'</b> — adverse effects from medical/health interventions.\n\u2022 Examples: Penicillin reactions, aplastic anaemia from chloramphenicol, hepatitis B from blood transfusion, leukaemia from prenatal X-rays."),

    ("KEY DEFINITIONS", "blue",
     "Surveillance",
     "<b>Continuous</b> analysis, interpretation and feedback of <b>systematically collected data</b> to observe trends in time, place and person — for appropriate action (prevention/control)."),

    ("KEY DEFINITIONS", "blue",
     "Eradication vs Elimination",
     "<b>Eradication</b> = Termination of ALL transmission WORLDWIDE by exterminating the agent. All-or-none, global process.\n\u2022 <b>Only smallpox eradicated</b> (1980).\n<b>Elimination</b> = Eradication from a large geographic region.\n\u2022 India: Polio-free since <b>March 2014</b>."),

    ("KEY DEFINITIONS", "blue",
     "Herd Immunity",
     "Indirect protection of susceptible individuals when a <b>sufficiently large proportion</b> of the population is immune.\n\u2022 Measles herd immunity threshold: <b>92\u201395%</b>\n\u2022 Polio: ~80\u201385%\n\u2022 Smallpox: ~80\u201385%"),

    ("KEY DEFINITIONS", "blue",
     "Incubation vs Generation Time",
     "<b>Incubation period</b> = time from INFECTION to FIRST SYMPTOM.\n<b>Generation time</b> = time from infection to PEAK INFECTIVITY (infection of a new host).\n\u2022 Serial interval = time between successive cases in a chain of transmission."),

    # ── EPIDEMIOLOGY MEASURES ────────────────────────────────────────────────
    ("EPIDEMIOLOGY MEASURES", "teal",
     "Incidence vs Prevalence",
     "<b>Incidence Rate</b> = New cases / Population at risk \u00d7 1000\n\u2022 Measures RISK; best for acute diseases.\n<b>Prevalence Rate</b> = All existing cases / Total population \u00d7 1000\n\u2022 Measures BURDEN; best for chronic diseases.\n\u2714 Key formula: <b>Prevalence = Incidence \u00d7 Duration</b>"),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "Attack Rate &amp; CFR",
     "<b>Attack Rate</b> = Cases during epidemic / Population exposed \u00d7 100\n\u2022 Secondary Attack Rate = spread within households.\n<b>Case Fatality Rate (CFR)</b> = Deaths / Total cases \u00d7 100\n\u2022 Measures disease SEVERITY. Not a true rate (no time component)."),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "IMR — Infant Mortality Rate",
     "= Deaths &lt;1 year / Live births \u00d7 <b>1000</b>\n\u2022 <b>BEST single indicator of socioeconomic development</b>\n\u2022 India IMR: ~<b>28</b>/1000 (2020)\n\u2022 Perinatal Mortality Rate = (stillbirths + deaths &lt;7 days) / Total births \u00d7 1000"),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "MMR — Maternal Mortality Rate",
     "= Maternal deaths / Live births \u00d7 <b>100,000</b>\n\u2022 India MMR: ~<b>103</b>/100,000 live births\n\u2022 Top causes: Haemorrhage, Hypertension, Sepsis\n\u2022 NMR (Neonatal Mortality Rate) = <b>BEST indicator of quality of health services</b>"),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "Sensitivity &amp; Specificity",
     "<b>Sensitivity</b> = TP / (TP+FN) \u2192 Detects TRUE cases. Use for SERIOUS diseases (no miss).\n<b>Specificity</b> = TN / (TN+FP) \u2192 Excludes true negatives. Use to CONFIRM diagnosis.\n<b>PPV</b> = TP/(TP+FP) \u2014 rises with higher prevalence.\n<b>Mnemonic:</b> SnNout (Sensitive \u2192 Negative rules out) | SpPin (Specific \u2192 Positive rules in)"),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "RR vs OR",
     "<b>Relative Risk (RR)</b> = used in COHORT studies\n= Incidence in exposed / Incidence in unexposed\n<b>Odds Ratio (OR)</b> = used in CASE-CONTROL studies\n= (a\u00d7d) / (b\u00d7c) \u2192 approximates RR when disease is rare\n\u2022 RR/OR =1: no association; &gt;1: positive; &lt;1: protective"),

    ("EPIDEMIOLOGY MEASURES", "teal",
     "Study Design Pyramid",
     "Top \u2192 Bottom (Highest to Lowest evidence):\n1. Systematic Review / Meta-analysis\n2. Randomised Controlled Trial (RCT)\n3. Cohort Study (prospective)\n4. Case-Control Study (retrospective)\n5. Cross-sectional Study\n6. Case Reports / Case Series\n7. Expert Opinion / Editorials"),

    # ── KEY NUMBERS ──────────────────────────────────────────────────────────
    ("KEY NUMBERS", "orange",
     "Health Infrastructure — India",
     "\u2022 Sub-centre: <b>5,000</b> (plains) / <b>3,000</b> (hilly/tribal)\n\u2022 PHC: <b>30,000</b> (plains) / <b>20,000</b> (hilly) \u2014 <b>6 beds</b>\n\u2022 CHC: <b>80,000\u20131,20,000</b> \u2014 <b>30 beds</b>\n\u2022 PHCs in India (2017): <b>25,650</b>"),

    ("KEY NUMBERS", "orange",
     "ASHA Worker",
     "\u2022 <b>1 ASHA per 1,000 rural population</b>\n\u2022 Bridge between community and health system\n\u2022 Incentive-based (not salaried)\n\u2022 Key roles: ANC registration, immunisation mobilisation, institutional delivery, ORS distribution, DOTS support"),

    ("KEY NUMBERS", "orange",
     "Water Supply Requirements",
     "\u2022 Urban: <b>135 litres/person/day</b>\n\u2022 Rural minimum: <b>40 litres/person/day</b>\n\u2022 Residual chlorine at tap: <b>0.2\u20130.5 mg/litre</b>\n\u2022 Permissible coliforms: <b>0 per 100 mL</b> (drinking water)\n\u2022 Alum dose for coagulation: 5\u201340 mg/litre"),

    ("KEY NUMBERS", "orange",
     "Tuberculosis — Key Numbers",
     "\u2022 1/3 of global population asymptomatically infected\n\u2022 5\u201310% will develop disease in lifetime\n\u2022 1 case infects <b>10\u201315 persons/year</b>\n\u2022 India = <b>26%</b> of global TB burden (highest)\n\u2022 MDR-TB: <b>3.3%</b> new cases; <b>18%</b> previously treated cases"),

    ("KEY NUMBERS", "orange",
     "Nutrition Statistics — India (NFHS-4)",
     "\u2022 Low birth weight: <b>18.5%</b>\n\u2022 Underweight (&lt;5 yrs): <b>35.7%</b>\n\u2022 Stunted (&lt;5 yrs): <b>38.4%</b> (chronic malnutrition)\n\u2022 Wasted (&lt;5 yrs): <b>21%</b> (acute malnutrition)\n\u2022 Adult BMI &lt;18.5: <b>33% men, 36% women</b>"),

    ("KEY NUMBERS", "orange",
     "Caloric Requirements (ICMR)",
     "\u2022 Sedentary adult man: <b>~2320 kcal/day</b>\n\u2022 Sedentary adult woman: <b>~1900 kcal/day</b>\n\u2022 Pregnant woman: <b>+350 kcal/day</b>\n\u2022 Lactating woman: <b>+600 kcal/day</b>\n\u2022 IFA in pregnancy: <b>100 mg iron + 500 mcg folic acid daily</b>"),

    ("KEY NUMBERS", "orange",
     "ANC Visits &amp; Immunisation",
     "\u2022 WHO recommends: <b>8 ANC visits</b> (2016 guidelines)\n\u2022 Older minimum: 4 ANC visits\n\u2022 First ANC: within <b>first trimester</b> (&lt;12 weeks)\n\u2022 TT doses: TT1 + TT2 (4 weeks apart) or booster if previously immunised\n\u2022 Herd immunity threshold: Measles <b>92\u201395%</b>"),

    ("KEY NUMBERS", "orange",
     "Noise &amp; Workplace Standards",
     "\u2022 Permissible noise at workplace: <b>90 dB for 8 hrs</b>\n\u2022 NIHL threshold: <b>&gt;85 dB</b> sustained\n\u2022 Residential area (day): 55 dB; (night): 45 dB\n\u2022 Hospital/school silent zone: 50 dB (day), 40 dB (night)"),

    # ── NATIONAL PROGRAMMES ──────────────────────────────────────────────────
    ("NATIONAL PROGRAMMES", "purple",
     "Important Years to Remember",
     "\u2022 NHM launched: <b>2005</b> (NRHM+NUHM merged 2013)\n\u2022 ICDS: <b>1975</b> | UIP: <b>1985</b> | Pulse Polio: <b>1995</b>\n\u2022 India Polio-free: <b>March 2014</b>\n\u2022 NACP (HIV): <b>1992</b> | NMHP: <b>1982</b>\n\u2022 Ayushman Bharat (PMJAY): <b>2018</b>\n\u2022 Alma-Ata: <b>1978</b> | Ottawa Charter: <b>1986</b>"),

    ("NATIONAL PROGRAMMES", "purple",
     "END TB Strategy Targets",
     "Period: <b>2015\u20132030</b>\n\u2022 <b>90%</b> reduction in TB deaths\n\u2022 <b>80%</b> reduction in new TB cases\n\u2022 Zero catastrophic costs for TB families\n\u2022 India target: <b>Eliminate TB by 2025</b>\n\u2022 UN 2018\u20132022 targets: 40M treated; 30M preventive Rx; USD 13 billion/year"),

    ("NATIONAL PROGRAMMES", "purple",
     "DOTS \u2014 5 Components",
     "1. <b>Political commitment</b> with increased &amp; sustained financing\n2. <b>Case detection</b> by quality-assured sputum smear microscopy\n3. <b>Standardised short-course chemotherapy</b> under direct observation\n4. <b>Uninterrupted drug supply</b>\n5. <b>Systematic monitoring</b> &amp; accountability (recording &amp; reporting)"),

    ("NATIONAL PROGRAMMES", "purple",
     "UIP Vaccine Schedule (Key Ages)",
     "<b>Birth:</b> BCG, OPV-0, HepB-1\n<b>6 wks:</b> DPT-1, OPV-1, HepB-2, IPV-1, Hib-1, Rota-1, PCV-1\n<b>10 wks:</b> DPT-2, OPV-2, Hib-2, Rota-2, PCV-2\n<b>14 wks:</b> DPT-3, OPV-3, IPV-2, Hib-3, Rota-3, PCV-3\n<b>9\u201312 mo:</b> MR-1, HepB-3\n<b>16\u201324 mo:</b> DPT booster, OPV booster, MR-2"),

    ("NATIONAL PROGRAMMES", "purple",
     "Cold Chain Rules",
     "\u2022 Storage temp (most vaccines): <b>2\u20138\u00b0C</b>\n\u2022 OPV long-term: <b>\u221215 to \u221225\u00b0C</b>\n\u2022 Most <b>HEAT-sensitive:</b> OPV &gt; Measles\n\u2022 Most <b>FREEZE-sensitive:</b> DPT, TT, Hepatitis B, IPV\n\u2022 VVM (Vaccine Vial Monitor) changes colour if heat exceeded"),

    ("NATIONAL PROGRAMMES", "purple",
     "Key Committees &amp; Declarations",
     "\u2022 <b>Bhore (1946):</b> PHC concept, 3-tier system, social orientation\n\u2022 <b>Mudaliar (1962):</b> Strengthen PHCs; 40,000 pop/PHC\n\u2022 <b>Shrivastav (1975):</b> Community health workers\n\u2022 <b>Alma-Ata (1978):</b> 'Health for All by 2000 AD'\n\u2022 <b>Ottawa Charter (1986):</b> 5 health promotion action areas"),

    # ── DISEASE PREVENTION ───────────────────────────────────────────────────
    ("DISEASE PREVENTION", "green",
     "Levels of Prevention",
     "<b>PRIMORDIAL:</b> Before risk factors develop (socioeconomic development)\n<b>PRIMARY:</b> Before disease (vaccination, safe water, condoms)\n<b>SECONDARY:</b> Early disease \u2014 screening, early Dx + Rx\n<b>TERTIARY:</b> Established disease \u2014 disability limitation, rehabilitation\nLeavell &amp; Clark's 5 levels: Health promotion \u2192 Specific protection \u2192 Early Dx/Rx \u2192 Disability limitation \u2192 Rehabilitation"),

    ("DISEASE PREVENTION", "green",
     "First-Line Anti-TB Drugs (RIPE)",
     "<b>R</b> \u2014 Rifampicin: orange urine, hepatotoxicity, drug interactions\n<b>I</b> \u2014 Isoniazid (INH): peripheral neuropathy, hepatotoxicity\n<b>P</b> \u2014 Pyrazinamide: hyperuricaemia (gout), hepatotoxicity\n<b>E</b> \u2014 Ethambutol: <b>OPTIC NEURITIS</b> (check colour vision!)\nMnemonic: <b>RIPE</b> or <b>SHREP</b>"),

    ("DISEASE PREVENTION", "green",
     "Vaccine Types",
     "<b>Live attenuated:</b> BCG, OPV, MMR, Yellow fever, Varicella\n<b>Killed/Inactivated:</b> Pertussis (whole cell), IPV, Cholera, Rabies (HDCV)\n<b>Toxoid:</b> Diphtheria (DT), Tetanus (TT)\n<b>Recombinant:</b> Hepatitis B, HPV\n<b>Polysaccharide:</b> Typhim Vi (typhoid), Meningococcal"),

    ("DISEASE PREVENTION", "green",
     "Vector-Borne Diseases",
     "\u2022 Malaria \u2192 <b>Anopheles</b> (female)\n\u2022 Dengue / Chikungunya \u2192 <b>Aedes aegypti</b>\n\u2022 Filariasis \u2192 <b>Culex quinquefasciatus</b>\n\u2022 Kala-azar \u2192 <b>Phlebotomus</b> (sandfly)\n\u2022 Plague \u2192 <b>Rat flea</b> (Xenopsylla cheopis)\n\u2022 Japanese Encephalitis \u2192 <b>Culex tritaeniorhynchus</b>"),

    ("DISEASE PREVENTION", "green",
     "Fecal-Oral Diseases",
     "Mnemonic: <b>TCHAP</b>\n<b>T</b> \u2014 Typhoid\n<b>C</b> \u2014 Cholera\n<b>H</b> \u2014 Hepatitis A &amp; E\n<b>A</b> \u2014 Amoebiasis / Ascariasis\n<b>P</b> \u2014 Polio\nAlso: Rotavirus, Giardiasis\n<b>Prevention:</b> Safe water, sanitation, hand hygiene"),

    ("DISEASE PREVENTION", "green",
     "Airborne Diseases (CAVTM)",
     "Mnemonic: <b>CAVTM</b>\n<b>C</b> \u2014 Chickenpox (varicella)\n<b>A</b> \u2014 Aspergillosis\n<b>V</b> \u2014 (Varicella again)\n<b>T</b> \u2014 Tuberculosis\n<b>M</b> \u2014 Measles\n<b>Precautions:</b> N95 mask, negative pressure room, HEPA filtration"),

    # ── NUTRITION ────────────────────────────────────────────────────────────
    ("NUTRITION", "yellow",
     "Kwashiorkor vs Marasmus",
     "<b>KWASHIORKOR</b> (protein deficiency):\n\u2022 EDEMA (hallmark), moon face, pot belly\n\u2022 Flag sign in hair (depigmentation)\n\u2022 Age: 1\u20133 yrs (post-weaning)\n<b>MARASMUS</b> (total calorie deficiency):\n\u2022 NO edema, wasted 'old man' face\n\u2022 Severely underweight\n\u2022 Age: &lt;1 yr"),

    ("NUTRITION", "yellow",
     "IAP Grading of Malnutrition",
     "Based on <b>Weight-for-Age:</b>\n\u2022 Normal: &gt;80% expected weight\n\u2022 Grade I: 71\u201380%\n\u2022 Grade II: 61\u201370%\n\u2022 Grade III: 51\u201360%\n\u2022 Grade IV: &lt;50% (severe)\n<b>WHO MUAC (&lt;5 yrs):</b>\n\u2022 &lt;11.5 cm = SAM | 11.5\u201312.5 cm = MAM"),

    ("NUTRITION", "yellow",
     "Micronutrient Deficiency Diseases",
     "\u2022 <b>Vit A</b> \u2192 Xerophthalmia, Bitot's spots, Night blindness\n\u2022 <b>Vit D</b> \u2192 Rickets (child), Osteomalacia (adult)\n\u2022 <b>Vit C</b> \u2192 Scurvy (bleeding gums)\n\u2022 <b>Vit B1</b> \u2192 Beriberi (wet=cardiac, dry=neuro)\n\u2022 <b>Vit B3</b> \u2192 Pellagra (3Ds: Dermatitis, Diarrhoea, Dementia)\n\u2022 <b>Iodine</b> \u2192 Goitre, Cretinism"),

    ("NUTRITION", "yellow",
     "ICDS Programme",
     "<b>Integrated Child Development Services</b> \u2014 Started: <b>1975</b>\nTarget: Children &lt;6 yrs + pregnant &amp; lactating mothers\n<b>6 Services:</b>\n1. Supplementary nutrition\n2. Immunisation\n3. Health check-up\n4. Referral services\n5. Pre-school education\n6. Health &amp; nutrition education\nWorld's <b>largest</b> integrated child development programme"),

    # ── ENVIRONMENT &amp; OCCUPATIONAL HEALTH ────────────────────────────────
    ("ENVIRONMENT &amp; OCC. HEALTH", "red",
     "Water Purification Steps",
     "1. <b>Storage &amp; Sedimentation</b> (removes large particles)\n2. <b>Coagulation/Flocculation</b> (alum \u2014 removes suspended matter)\n3. <b>Filtration:</b>\n   \u2022 Slow sand: 0.1\u20130.4 m/hr | Schmutzdecke layer kills bacteria\n   \u2022 Rapid sand: 5\u201315 m/hr | needs coagulant + backwashing\n4. <b>Chlorination</b> (break-point chlorination: all demand met, residual appears)"),

    ("ENVIRONMENT &amp; OCC. HEALTH", "red",
     "Occupational Lung Diseases",
     "\u2022 <b>Silicosis</b> (most common): silica dust \u2192 mining, quarrying\n\u2022 <b>CWP</b>: coal dust \u2192 coal miners\n\u2022 <b>Asbestosis</b>: asbestos \u2192 shipbuilding (risk of mesothelioma!)\n\u2022 <b>Byssinosis</b>: cotton/flax dust \u2192 textile workers\n\u2022 <b>Bagassosis</b>: sugarcane bagasse \u2192 sugar industry\n\u2022 <b>Farmer's lung</b>: mouldy hay (thermophilic actinomycetes)"),

    ("ENVIRONMENT &amp; OCC. HEALTH", "red",
     "Air Pollutants &amp; Health Effects",
     "\u2022 <b>CO</b>: carboxyhaemoglobin \u2192 tissue hypoxia\n\u2022 <b>SO\u2082</b>: respiratory irritation, acid rain\n\u2022 <b>NO\u2082</b>: lung damage, brown haze\n\u2022 <b>PM\u2082.\u2085/PM\u2081\u2080</b>: deep lung penetration, cancer\n\u2022 <b>Ozone</b>: secondary pollutant, respiratory irritation\n\u2022 <b>Lead</b>: neurotoxicity (especially children)"),

    ("ENVIRONMENT &amp; OCC. HEALTH", "red",
     "Biomedical Waste Categories",
     "\u2022 <b>Yellow bag:</b> anatomical, cytotoxic, chemical, expired drugs\n\u2022 <b>Red bag:</b> contaminated recyclables (IV tubes, syringes without needles)\n\u2022 <b>White/translucent:</b> sharps (needles, blades, glass)\n\u2022 <b>Blue bag:</b> glassware, metallic implants\n<b>Disposal:</b> Incineration (most effective) / Autoclaving / Chemical treatment"),

    # ── MNEMONICS ────────────────────────────────────────────────────────────
    ("MNEMONICS", "gray",
     "Ottawa Charter \u2014 5 Action Areas (1986)",
     "Mnemonic: <b>'Build Creates Strength Developing Reorientation'</b>\n1. <b>B</b>uild healthy PUBLIC POLICY\n2. <b>C</b>reate SUPPORTIVE ENVIRONMENTS\n3. <b>S</b>trengthen COMMUNITY ACTION\n4. <b>D</b>evelop PERSONAL SKILLS\n5. <b>R</b>eorient HEALTH SERVICES\nGoal: Health Promotion beyond healthcare"),

    ("MNEMONICS", "gray",
     "Alma-Ata (1978) \u2014 8 PHC Elements",
     "Mnemonic: <b>'SEEDS ME'</b>\n<b>S</b> \u2014 Safe water &amp; basic sanitation\n<b>E</b> \u2014 Education about health\n<b>E</b> \u2014 Endemic disease control\n<b>D</b> \u2014 Drug supply (essential)\n<b>S</b> \u2014 Sound MCH + family planning\n<b>M</b> \u2014 Mental health\n<b>E</b> \u2014 Expanded immunisation\n(+) Nutrition &amp; Treatment of common diseases"),

    ("MNEMONICS", "gray",
     "Wilson &amp; Jungner Screening Criteria",
     "10 criteria (mnemonic: <b>IAFRSANCA C2</b>):\n1. Important health problem\n2. Acceptable treatment available\n3. Facilities for Dx &amp; Rx\n4. Recognisable latent/early stage\n5. Suitable test available\n6. Acceptable test to population\n7. Natural history understood\n8. Agreed policy on whom to treat\n9. Cost balanced economically\n10. Continuing (ongoing) process"),

    ("MNEMONICS", "gray",
     "Top 15 MCQ Must-Know Facts",
     "1. Only eradicated disease: <b>Smallpox</b>\n2. India polio-free: <b>2014</b>\n3. Bhore Committee: <b>1946</b> (PHC concept)\n4. IMR = best indicator of <b>socioeconomic development</b>\n5. NMR = best indicator of <b>quality of health services</b>\n6. ASHA = <b>1 per 1000</b> rural population\n7. Silicosis = <b>most common</b> occupational lung disease\n8. Schmutzdecke = biological layer in <b>slow sand filter</b>\n9. Kwashiorkor landmark = <b>EDEMA</b>; Marasmus = <b>wasting</b>\n10. TFR replacement level = <b>2.1</b>"),
]

# ── BUILD PDF ─────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=12*mm,
    rightMargin=12*mm,
    topMargin=12*mm,
    bottomMargin=12*mm,
    title="PSM Flashcards — Key Definitions & Numbers",
    author="Orris Medical",
    subject="Preventive & Social Medicine — 3rd Prof MBBS",
)

PAGE_W = A4[0] - 24*mm   # usable width
CARD_W = (PAGE_W - 6*mm) / 2  # 2 columns with 6mm gap

def make_card(section, color_key, question, answer):
    hdr_color = C[color_key]
    bg_color  = C[color_key + "_bg"]

    # Header row
    hdr_para = Paragraph(f"&#9642; {section}", S["section"])
    hdr_cell = Table([[hdr_para]], colWidths=[CARD_W - 4])
    hdr_cell.setStyle(TableStyle([
        ("BACKGROUND",  (0,0), (-1,-1), hdr_color),
        ("TOPPADDING",  (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING",(0,0), (-1,-1), 4),
    ]))

    # Question
    q_para = Paragraph(question, S["question"])

    # Divider
    hr = HRFlowable(width="100%", thickness=0.8, color=hdr_color, spaceAfter=3)

    # Answer
    a_para = Paragraph(answer.replace('\n', '<br/>'), S["answer"])

    # Assemble inner content
    inner = Table(
        [[hdr_cell], [q_para], [hr], [a_para]],
        colWidths=[CARD_W - 4]
    )
    inner.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg_color),
        ("TOPPADDING",    (0,0), (0,0),   0),
        ("BOTTOMPADDING", (0,0), (0,0),   0),
        ("LEFTPADDING",   (0,0), (-1,-1), 0),
        ("RIGHTPADDING",  (0,0), (-1,-1), 0),
        ("TOPPADDING",    (0,1), (-1,-1), 4),
        ("BOTTOMPADDING", (0,-1),(-1,-1), 6),
        ("LEFTPADDING",   (0,1), (-1,-1), 7),
        ("RIGHTPADDING",  (0,1), (-1,-1), 7),
    ]))

    # Outer card with border
    card = Table([[inner]], colWidths=[CARD_W])
    card.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg_color),
        ("BOX",           (0,0), (-1,-1), 1.2, hdr_color),
        ("TOPPADDING",    (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 0),
        ("LEFTPADDING",   (0,0), (-1,-1), 2),
        ("RIGHTPADDING",  (0,0), (-1,-1), 2),
    ]))
    return card

def make_cover():
    elems = []
    # Big navy box
    cover_data = [[
        Paragraph("PSM FLASHCARDS", ParagraphStyle(
            "ct", fontName="Helvetica-Bold", fontSize=30,
            textColor=C["white"], alignment=TA_CENTER, leading=36)),
    ]]
    cover_box = Table(cover_data, colWidths=[PAGE_W])
    cover_box.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), C["navy"]),
        ("TOPPADDING", (0,0),(-1,-1), 18),
        ("BOTTOMPADDING",(0,0),(-1,-1), 18),
    ]))
    elems.append(cover_box)
    elems.append(Spacer(1, 4*mm))

    sub_data = [[
        Paragraph("Preventive &amp; Social Medicine", ParagraphStyle(
            "cs", fontName="Helvetica-Bold", fontSize=15,
            textColor=C["navy"], alignment=TA_CENTER))
    ]]
    sub_box = Table(sub_data, colWidths=[PAGE_W])
    sub_box.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), C["gold"]),
        ("TOPPADDING", (0,0),(-1,-1), 8),
        ("BOTTOMPADDING",(0,0),(-1,-1), 8),
    ]))
    elems.append(sub_box)
    elems.append(Spacer(1, 4*mm))

    desc = Paragraph("Key Definitions &bull; Key Numbers &bull; Mnemonics &bull; National Programmes",
        ParagraphStyle("desc", fontName="Helvetica", fontSize=10,
        textColor=C["gray"], alignment=TA_CENTER))
    elems.append(desc)
    elems.append(Spacer(1, 5*mm))

    # Section index table
    sections_info = [
        ("📖  KEY DEFINITIONS", "13 cards", C["blue"], C["blue_bg"]),
        ("📊  EPIDEMIOLOGY MEASURES", "6 cards",  C["teal"],  C["teal_bg"]),
        ("🔢  KEY NUMBERS", "8 cards",  C["orange"],C["orange_bg"]),
        ("🏥  NATIONAL PROGRAMMES", "6 cards",  C["purple"],C["purple_bg"]),
        ("🛡️   DISEASE PREVENTION", "6 cards",  C["green"], C["green_bg"]),
        ("🥗  NUTRITION", "4 cards",  C["yellow"],C["yellow_bg"]),
        ("🌿  ENVIRONMENT & OCC. HEALTH","4 cards",  C["red"],   C["red_bg"]),
        ("💡  MNEMONICS", "4 cards",  C["gray"],  C["gray_bg"]),
    ]
    idx_rows = []
    for label, count, hc, bc in sections_info:
        row_data = [
            Paragraph(f"<b>{label}</b>", ParagraphStyle("il", fontName="Helvetica-Bold",
                fontSize=9, textColor=hc)),
            Paragraph(count, ParagraphStyle("ic", fontName="Helvetica", fontSize=9,
                textColor=C["gray"], alignment=TA_CENTER)),
        ]
        idx_rows.append(row_data)

    idx_table = Table(idx_rows, colWidths=[PAGE_W*0.78, PAGE_W*0.22])
    ts = TableStyle([
        ("TOPPADDING",    (0,0),(-1,-1), 5),
        ("BOTTOMPADDING", (0,0),(-1,-1), 5),
        ("LEFTPADDING",   (0,0),(-1,-1), 8),
        ("RIGHTPADDING",  (0,0),(-1,-1), 8),
        ("LINEBELOW",     (0,0),(-1,-2), 0.5, C["light_gray"]),
        ("VALIGN",        (0,0),(-1,-1), "MIDDLE"),
    ])
    # Alternate row backgrounds
    for i, (_, _, hc, bc) in enumerate(sections_info):
        ts.add("BACKGROUND", (0,i), (-1,i), bc)
    idx_table.setStyle(ts)
    elems.append(idx_table)
    elems.append(Spacer(1, 5*mm))

    footer = Paragraph(
        "Based on Park's Textbook of Preventive &amp; Social Medicine &bull; 3rd Prof MBBS",
        ParagraphStyle("ft", fontName="Helvetica-Oblique", fontSize=8,
        textColor=C["light_gray"], alignment=TA_CENTER))
    elems.append(footer)
    elems.append(PageBreak())
    return elems

# ── SECTION HEADERS ───────────────────────────────────────────────────────────
SECTION_COLORS = {
    "KEY DEFINITIONS":       ("blue", "📖"),
    "EPIDEMIOLOGY MEASURES": ("teal", "📊"),
    "KEY NUMBERS":           ("orange", "🔢"),
    "NATIONAL PROGRAMMES":   ("purple", "🏥"),
    "DISEASE PREVENTION":    ("green", "🛡️"),
    "NUTRITION":             ("yellow", "🥗"),
    "ENVIRONMENT &amp; OCC. HEALTH": ("red", "🌿"),
    "MNEMONICS":             ("gray", "💡"),
}

def make_section_header(section):
    color_key, emoji = SECTION_COLORS.get(section, ("gray", ""))
    hdr_color = C[color_key]
    hdr_para = Paragraph(
        f"<b>{emoji}  {section}</b>",
        ParagraphStyle("sh", fontName="Helvetica-Bold", fontSize=12,
            textColor=C["white"], alignment=TA_CENTER, leading=16)
    )
    hdr_table = Table([[hdr_para]], colWidths=[PAGE_W])
    hdr_table.setStyle(TableStyle([
        ("BACKGROUND",    (0,0),(-1,-1), hdr_color),
        ("TOPPADDING",    (0,0),(-1,-1), 8),
        ("BOTTOMPADDING", (0,0),(-1,-1), 8),
    ]))
    return hdr_table

# ── LAYOUT: 2 CARDS PER ROW ───────────────────────────────────────────────────
def layout_cards(cards):
    """Arrange cards into 2-column rows, with section headers."""
    elems = []
    current_section = None
    row_buffer = []

    def flush_row(buf):
        if len(buf) == 1:
            row = Table([[buf[0], ""]], colWidths=[CARD_W, CARD_W + 6*mm])
        else:
            row = Table([[buf[0], buf[1]]], colWidths=[CARD_W, CARD_W])
        row.setStyle(TableStyle([
            ("LEFTPADDING",   (0,0),(-1,-1), 0),
            ("RIGHTPADDING",  (0,0),(-1,-1), 0),
            ("TOPPADDING",    (0,0),(-1,-1), 0),
            ("BOTTOMPADDING", (0,0),(-1,-1), 0),
            ("COLPADDING",    (0,0),(-1,-1), 3),
        ]))
        elems.append(row)
        elems.append(Spacer(1, 3*mm))

    for section, color_key, question, answer in cards:
        # New section
        if section != current_section:
            # Flush any leftover card in buffer
            if row_buffer:
                flush_row(row_buffer)
                row_buffer = []
            if current_section is not None:
                elems.append(Spacer(1, 3*mm))
            elems.append(make_section_header(section))
            elems.append(Spacer(1, 3*mm))
            current_section = section

        card = make_card(section, color_key, question, answer)
        row_buffer.append(card)

        if len(row_buffer) == 2:
            flush_row(row_buffer)
            row_buffer = []

    if row_buffer:
        flush_row(row_buffer)

    return elems

# ── ASSEMBLE ──────────────────────────────────────────────────────────────────
story = []
story.extend(make_cover())
story.extend(layout_cards(CARDS))

doc.build(story)
print(f"SUCCESS: {OUTPUT}")
print(f"Total flashcards: {len(CARDS)}")

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>PSM Flashcards — Key Definitions & Numbers</title>
<style>
  * { box-sizing: border-box; margin: 0; padding: 0; }
  body { font-family: Arial, sans-serif; background: #f0f4f8; padding: 20px; }

  .cover {
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    color: white; border-radius: 16px; padding: 40px;
    text-align: center; margin-bottom: 30px;
    box-shadow: 0 4px 20px rgba(0,0,0,0.3);
  }
  .cover h1 { font-size: 2.6em; letter-spacing: 2px; margin-bottom: 8px; }
  .cover h2 { font-size: 1.3em; color: #FFC107; margin-bottom: 10px; }
  .cover p  { font-size: 0.95em; color: #B3E5FC; }

  .index {
    display: flex; flex-wrap: wrap; gap: 10px;
    justify-content: center; margin-top: 20px;
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    padding: 6px 14px; border-radius: 20px;
    font-size: 0.85em; font-weight: bold; color: white;
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  .section-title {
    font-size: 1.1em; font-weight: bold; color: white;
    padding: 10px 20px; border-radius: 8px;
    margin: 30px 0 14px; letter-spacing: 1px;
    display: flex; align-items: center; gap: 8px;
  }

  .grid {
    display: grid;
    grid-template-columns: repeat(auto-fill, minmax(340px, 1fr));
    gap: 16px;
    margin-bottom: 10px;
  }

  .card {
    border-radius: 12px; overflow: hidden;
    box-shadow: 0 2px 10px rgba(0,0,0,0.12);
    display: flex; flex-direction: column;
  }
  .card-header {
    padding: 7px 12px;
    font-size: 0.72em; font-weight: bold;
    color: white; letter-spacing: 0.8px;
    text-transform: uppercase;
  }
  .card-body { padding: 12px 14px; flex: 1; }
  .card-q {
    font-size: 1em; font-weight: bold;
    margin-bottom: 8px; line-height: 1.3;
  }
  .card-divider {
    height: 1.5px; margin-bottom: 8px; opacity: 0.35; border-radius: 1px;
  }
  .card-a {
    font-size: 0.83em; line-height: 1.55; color: #263238;
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  .card-a b { color: #000; }

  /* Section colors */
  .blue   { background:#1565C0; } .blue-bg   { background:#E3F2FD; }
  .teal   { background:#00796B; } .teal-bg   { background:#E0F2F1; }
  .orange { background:#E65100; } .orange-bg { background:#FFF3E0; }
  .purple { background:#6A1B9A; } .purple-bg { background:#F3E5F5; }
  .green  { background:#2E7D32; } .green-bg  { background:#E8F5E9; }
  .yellow { background:#F57F17; } .yellow-bg { background:#FFFDE7; }
  .red    { background:#B71C1C; } .red-bg    { background:#FFEBEE; }
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  .divider-yellow { background:#F57F17; }
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  .q-blue   { color:#1565C0; }
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  .q-purple { color:#6A1B9A; }
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  .q-yellow { color:#E65100; }
  .q-red    { color:#B71C1C; }
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  @media print {
    body { background: white; padding: 10px; }
    .card { break-inside: avoid; }
    .grid { grid-template-columns: repeat(2, 1fr); }
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    font-weight: bold; cursor: pointer;
    box-shadow: 0 4px 14px rgba(21,101,192,0.5);
    z-index: 999;
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  footer {
    text-align: center; margin-top: 30px; padding: 16px;
    color: #90A4AE; font-size: 0.82em;
  }
</style>
</head>
<body>

<button class="print-btn" onclick="window.print()">🖨️ Print / Save PDF</button>

<!-- COVER -->
<div class="cover">
  <h1>📚 PSM FLASHCARDS</h1>
  <h2>Preventive &amp; Social Medicine</h2>
  <p>Key Definitions &bull; Key Numbers &bull; Mnemonics &bull; National Programmes</p>
  <div class="index">
    <span class="index-badge blue">📖 Key Definitions</span>
    <span class="index-badge teal">📊 Epi Measures</span>
    <span class="index-badge orange">🔢 Key Numbers</span>
    <span class="index-badge purple">🏥 National Programmes</span>
    <span class="index-badge green">🛡️ Disease Prevention</span>
    <span class="index-badge yellow">🥗 Nutrition</span>
    <span class="index-badge red">🌿 Environment &amp; OH</span>
    <span class="index-badge gray">💡 Mnemonics</span>
  </div>
  <p style="margin-top:16px; font-size:0.8em; color:#90CAF9;">Based on Park's Textbook of Preventive &amp; Social Medicine &bull; 3rd Prof MBBS</p>
</div>

<!-- ─── SECTION 1: KEY DEFINITIONS ─────────────────────────────────────── -->
<div class="section-title blue">📖 &nbsp;KEY DEFINITIONS</div>
<div class="grid">

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Communicable Disease</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Illness due to a specific infectious agent or its toxic products, arising through <b>transmission</b> from an infected person, animal or inanimate reservoir to a <b>susceptible host</b> — directly or indirectly through a vector or intermediate host.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Epidemic</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Occurrence of cases <b>clearly in excess of normal expectancy</b> in a community/region within a specified time period.<br><br>Even <b>2 cases</b> of a rare/new disease in the same time and place may constitute an epidemic.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Endemic</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a"><b>Constant presence</b> of a disease/agent in a geographic area without importation from outside. Example: common cold.<br><br>• <b>Hyperendemic</b> = high incidence, all age groups equally<br>• <b>Holoendemic</b> = high infection rate early in life, mainly children (e.g. Malaria)</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Pandemic</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Epidemic crossing <b>international boundaries</b>, affecting a large number of people worldwide.<br><br>Examples: Influenza pandemics, <b>COVID-19</b>, Cholera pandemics.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Sporadic</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Cases occurring <b>irregularly, haphazardly</b>, widely separated in space and time, with little or no connection to each other.<br><br>Examples: <b>Tetanus, Herpes zoster, Meningococcal meningitis</b></div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Zoonosis</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Disease <b>naturally transmitted from vertebrate animals to man</b>.<br><br>Examples: Rabies, Plague, Brucellosis, Leptospirosis, Anthrax, Japanese Encephalitis</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Nosocomial (Hospital-Acquired) Infection</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Infection acquired <b>IN HOSPITAL, NOT present at admission</b>.<br><br>Examples: Surgical wound infection, Catheter-associated UTI, Hepatitis B, MRSA, VAP (ventilator-associated pneumonia)</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Opportunistic Infection</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Infection by normally <b>innocuous organisms</b> that become pathogenic when <b>host immunity is compromised</b>.<br><br>Classic example: PCP, CMV retinitis, Cryptococcal meningitis in <b>AIDS</b> patients.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Iatrogenic Disease</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a"><b>"Doctor-generated"</b> — adverse effects from medical interventions.<br><br>Examples: Penicillin reactions, aplastic anaemia from <b>chloramphenicol</b>, hepatitis B from blood transfusion, leukaemia from prenatal X-rays.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Surveillance</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a"><b>Continuous</b> analysis, interpretation and feedback of <b>systematically collected data</b>.<br><br>Used to observe trends in time, place and person → for appropriate prevention/control action.</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Eradication vs Elimination</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a"><b>Eradication</b> = Termination of ALL transmission WORLDWIDE. All-or-none, global.<br>→ Only <b>Smallpox eradicated (1980)</b><br>→ Amenable: Measles, Diphtheria, Polio, Guinea worm<br><br><b>Elimination</b> = Eradication from a large geographic region.<br>→ India: <b>Polio-free since March 2014</b></div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Herd Immunity</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a">Indirect protection of susceptible individuals when a <b>sufficiently large proportion</b> of the population is immune.<br><br>• Measles: <b>92–95%</b> threshold<br>• Polio: ~80–85%<br>• COVID-19: ~60–70%</div>
    </div>
  </div>

  <div class="card border-blue">
    <div class="card-header blue">Key Definitions</div>
    <div class="card-body blue-bg">
      <div class="card-q q-blue">Incubation Period vs Generation Time</div>
      <div class="card-divider divider-blue"></div>
      <div class="card-a"><b>Incubation period</b> = Time from INFECTION → FIRST SYMPTOM<br><br><b>Generation time</b> = Time from infection → PEAK INFECTIVITY (infecting a new host)<br><br><b>Serial interval</b> = Time between successive cases in a chain of transmission</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 2: EPIDEMIOLOGY MEASURES ───────────────────────────────── -->
<div class="section-title teal">📊 &nbsp;EPIDEMIOLOGY MEASURES</div>
<div class="grid">

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">Incidence vs Prevalence</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a"><b>Incidence Rate</b> = New cases ÷ Pop. at risk × 1000<br>→ Measures RISK; best for <b>acute</b> diseases<br><br><b>Prevalence Rate</b> = All existing cases ÷ Total population × 1000<br>→ Measures BURDEN; best for <b>chronic</b> diseases<br><br>⭐ <b>Prevalence = Incidence × Duration</b></div>
    </div>
  </div>

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">Attack Rate &amp; CFR</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a"><b>Attack Rate</b> = Cases during epidemic ÷ Population exposed × 100<br>→ Used during outbreaks<br><br><b>Case Fatality Rate (CFR)</b> = Deaths ÷ Total cases × 100<br>→ Measures disease <b>SEVERITY</b><br>→ NOT a true rate (no time component)</div>
    </div>
  </div>

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">IMR — Infant Mortality Rate</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a">= Deaths &lt;1 year ÷ Live births × <b>1000</b><br><br>⭐ <b>BEST single indicator of socioeconomic development</b><br><br>India IMR: <b>~28/1000</b> (2020)<br><br><b>NMR</b> (deaths &lt;28 days ÷ live births × 1000) = best indicator of <b>quality of health services</b></div>
    </div>
  </div>

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">MMR — Maternal Mortality Rate</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a">= Maternal deaths ÷ Live births × <b>100,000</b><br><br>India MMR: <b>~103/100,000</b> live births<br><br>Top causes: <b>Haemorrhage &gt; Hypertension &gt; Sepsis</b><br><br>TFR India: <b>~2.0</b> (2021) | Replacement level = <b>2.1</b></div>
    </div>
  </div>

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">Sensitivity &amp; Specificity</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a"><b>Sensitivity</b> = TP ÷ (TP+FN)<br>→ Detects TRUE cases. Use for <b>serious diseases</b> (no miss).<br><br><b>Specificity</b> = TN ÷ (TN+FP)<br>→ Excludes true negatives. Use to <b>confirm diagnosis</b>.<br><br>Mnemonic: <b>SnNout</b> (Sensitive–Negative rules OUT) | <b>SpPin</b> (Specific–Positive rules IN)</div>
    </div>
  </div>

  <div class="card border-teal">
    <div class="card-header teal">Epidemiology Measures</div>
    <div class="card-body teal-bg">
      <div class="card-q q-teal">RR vs OR &amp; Study Types</div>
      <div class="card-divider divider-teal"></div>
      <div class="card-a"><b>Relative Risk (RR)</b> → <b>Cohort</b> studies<br><b>Odds Ratio (OR)</b> → <b>Case-Control</b> studies (approximates RR when disease is rare)<br><br>RR/OR = 1: no association | &gt;1: positive | &lt;1: protective<br><br>Evidence pyramid (top→bottom): SR/Meta → RCT → Cohort → Case-Control → Cross-sectional</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 3: KEY NUMBERS ──────────────────────────────────────────── -->
<div class="section-title orange">🔢 &nbsp;KEY NUMBERS</div>
<div class="grid">

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Health Infrastructure — India</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• Sub-centre: <b>5,000</b> (plains) / <b>3,000</b> (hilly/tribal)<br>• PHC: <b>30,000</b> (plains) / <b>20,000</b> (hilly) — <b>6 beds</b><br>• CHC: <b>80,000–1,20,000</b> — <b>30 beds</b><br>• PHCs in India (2017): <b>25,650</b><br>• Bhore Committee concept: <b>1946</b></div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">ASHA Worker</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">⭐ <b>1 ASHA per 1,000 rural population</b><br><br>• Incentive-based (not salaried)<br>• Bridge between community &amp; health system<br>• Roles: ANC registration, immunisation, institutional delivery, ORS distribution, DOTS support</div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Water Supply Standards</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• Urban: <b>135 litres/person/day</b><br>• Rural minimum: <b>40 litres/person/day</b><br>• Residual chlorine at tap: <b>0.2–0.5 mg/litre</b><br>• Permissible coliforms: <b>0 per 100 mL</b><br>• Alum for coagulation: 5–40 mg/litre</div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Tuberculosis — Key Numbers</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• <b>1/3</b> of global population asymptomatically infected<br>• <b>5–10%</b> will develop clinical disease in lifetime<br>• 1 case infects <b>10–15 persons/year</b><br>• India = <b>26%</b> of global TB burden (highest)<br>• MDR-TB: <b>3.3%</b> new cases; <b>18%</b> previously treated</div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Nutrition Statistics — India (NFHS-4)</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• Low birth weight: <b>18.5%</b><br>• Underweight (&lt;5 yrs): <b>35.7%</b><br>• Stunted (&lt;5 yrs): <b>38.4%</b> (chronic malnutrition)<br>• Wasted (&lt;5 yrs): <b>21%</b> (acute malnutrition)<br>• Adult BMI &lt;18.5: <b>33% men, 36% women</b></div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Caloric Requirements (ICMR)</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• Sedentary adult man: <b>~2320 kcal/day</b><br>• Sedentary adult woman: <b>~1900 kcal/day</b><br>• Pregnant woman: <b>+350 kcal/day</b><br>• Lactating woman: <b>+600 kcal/day</b><br>• IFA in pregnancy: <b>100 mg iron + 500 mcg folic acid</b> daily</div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">ANC Visits</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• WHO recommends: <b>8 ANC visits</b> (2016)<br>• Older minimum: <b>4 ANC visits</b><br>• First ANC: within <b>first trimester</b> (&lt;12 weeks)<br>• TT doses: TT1 + TT2 (4 weeks apart)<br>• Herd immunity threshold: Measles <b>92–95%</b></div>
    </div>
  </div>

  <div class="card border-orange">
    <div class="card-header orange">Key Numbers</div>
    <div class="card-body orange-bg">
      <div class="card-q q-orange">Noise &amp; Workplace Limits</div>
      <div class="card-divider divider-orange"></div>
      <div class="card-a">• Permissible workplace noise: <b>90 dB for 8 hrs</b><br>• NIHL threshold: <b>&gt;85 dB</b> sustained<br>• Residential (day): 55 dB | (night): 45 dB<br>• Hospital/school silent zone: 50 dB (day), 40 dB (night)</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 4: NATIONAL PROGRAMMES ─────────────────────────────────── -->
<div class="section-title purple">🏥 &nbsp;NATIONAL PROGRAMMES</div>
<div class="grid">

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">Important Years to Remember</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a">• ICDS: <b>1975</b> | UIP: <b>1985</b> | Pulse Polio: <b>1995</b><br>• India Polio-free: <b>March 2014</b><br>• NHM: <b>2005</b> (NRHM + NUHM merged 2013)<br>• NACP (HIV): <b>1992</b> | NMHP: <b>1982</b><br>• Ayushman Bharat (PMJAY): <b>2018</b><br>• Alma-Ata: <b>1978</b> | Ottawa Charter: <b>1986</b></div>
    </div>
  </div>

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">END TB Strategy Targets</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a">Period: <b>2015–2030</b><br>• <b>90%</b> reduction in TB deaths<br>• <b>80%</b> reduction in new TB cases<br>• Zero catastrophic costs for TB families<br><br>India target: <b>Eliminate TB by 2025</b><br>DOTS strategy period: mid-1990s → 2005</div>
    </div>
  </div>

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">DOTS — 5 Components</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a">1. <b>Political commitment</b> with sustained financing<br>2. <b>Case detection</b> by sputum smear microscopy<br>3. <b>Standardised short-course chemotherapy</b> under direct observation<br>4. <b>Uninterrupted drug supply</b><br>5. <b>Systematic monitoring</b> &amp; accountability (recording &amp; reporting)</div>
    </div>
  </div>

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">UIP Vaccine Schedule (Key Ages)</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a"><b>Birth:</b> BCG, OPV-0, HepB-1<br><b>6 wks:</b> DPT-1, OPV-1, HepB-2, IPV-1, Hib-1, Rota-1, PCV-1<br><b>10 wks:</b> DPT-2, OPV-2, Hib-2, Rota-2, PCV-2<br><b>14 wks:</b> DPT-3, OPV-3, IPV-2, Hib-3, Rota-3, PCV-3<br><b>9–12 mo:</b> MR-1, HepB-3<br><b>16–24 mo:</b> DPT booster, OPV booster, MR-2</div>
    </div>
  </div>

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">Cold Chain Rules</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a">• Storage temp (most vaccines): <b>+2 to +8°C</b><br>• OPV long-term: <b>−15 to −25°C</b><br>• Most <b>HEAT-sensitive:</b> OPV &gt; Measles<br>• Most <b>FREEZE-sensitive:</b> DPT, TT, Hepatitis B, IPV<br>• VVM = Vaccine Vial Monitor (changes colour with heat)</div>
    </div>
  </div>

  <div class="card border-purple">
    <div class="card-header purple">National Programmes</div>
    <div class="card-body purple-bg">
      <div class="card-q q-purple">Key Committees &amp; Declarations</div>
      <div class="card-divider divider-purple"></div>
      <div class="card-a">• <b>Bhore (1946):</b> PHC concept, 3-tier system<br>• <b>Mudaliar (1962):</b> Strengthen PHCs; 40,000 pop/PHC<br>• <b>Shrivastav (1975):</b> Community health workers<br>• <b>Alma-Ata (1978):</b> "Health for All by 2000 AD"<br>• <b>Ottawa Charter (1986):</b> 5 health promotion action areas</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 5: DISEASE PREVENTION ──────────────────────────────────── -->
<div class="section-title green">🛡️ &nbsp;DISEASE PREVENTION</div>
<div class="grid">

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">Levels of Prevention</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a"><b>PRIMORDIAL:</b> Before risk factors develop (socioeconomic development)<br><b>PRIMARY:</b> Before disease (vaccination, safe water, condoms)<br><b>SECONDARY:</b> Early disease — screening, early Dx + Rx<br><b>TERTIARY:</b> Established disease — disability limitation, rehabilitation<br><br>Leavell &amp; Clark 5 levels: Promotion → Protection → Early Dx → Disability limitation → Rehab</div>
    </div>
  </div>

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">First-Line Anti-TB Drugs (RIPE)</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a"><b>R</b> — Rifampicin: orange urine, hepatotoxicity, drug interactions<br><b>I</b> — Isoniazid (INH): peripheral neuropathy, hepatotoxicity<br><b>P</b> — Pyrazinamide: hyperuricaemia (gout), hepatotoxicity<br><b>E</b> — Ethambutol: ⚠️ <b>OPTIC NEURITIS</b> (check colour vision!)<br><br>Mnemonic: <b>RIPE</b></div>
    </div>
  </div>

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">Vaccine Types</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a"><b>Live attenuated:</b> BCG, OPV, MMR, Yellow fever, Varicella<br><b>Killed/Inactivated:</b> Pertussis (whole cell), IPV, Cholera, Rabies (HDCV)<br><b>Toxoid:</b> Diphtheria (DT), Tetanus (TT)<br><b>Recombinant:</b> Hepatitis B, HPV<br><b>Polysaccharide:</b> Typhim Vi, Meningococcal</div>
    </div>
  </div>

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">Vector-Borne Diseases</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a">• Malaria → <b>Anopheles</b> (female mosquito)<br>• Dengue/Chikungunya → <b>Aedes aegypti</b><br>• Filariasis → <b>Culex quinquefasciatus</b><br>• Kala-azar → <b>Phlebotomus</b> (sandfly)<br>• Plague → <b>Rat flea</b> (Xenopsylla cheopis)<br>• JE → <b>Culex tritaeniorhynchus</b></div>
    </div>
  </div>

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">Fecal-Oral Diseases (TCHAP)</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a">Mnemonic: <b>TCHAP</b><br><b>T</b> — Typhoid<br><b>C</b> — Cholera<br><b>H</b> — Hepatitis A &amp; E<br><b>A</b> — Amoebiasis / Ascariasis<br><b>P</b> — Polio<br><br>Also: Rotavirus, Giardiasis<br><b>Prevention:</b> Safe water, sanitation, hand hygiene</div>
    </div>
  </div>

  <div class="card border-green">
    <div class="card-header green">Disease Prevention</div>
    <div class="card-body green-bg">
      <div class="card-q q-green">Airborne Diseases (CAVTM)</div>
      <div class="card-divider divider-green"></div>
      <div class="card-a">Mnemonic: <b>CAVTM</b><br><b>C</b> — Chickenpox (varicella)<br><b>A</b> — Aspergillosis<br><b>V</b> — Varicella<br><b>T</b> — Tuberculosis<br><b>M</b> — Measles<br><br><b>Precautions:</b> N95 mask, negative pressure room, HEPA filter</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 6: NUTRITION ─────────────────────────────────────────────── -->
<div class="section-title yellow">🥗 &nbsp;NUTRITION</div>
<div class="grid">

  <div class="card border-yellow">
    <div class="card-header yellow">Nutrition</div>
    <div class="card-body yellow-bg">
      <div class="card-q q-yellow">Kwashiorkor vs Marasmus</div>
      <div class="card-divider divider-yellow"></div>
      <div class="card-a"><b>KWASHIORKOR</b> (protein deficiency):<br>• <b>EDEMA</b> (hallmark), moon face, pot belly<br>• Flag sign in hair (depigmentation)<br>• Age: <b>1–3 yrs</b> (post-weaning)<br><br><b>MARASMUS</b> (total calorie deficiency):<br>• NO edema, "old man" wasted face<br>• Severely underweight<br>• Age: <b>&lt;1 yr</b></div>
    </div>
  </div>

  <div class="card border-yellow">
    <div class="card-header yellow">Nutrition</div>
    <div class="card-body yellow-bg">
      <div class="card-q q-yellow">IAP Grading of Malnutrition</div>
      <div class="card-divider divider-yellow"></div>
      <div class="card-a">Based on <b>Weight-for-Age:</b><br>• Normal: <b>&gt;80%</b> expected weight<br>• Grade I: <b>71–80%</b><br>• Grade II: <b>61–70%</b><br>• Grade III: <b>51–60%</b><br>• Grade IV: <b>&lt;50%</b> (severe)<br><br><b>WHO MUAC (&lt;5 yrs):</b><br>• &lt;11.5 cm = SAM | 11.5–12.5 cm = MAM</div>
    </div>
  </div>

  <div class="card border-yellow">
    <div class="card-header yellow">Nutrition</div>
    <div class="card-body yellow-bg">
      <div class="card-q q-yellow">Micronutrient Deficiency Diseases</div>
      <div class="card-divider divider-yellow"></div>
      <div class="card-a">• <b>Vit A</b> → Xerophthalmia, Bitot's spots, Night blindness<br>• <b>Vit D</b> → Rickets (child), Osteomalacia (adult)<br>• <b>Vit C</b> → Scurvy (bleeding gums, perifollicular haemorrhage)<br>• <b>Vit B1</b> → Beriberi (wet=cardiac, dry=neurological)<br>• <b>Vit B3</b> → Pellagra (3 Ds: Dermatitis, Diarrhoea, Dementia)<br>• <b>Iodine</b> → Goitre, Cretinism</div>
    </div>
  </div>

  <div class="card border-yellow">
    <div class="card-header yellow">Nutrition</div>
    <div class="card-body yellow-bg">
      <div class="card-q q-yellow">ICDS Programme</div>
      <div class="card-divider divider-yellow"></div>
      <div class="card-a"><b>Integrated Child Development Services</b> — started <b>1975</b><br>Target: Children &lt;6 yrs + pregnant &amp; lactating mothers<br><br><b>6 Services:</b> Supplementary nutrition, Immunisation, Health check-up, Referral, Pre-school education, Health &amp; nutrition education<br><br>⭐ World's <b>largest</b> integrated child development programme</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 7: ENVIRONMENT & OCC HEALTH ─────────────────────────────── -->
<div class="section-title red">🌿 &nbsp;ENVIRONMENT &amp; OCCUPATIONAL HEALTH</div>
<div class="grid">

  <div class="card border-red">
    <div class="card-header red">Environment &amp; Occ. Health</div>
    <div class="card-body red-bg">
      <div class="card-q q-red">Water Purification Steps</div>
      <div class="card-divider divider-red"></div>
      <div class="card-a">1. <b>Storage &amp; Sedimentation</b> (large particles settle)<br>2. <b>Coagulation/Flocculation</b> (alum — removes suspended matter)<br>3. <b>Filtration:</b><br>&nbsp;&nbsp;• Slow sand: 0.1–0.4 m/hr | <b>Schmutzdecke</b> layer kills bacteria<br>&nbsp;&nbsp;• Rapid sand: 5–15 m/hr | needs coagulant + backwashing<br>4. <b>Chlorination</b> (break-point = all demand met, residual appears)</div>
    </div>
  </div>

  <div class="card border-red">
    <div class="card-header red">Environment &amp; Occ. Health</div>
    <div class="card-body red-bg">
      <div class="card-q q-red">Occupational Lung Diseases</div>
      <div class="card-divider divider-red"></div>
      <div class="card-a">• <b>Silicosis</b> (most common): silica dust → mining, quarrying<br>• <b>CWP</b>: coal dust → coal miners<br>• <b>Asbestosis</b>: asbestos → shipbuilding ⚠️ risk of mesothelioma<br>• <b>Byssinosis</b>: cotton/flax dust → textile workers<br>• <b>Bagassosis</b>: sugarcane bagasse → sugar industry<br>• <b>Farmer's lung</b>: mouldy hay (thermophilic actinomycetes)</div>
    </div>
  </div>

  <div class="card border-red">
    <div class="card-header red">Environment &amp; Occ. Health</div>
    <div class="card-body red-bg">
      <div class="card-q q-red">Air Pollutants &amp; Health Effects</div>
      <div class="card-divider divider-red"></div>
      <div class="card-a">• <b>CO</b>: carboxyHb formation → tissue hypoxia<br>• <b>SO₂</b>: respiratory irritation, acid rain<br>• <b>NO₂</b>: lung damage, brown haze<br>• <b>PM₂.₅/PM₁₀</b>: deep lung penetration, cancer<br>• <b>Ozone (O₃)</b>: secondary pollutant, resp. irritation<br>• <b>Lead</b>: neurotoxicity (especially children)</div>
    </div>
  </div>

  <div class="card border-red">
    <div class="card-header red">Environment &amp; Occ. Health</div>
    <div class="card-body red-bg">
      <div class="card-q q-red">Biomedical Waste Categories</div>
      <div class="card-divider divider-red"></div>
      <div class="card-a">• <b>Yellow bag:</b> anatomical, cytotoxic, chemical, expired drugs<br>• <b>Red bag:</b> contaminated recyclables (IV tubes, syringes without needles)<br>• <b>White/translucent:</b> sharps (needles, blades, glass)<br>• <b>Blue bag:</b> glassware, metallic implants<br><br><b>Disposal:</b> Incineration (most effective) / Autoclaving</div>
    </div>
  </div>

</div>

<!-- ─── SECTION 8: MNEMONICS ─────────────────────────────────────────────── -->
<div class="section-title gray">💡 &nbsp;MNEMONICS &amp; MUST-KNOW FACTS</div>
<div class="grid">

  <div class="card border-gray">
    <div class="card-header gray">Mnemonics</div>
    <div class="card-body gray-bg">
      <div class="card-q q-gray">Ottawa Charter — 5 Action Areas (1986)</div>
      <div class="card-divider divider-gray"></div>
      <div class="card-a">Mnemonic: <b>"Build Creates Strength Developing Reorientation"</b><br><br>1. <b>B</b>uild healthy PUBLIC POLICY<br>2. <b>C</b>reate SUPPORTIVE ENVIRONMENTS<br>3. <b>S</b>trengthen COMMUNITY ACTION<br>4. <b>D</b>evelop PERSONAL SKILLS<br>5. <b>R</b>eorient HEALTH SERVICES</div>
    </div>
  </div>

  <div class="card border-gray">
    <div class="card-header gray">Mnemonics</div>
    <div class="card-body gray-bg">
      <div class="card-q q-gray">Alma-Ata (1978) — 8 PHC Elements</div>
      <div class="card-divider divider-gray"></div>
      <div class="card-a">Mnemonic: <b>"SEEDS ME"</b><br><br><b>S</b> — Safe water &amp; basic sanitation<br><b>E</b> — Education about health<br><b>E</b> — Endemic disease control<br><b>D</b> — Drug supply (essential)<br><b>S</b> — Sound MCH + family planning<br><b>M</b> — Mental health<br><b>E</b> — Expanded immunisation<br>(+) Nutrition &amp; Treatment of common diseases</div>
    </div>
  </div>

  <div class="card border-gray">
    <div class="card-header gray">Mnemonics</div>
    <div class="card-body gray-bg">
      <div class="card-q q-gray">Wilson &amp; Jungner — 10 Screening Criteria</div>
      <div class="card-divider divider-gray"></div>
      <div class="card-a">1. <b>Important</b> health problem<br>2. <b>Acceptable</b> treatment available<br>3. <b>Facilities</b> for Dx &amp; Rx available<br>4. <b>Recognisable</b> latent/early stage<br>5. <b>Suitable</b> test available<br>6. <b>Acceptable</b> test to population<br>7. <b>Natural history</b> understood<br>8. <b>Agreed</b> policy on whom to treat<br>9. <b>Cost</b> balanced economically<br>10. <b>Continuing</b> (ongoing) process</div>
    </div>
  </div>

  <div class="card border-gray">
    <div class="card-header gray">Mnemonics</div>
    <div class="card-body gray-bg">
      <div class="card-q q-gray">Top 15 MCQ Must-Know Facts ⭐</div>
      <div class="card-divider divider-gray"></div>
      <div class="card-a">1. Only eradicated disease: <b>Smallpox (1980)</b><br>2. India polio-free: <b>March 2014</b><br>3. IMR = best indicator of <b>socioeconomic development</b><br>4. NMR = best indicator of <b>quality of health services</b><br>5. ASHA = <b>1 per 1000</b> rural pop.<br>6. Most common occ. lung disease: <b>Silicosis</b><br>7. Schmutzdecke = biological layer in <b>slow sand filter</b><br>8. Kwashiorkor hallmark: <b>EDEMA</b><br>9. Marasmus hallmark: <b>wasting</b><br>10. TFR replacement level: <b>2.1</b></div>
    </div>
  </div>

</div>

<footer>
  <p>📚 Based on <strong>Park's Textbook of Preventive &amp; Social Medicine</strong> &bull; 3rd Prof MBBS &bull; 52 Flashcards</p>
  <p style="margin-top:6px;">To save as PDF: Click the <strong>Print / Save PDF</strong> button → Choose "Save as PDF" in printer options</p>
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<!-- ══════════════════════════════════════════════════════════ COVER -->
<div class="cover-page">
  <div style="font-size:48px; margin-bottom:10px;">📚</div>
  <h1>PSM COMPLETE<br>EXAM SUMMARY</h1>
  <h2>Preventive &amp; Social Medicine</h2>
  <p>3rd Professional MBBS</p>
  <div class="cover-divider"></div>
  <ul class="cover-toc">
    <li>📖 &nbsp;Section 1 — Epidemiology &amp; Biostatistics</li>
    <li>🦠 &nbsp;Section 2 — Communicable Diseases</li>
    <li>🥗 &nbsp;Section 3 — Nutrition &amp; Disease Prevention</li>
    <li>🏥 &nbsp;Section 4 — Health Programs &amp; National Policies</li>
    <li>🌿 &nbsp;Section 5 — Environment &amp; Occupational Health</li>
    <li>🛡️  &nbsp;Section 6 — Levels of Prevention</li>
    <li>👨‍👩‍👧 &nbsp;Section 7 — Family Health &amp; Demography</li>
    <li>⭐ &nbsp;Section 8 — Quick MCQ Facts &amp; Mnemonics</li>
  </ul>
  <p style="margin-top:30px; font-size:11px; color:#90CAF9;">Based on Park's Textbook of Preventive &amp; Social Medicine</p>
</div>

<!-- ══════════════════════════════════════════════════════ CONTENT -->
<div class="content">

<!-- ────────────────────────────────────────────────────────────────
     SECTION 1 : EPIDEMIOLOGY & BIOSTATISTICS
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-blue">📖 SECTION 1 : EPIDEMIOLOGY &amp; BIOSTATISTICS</div>

<div class="sub-header sec-blue">1.1 What is Epidemiology?</div>
<div class="box box-blue">
  <b>"The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems."</b>
</div>

<p><b>3 Main Aims (IEA):</b></p>
<ul class="psm">
  <li>Describe <b>distribution &amp; magnitude</b> of health/disease in populations</li>
  <li>Identify <b>aetiological (risk) factors</b> in pathogenesis</li>
  <li>Provide data for <b>planning, implementation &amp; evaluation</b> of health services</li>
</ul>

<table class="tbl-blue">
  <tr><th>Feature</th><th>Clinical Medicine</th><th>Epidemiology</th></tr>
  <tr><td>Unit of study</td><td>Individual case</td><td>Defined population</td></tr>
  <tr><td>Focus</td><td>Sick patients only</td><td>Both sick AND healthy</td></tr>
  <tr><td>Goal</td><td>Diagnosis + Treatment</td><td>Disease distribution + Control</td></tr>
  <tr><td>Key tool</td><td>Clinical examination</td><td>Rates &amp; statistics</td></tr>
</table>

<div class="sub-header sec-blue">1.2 Types of Epidemiological Studies</div>
<table class="tbl-blue">
  <tr><th>Study Type</th><th>Design</th><th>Measure</th><th>Direction</th></tr>
  <tr><td>Cohort</td><td>Exposed → follow → outcome</td><td>Relative Risk (RR)</td><td>Prospective</td></tr>
  <tr><td>Case-Control</td><td>Outcome → look back → exposure</td><td>Odds Ratio (OR)</td><td>Retrospective</td></tr>
  <tr><td>Cross-sectional</td><td>Exposure + outcome at same time</td><td>Prevalence</td><td>Snapshot</td></tr>
  <tr><td>RCT</td><td>Randomized intervention</td><td>RR / NNT</td><td>Prospective</td></tr>
  <tr><td>Descriptive</td><td>Who? When? Where?</td><td>Rates</td><td>Any</td></tr>
</table>

<div class="sub-header sec-blue">1.3 Key Epidemiological Measures</div>
<table class="tbl-blue">
  <tr><th>Measure</th><th>Formula</th><th>Per</th></tr>
  <tr><td>Incidence Rate</td><td>New cases / Population at risk × time</td><td>1000</td></tr>
  <tr><td>Prevalence Rate</td><td>All existing cases / Total population</td><td>1000</td></tr>
  <tr><td>Attack Rate</td><td>Cases during epidemic / Population exposed</td><td>100</td></tr>
  <tr><td>CFR</td><td>Deaths from disease / Cases of that disease</td><td>100</td></tr>
  <tr><td>IMR</td><td>Deaths &lt;1 yr / Live births</td><td>1000 live births</td></tr>
  <tr><td>MMR</td><td>Maternal deaths / Live births</td><td>100,000 live births</td></tr>
  <tr><td>NMR</td><td>Deaths &lt;28 days / Live births</td><td>1000 live births</td></tr>
  <tr><td>TFR</td><td>Avg children born per woman (15–49 yrs)</td><td>—</td></tr>
</table>

<div class="box box-orange">
  <b>⭐ Key Formula: Prevalence = Incidence × Duration</b><br>
  Incidence used for <b>acute</b> diseases | Prevalence used for <b>chronic</b> diseases<br>
  <b>IMR</b> = best single indicator of <b>socioeconomic development</b><br>
  <b>NMR</b> = best indicator of <b>quality of health services</b><br>
  India IMR: <span class="hl-orange">~28/1000</span> (2020) | India MMR: <span class="hl-orange">~103/100,000</span>
</div>

<div class="sub-header sec-blue">1.4 Screening</div>
<p><b>Wilson &amp; Jungner 10 Criteria:</b></p>
<div class="mcq-grid">
  <div class="mcq-item"><b>1.</b> Important health problem</div>
  <div class="mcq-item"><b>2.</b> Acceptable treatment available</div>
  <div class="mcq-item"><b>3.</b> Facilities for Dx &amp; Rx available</div>
  <div class="mcq-item"><b>4.</b> Recognisable latent/early stage</div>
  <div class="mcq-item"><b>5.</b> Suitable test available</div>
  <div class="mcq-item"><b>6.</b> Test acceptable to population</div>
  <div class="mcq-item"><b>7.</b> Natural history understood</div>
  <div class="mcq-item"><b>8.</b> Agreed policy on whom to treat</div>
  <div class="mcq-item"><b>9.</b> Cost balanced economically</div>
  <div class="mcq-item"><b>10.</b> Continuing (ongoing) process</div>
</div>

<table class="tbl-blue">
  <tr><th>Test Metric</th><th>Formula</th><th>Use When</th></tr>
  <tr><td>Sensitivity</td><td>TP / (TP + FN)</td><td>Serious disease — no miss (SnNout)</td></tr>
  <tr><td>Specificity</td><td>TN / (TN + FP)</td><td>Confirm diagnosis (SpPin)</td></tr>
  <tr><td>PPV</td><td>TP / (TP + FP)</td><td>Rises with higher prevalence</td></tr>
  <tr><td>NPV</td><td>TN / (TN + FN)</td><td>Rises with lower prevalence</td></tr>
</table>

<div class="sub-header sec-blue">1.5 Biostatistics Basics</div>
<table class="tbl-blue">
  <tr><th>Term</th><th>Meaning</th></tr>
  <tr><td>Mean</td><td>Sum ÷ n (affected by outliers)</td></tr>
  <tr><td>Median</td><td>Middle value (not affected by outliers)</td></tr>
  <tr><td>Mode</td><td>Most frequent value</td></tr>
  <tr><td>Standard Deviation (SD)</td><td>Spread around mean</td></tr>
  <tr><td>Standard Error (SE)</td><td>SD ÷ √n — precision of sample mean</td></tr>
  <tr><td>p-value</td><td>&lt;0.05 = statistically significant</td></tr>
  <tr><td>95% CI</td><td>True value lies here 95% of the time</td></tr>
</table>
<div class="box box-green">
  <b>Normal Distribution:</b> Mean = Median = Mode | 68% within 1 SD | 95% within 2 SD | 99.7% within 3 SD
</div>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 2 : COMMUNICABLE DISEASES
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-teal">🦠 SECTION 2 : COMMUNICABLE DISEASES</div>

<div class="sub-header sec-teal">2.1 Key Definitions</div>
<table class="tbl-teal">
  <tr><th>Term</th><th>Definition / Example</th></tr>
  <tr><td>Epidemic</td><td>Cases clearly in excess of normal expectancy in a community/region/time</td></tr>
  <tr><td>Endemic</td><td>Constant presence in a geographic area (e.g. common cold). Hyperendemic = high, all ages. Holoendemic = mainly children (e.g. malaria)</td></tr>
  <tr><td>Pandemic</td><td>Epidemic crossing international boundaries (e.g. COVID-19, cholera, influenza)</td></tr>
  <tr><td>Sporadic</td><td>Irregular, widely separated cases (e.g. tetanus, herpes zoster)</td></tr>
  <tr><td>Zoonosis</td><td>Animal→man transmission (e.g. rabies, plague, brucellosis)</td></tr>
  <tr><td>Nosocomial</td><td>Hospital-acquired; not present at admission (e.g. surgical wound infection, UTI)</td></tr>
  <tr><td>Eradication</td><td>Worldwide termination of ALL transmission. Only <b>Smallpox (1980)</b></td></tr>
  <tr><td>Elimination</td><td>Eradication from a region (e.g. India polio-free <b>March 2014</b>)</td></tr>
  <tr><td>Herd Immunity</td><td>Indirect protection when enough of population is immune. Measles threshold: <b>92–95%</b></td></tr>
</table>

<div class="sub-header sec-teal">2.2 Chain of Infection</div>
<div class="box box-teal">
  <b>Infectious Agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of Entry → Susceptible Host</b><br><br>
  <b>Breaking ANY link = Disease Control</b>
</div>

<table class="tbl-teal">
  <tr><th>Mode</th><th>Examples</th></tr>
  <tr><td>Direct contact</td><td>STIs, rabies bite, chickenpox (touch)</td></tr>
  <tr><td>Droplet</td><td>Measles, influenza, COVID-19, whooping cough</td></tr>
  <tr><td>Airborne</td><td>TB, Chickenpox (varicella), Measles (also airborne)</td></tr>
  <tr><td>Fecal-oral</td><td>Typhoid, Cholera, Hepatitis A&amp;E, Polio — Mnemonic: <b>TCHAP</b></td></tr>
  <tr><td>Vector-borne</td><td>Malaria (Anopheles), Dengue (Aedes), Plague (rat flea), Kala-azar (sandfly)</td></tr>
  <tr><td>Vertical (MTCT)</td><td>HIV, Hepatitis B, Rubella, Syphilis, CMV</td></tr>
</table>

<div class="sub-header sec-teal">2.3 Important Diseases at a Glance</div>
<table class="tbl-teal">
  <tr><th>Disease</th><th>Agent</th><th>Vector / Route</th><th>Vaccine?</th></tr>
  <tr><td>Malaria</td><td>Plasmodium spp.</td><td>Anopheles (female)</td><td>Limited (RTS,S)</td></tr>
  <tr><td>Dengue</td><td>Dengue virus</td><td>Aedes aegypti</td><td>Limited</td></tr>
  <tr><td>Typhoid</td><td>Salmonella typhi</td><td>Fecal-oral</td><td>Yes (TAB, Typhim Vi)</td></tr>
  <tr><td>Cholera</td><td>Vibrio cholerae</td><td>Contaminated water</td><td>Yes (oral OCV)</td></tr>
  <tr><td>Rabies</td><td>Rabies virus</td><td>Dog bite (mainly)</td><td>Yes (pre/post-exposure)</td></tr>
  <tr><td>Polio</td><td>Poliovirus</td><td>Fecal-oral</td><td>Yes (OPV/IPV)</td></tr>
  <tr><td>Measles</td><td>Measles virus</td><td>Airborne/droplet</td><td>Yes (MMR)</td></tr>
  <tr><td>Hepatitis B</td><td>HBV</td><td>Blood, sexual, vertical</td><td>Yes (recombinant)</td></tr>
  <tr><td>HIV/AIDS</td><td>HIV</td><td>Sexual, blood, vertical</td><td>No</td></tr>
  <tr><td>Tuberculosis</td><td>M. tuberculosis</td><td>Airborne</td><td>BCG (partial)</td></tr>
</table>

<div class="sub-header sec-teal">2.4 Tuberculosis — Key Points</div>
<ul class="psm">
  <li>1/3 of global population infected asymptomatically; 5–10% develop clinical disease</li>
  <li>1 case can infect <span class="hl-green">10–15 persons/year</span></li>
  <li>India = <span class="hl-orange">26%</span> of global TB burden (highest)</li>
  <li>MDR-TB: <span class="hl-orange">3.3%</span> new cases; <span class="hl-orange">18%</span> previously treated</li>
</ul>

<table class="tbl-teal">
  <tr><th>Drug</th><th>Full Name</th><th>Key Side Effect</th></tr>
  <tr><td>R</td><td>Rifampicin</td><td>Orange urine, hepatotoxicity, drug interactions</td></tr>
  <tr><td>I</td><td>Isoniazid (INH)</td><td>Peripheral neuropathy, hepatotoxicity</td></tr>
  <tr><td>P</td><td>Pyrazinamide</td><td>Hyperuricaemia (gout), hepatotoxicity</td></tr>
  <tr><td>E</td><td>Ethambutol</td><td><b>Optic neuritis</b> — check colour vision!</td></tr>
</table>
<div class="box box-green"><b>Mnemonic: RIPE</b> | TB Strategies: DOTS (mid-1990s–2005) → Stop TB (2006–2015) → END TB (2015–2030)<br>END TB targets: <b>90%</b> reduction in deaths, <b>80%</b> reduction in new cases by 2030 | India: <b>Eliminate TB by 2025</b></div>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 3 : NUTRITION & DISEASE PREVENTION
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-yellow">🥗 SECTION 3 : NUTRITION &amp; DISEASE PREVENTION</div>

<div class="sub-header sec-yellow">3.1 Protein-Energy Malnutrition (PEM)</div>
<table class="tbl-yellow">
  <tr><th>Feature</th><th>Kwashiorkor</th><th>Marasmus</th></tr>
  <tr><td>Main deficiency</td><td>Protein</td><td>Total calories (food)</td></tr>
  <tr><td>Edema</td><td><b>Present (hallmark)</b></td><td>Absent</td></tr>
  <tr><td>Appearance</td><td>Moon face, pot belly, skin changes</td><td>Wasted, "old man" face</td></tr>
  <tr><td>Hair changes</td><td>Flag sign, depigmentation</td><td>Less common</td></tr>
  <tr><td>Weight</td><td>Near-normal (edema masks)</td><td>Severely underweight</td></tr>
  <tr><td>Age</td><td>1–3 years (post-weaning)</td><td>&lt;1 year</td></tr>
</table>

<div class="sub-header sec-yellow">3.2 IAP Grading (Weight-for-Age)</div>
<table class="tbl-yellow">
  <tr><th>Grade</th><th>% of Expected Weight</th><th>WHO MUAC (&lt;5 yrs)</th></tr>
  <tr><td>Normal</td><td>&gt;80%</td><td>&gt;12.5 cm = Normal</td></tr>
  <tr><td>Grade I</td><td>71–80%</td><td>11.5–12.5 cm = MAM</td></tr>
  <tr><td>Grade II</td><td>61–70%</td><td>&lt;11.5 cm = SAM</td></tr>
  <tr><td>Grade III</td><td>51–60%</td><td>—</td></tr>
  <tr><td>Grade IV</td><td>&lt;50% (severe)</td><td>—</td></tr>
</table>

<div class="sub-header sec-yellow">3.3 Micronutrient Deficiency Diseases</div>
<table class="tbl-yellow">
  <tr><th>Deficiency</th><th>Disease</th><th>Key Feature</th></tr>
  <tr><td>Vitamin A</td><td>Xerophthalmia, Night blindness</td><td>Bitot's spots → Keratomalacia → Blindness</td></tr>
  <tr><td>Vitamin D</td><td>Rickets (child), Osteomalacia (adult)</td><td>Bone deformities; bowing of legs</td></tr>
  <tr><td>Vitamin C</td><td>Scurvy</td><td>Bleeding gums, perifollicular haemorrhage</td></tr>
  <tr><td>Vitamin B1</td><td>Beriberi</td><td>Wet (cardiac) / Dry (neurological)</td></tr>
  <tr><td>Vitamin B3</td><td>Pellagra</td><td>3 Ds: Dermatitis, Diarrhoea, Dementia</td></tr>
  <tr><td>Iron</td><td>Microcytic hypochromic anaemia</td><td>Most common nutritional deficiency worldwide</td></tr>
  <tr><td>Iodine</td><td>Goitre, Cretinism</td><td>Endemic in Himalayan belt of India</td></tr>
  <tr><td>Fluoride (excess)</td><td>Fluorosis</td><td>Mottled enamel, skeletal fluorosis</td></tr>
</table>

<div class="sub-header sec-yellow">3.4 NFHS-4 Key Statistics (India)</div>
<div class="box box-yellow">
  Low birth weight: <span class="hl-orange">18.5%</span> | Underweight (&lt;5 yrs): <span class="hl-orange">35.7%</span> | Stunted (&lt;5 yrs): <span class="hl-orange">38.4%</span> | Wasted (&lt;5 yrs): <span class="hl-orange">21%</span><br>
  Adult BMI &lt;18.5: <span class="hl-orange">33%</span> men, <span class="hl-orange">36%</span> women
</div>

<div class="sub-header sec-yellow">3.5 Caloric Requirements (ICMR)</div>
<table class="tbl-yellow">
  <tr><th>Person</th><th>Requirement</th></tr>
  <tr><td>Sedentary adult man</td><td>~2320 kcal/day</td></tr>
  <tr><td>Sedentary adult woman</td><td>~1900 kcal/day</td></tr>
  <tr><td>Pregnant woman</td><td>+350 kcal/day extra</td></tr>
  <tr><td>Lactating woman</td><td>+600 kcal/day extra</td></tr>
  <tr><td>IFA in pregnancy</td><td>100 mg iron + 500 mcg folic acid daily</td></tr>
</table>

<div class="sub-header sec-yellow">3.6 National Nutrition Programmes</div>
<table class="tbl-yellow">
  <tr><th>Programme</th><th>Target</th><th>Key Intervention</th></tr>
  <tr><td>ICDS (1975)</td><td>Children &lt;6 yrs, pregnant &amp; lactating mothers</td><td>6 services: Supplementary nutrition, Immunisation, Health check-up, Referral, Pre-school education, Health education</td></tr>
  <tr><td>Mid-Day Meal (MDM)</td><td>School children Class I–VIII</td><td>Cooked meal at school</td></tr>
  <tr><td>National Iodine Deficiency Control</td><td>All</td><td>Iodized salt</td></tr>
  <tr><td>IFA Supplementation</td><td>Children, adolescents, pregnant women</td><td>Weekly IFA tablets</td></tr>
  <tr><td>Vitamin A Supplementation</td><td>Children 9 months–5 years</td><td>6-monthly doses</td></tr>
  <tr><td>POSHAN Abhiyaan</td><td>Children, adolescents, PL women</td><td>Reduce stunting/underweight/anaemia by 2022</td></tr>
</table>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 4 : HEALTH PROGRAMS & NATIONAL POLICIES
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<div class="sec-header sec-purple">🏥 SECTION 4 : HEALTH PROGRAMS &amp; NATIONAL POLICIES</div>

<div class="sub-header sec-purple">4.1 Health System Structure (India) — 3-Tier</div>
<table class="tbl-purple">
  <tr><th>Level</th><th>Population Served</th><th>Beds</th><th>Key Staff</th></tr>
  <tr><td>Sub-Centre</td><td>5,000 (plains) / 3,000 (hilly)</td><td>—</td><td>1 ANM + 1 MPW (Male)</td></tr>
  <tr><td>PHC (Primary Health Centre)</td><td>30,000 (plains) / 20,000 (hilly)</td><td>6 beds</td><td>MO, ANM, MPW, Lab tech</td></tr>
  <tr><td>CHC (Community Health Centre)</td><td>80,000–1,20,000</td><td>30 beds</td><td>Specialists: Surgeon, Physician, Obst., Paed.</td></tr>
  <tr><td>District Hospital</td><td>District level</td><td>Varies</td><td>All specialists</td></tr>
</table>
<div class="box box-purple">
  <b>Bhore Committee (1946)</b> — first gave the concept of PHC | PHCs in India (2017): <b>25,650</b><br>
  <b>Alma-Ata (1978)</b> — "Health for All by 2000 AD" via Primary Health Care<br>
  <b>ASHA</b> — 1 per 1,000 rural population | Incentive-based | Key bridge between community &amp; health system
</div>

<div class="sub-header sec-purple">4.2 Key National Health Programmes</div>
<table class="tbl-purple">
  <tr><th>Programme</th><th>Year</th><th>Target / Key Point</th></tr>
  <tr><td>NTEP (National TB Elimination Programme)</td><td>1962/revised</td><td>Eliminate TB by 2025; India has 26% global burden</td></tr>
  <tr><td>NVBDCP</td><td>2003</td><td>Malaria, Dengue, Kala-azar, JE, Filaria</td></tr>
  <tr><td>NACP (HIV/AIDS)</td><td>1992</td><td>HIV prevention &amp; control; ART, PPTCT</td></tr>
  <tr><td>UIP (Immunisation)</td><td>1985</td><td>Childhood vaccines; Pulse Polio started 1995</td></tr>
  <tr><td>NHM</td><td>2005</td><td>NRHM + NUHM; ASHA workers</td></tr>
  <tr><td>RMNCH+A</td><td>2013</td><td>Reproductive, Maternal, Newborn, Child &amp; Adolescent Health</td></tr>
  <tr><td>NPCDCS</td><td>2010</td><td>NCDs: Cancer, Diabetes, CVD, Stroke</td></tr>
  <tr><td>NMHP</td><td>1982</td><td>National Mental Health Programme</td></tr>
  <tr><td>Ayushman Bharat</td><td>2018</td><td>Health &amp; Wellness Centres + PMJAY (insurance up to ₹5 lakh)</td></tr>
</table>

<div class="sub-header sec-purple">4.3 UIP Vaccine Schedule</div>
<table class="tbl-purple">
  <tr><th>Age</th><th>Vaccines</th></tr>
  <tr><td>Birth</td><td>BCG, OPV-0, Hepatitis B-1</td></tr>
  <tr><td>6 weeks</td><td>DPT-1, OPV-1, HepB-2, IPV-1, Hib-1, Rotavirus-1, PCV-1</td></tr>
  <tr><td>10 weeks</td><td>DPT-2, OPV-2, Hib-2, Rotavirus-2, PCV-2</td></tr>
  <tr><td>14 weeks</td><td>DPT-3, OPV-3, IPV-2, Hib-3, Rotavirus-3, PCV-3</td></tr>
  <tr><td>9–12 months</td><td>Measles/MR-1, HepB-3, JE (endemic areas)</td></tr>
  <tr><td>16–24 months</td><td>DPT booster, OPV booster, MR-2, JE-2</td></tr>
  <tr><td>5–6 years</td><td>DPT booster-2</td></tr>
  <tr><td>10 &amp; 16 years</td><td>TT</td></tr>
</table>
<div class="box box-purple">
  <b>Cold Chain:</b> Most heat-sensitive: OPV &gt; Measles | Most freeze-sensitive: DPT, TT, Hepatitis B, IPV<br>
  Store at <b>+2 to +8°C</b> (most vaccines) | OPV long-term storage: <b>−15 to −25°C</b>
</div>

<div class="sub-header sec-purple">4.4 Key Committees &amp; Declarations</div>
<table class="tbl-purple">
  <tr><th>Committee/Event</th><th>Year</th><th>Key Recommendation</th></tr>
  <tr><td>Bhore Committee</td><td>1946</td><td>PHC concept, 3-tier system, social orientation of medicine</td></tr>
  <tr><td>Mudaliar Committee</td><td>1962</td><td>Strengthen existing PHCs; 40,000 population/PHC</td></tr>
  <tr><td>Shrivastav Committee</td><td>1975</td><td>Community health workers; barefoot doctors</td></tr>
  <tr><td>Alma-Ata Declaration</td><td>1978</td><td>"Health for All by 2000 AD"; Primary Health Care</td></tr>
  <tr><td>Ottawa Charter</td><td>1986</td><td>5 Health Promotion action areas</td></tr>
  <tr><td>Ayushman Bharat</td><td>2018</td><td>HWCs + PMJAY insurance</td></tr>
</table>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 5 : ENVIRONMENT & OCCUPATIONAL HEALTH
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-red">🌿 SECTION 5 : ENVIRONMENT &amp; OCCUPATIONAL HEALTH</div>

<div class="sub-header sec-red">5.1 Water Supply &amp; Purification</div>
<div class="box box-red">
  Urban per capita requirement: <span class="hl-red">135 L/day</span> | Rural minimum: <span class="hl-red">40 L/day</span><br>
  Residual chlorine at tap: <span class="hl-red">0.2–0.5 mg/litre</span> | Permissible coliforms: <span class="hl-red">0 per 100 mL</span>
</div>

<p><b>Steps:</b> Storage &amp; Sedimentation → Coagulation/Flocculation (alum) → Filtration → Chlorination</p>
<table class="tbl-red">
  <tr><th>Feature</th><th>Slow Sand Filter</th><th>Rapid Sand Filter</th></tr>
  <tr><td>Rate</td><td>0.1–0.4 m/hr</td><td>5–15 m/hr</td></tr>
  <tr><td>Coagulation needed?</td><td>No</td><td>Yes (before filtration)</td></tr>
  <tr><td>Backwashing</td><td>No</td><td>Yes</td></tr>
  <tr><td>Biological layer</td><td><b>Schmutzdecke</b> (removes bacteria)</td><td>No</td></tr>
  <tr><td>Area needed</td><td>Large</td><td>Small</td></tr>
</table>

<div class="sub-header sec-red">5.2 Air Pollution</div>
<table class="tbl-red">
  <tr><th>Pollutant</th><th>Source</th><th>Health Effect</th></tr>
  <tr><td>CO</td><td>Incomplete combustion, vehicles</td><td>CarboxyHb → tissue hypoxia</td></tr>
  <tr><td>SO₂</td><td>Burning fossil fuels, industries</td><td>Respiratory irritation, acid rain</td></tr>
  <tr><td>NO₂</td><td>Vehicle exhaust, industries</td><td>Lung damage, brown haze</td></tr>
  <tr><td>PM₂.₅ / PM₁₀</td><td>Dust, smoke, combustion</td><td>Deep lung penetration, cancer</td></tr>
  <tr><td>Ozone (O₃)</td><td>Secondary pollutant (photochemical)</td><td>Respiratory irritation</td></tr>
  <tr><td>Lead</td><td>Leaded petrol (banned), paint</td><td>Neurotoxicity (esp. children)</td></tr>
</table>

<div class="sub-header sec-red">5.3 Occupational Lung Diseases (Pneumoconioses)</div>
<table class="tbl-red">
  <tr><th>Disease</th><th>Causative Dust</th><th>Occupation</th></tr>
  <tr><td><b>Silicosis</b> (most common)</td><td>Silica (SiO₂)</td><td>Mining, stone cutting, quarrying</td></tr>
  <tr><td>CWP (Coal Workers' Pneumoconiosis)</td><td>Coal dust</td><td>Coal miners</td></tr>
  <tr><td>Asbestosis</td><td>Asbestos fibres</td><td>Shipbuilding, insulation ⚠️ mesothelioma risk</td></tr>
  <tr><td>Byssinosis</td><td>Cotton/flax dust</td><td>Textile workers</td></tr>
  <tr><td>Bagassosis</td><td>Sugarcane bagasse</td><td>Sugar industry workers</td></tr>
  <tr><td>Farmer's Lung</td><td>Mouldy hay (thermophilic actinomycetes)</td><td>Farmers</td></tr>
</table>

<div class="sub-header sec-red">5.4 Biomedical Waste</div>
<table class="tbl-red">
  <tr><th>Bag Color</th><th>Contents</th><th>Disposal</th></tr>
  <tr><td>Yellow</td><td>Anatomical, cytotoxic, chemical, expired drugs</td><td>Incineration</td></tr>
  <tr><td>Red</td><td>Contaminated recyclables (IV tubes, syringes without needles)</td><td>Autoclave/microwaving</td></tr>
  <tr><td>White/Translucent</td><td>Sharps (needles, blades, glass)</td><td>Puncture-proof container</td></tr>
  <tr><td>Blue</td><td>Glassware, metallic implants</td><td>Autoclave/chemical treatment</td></tr>
</table>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 6 : LEVELS OF PREVENTION
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-green">🛡️ SECTION 6 : LEVELS OF PREVENTION</div>

<table class="tbl-green">
  <tr><th>Level</th><th>Target</th><th>Examples</th></tr>
  <tr><td><b>Primordial</b></td><td>Before risk factors develop</td><td>Socioeconomic development, healthy public policy</td></tr>
  <tr><td><b>Primary</b></td><td>Before disease occurs</td><td>Vaccination, health education, safe water, condoms</td></tr>
  <tr><td><b>Secondary</b></td><td>Early/asymptomatic disease</td><td>Screening, early diagnosis, prompt treatment</td></tr>
  <tr><td><b>Tertiary</b></td><td>Established disease</td><td>Disability limitation, rehabilitation</td></tr>
</table>

<div class="box box-green">
  <b>Leavell &amp; Clark's 5 Levels:</b><br>
  1. Health Promotion → 2. Specific Protection → 3. Early Diagnosis &amp; Treatment → 4. Disability Limitation → 5. Rehabilitation
</div>

<div class="sub-header sec-green">6.1 Vaccine Types</div>
<table class="tbl-green">
  <tr><th>Type</th><th>Examples</th></tr>
  <tr><td>Live attenuated</td><td>BCG, OPV, MMR, Yellow fever, Varicella</td></tr>
  <tr><td>Killed/Inactivated</td><td>Pertussis (whole cell), IPV, Cholera, Rabies (HDCV)</td></tr>
  <tr><td>Toxoid</td><td>Diphtheria (DT), Tetanus (TT)</td></tr>
  <tr><td>Recombinant</td><td>Hepatitis B, HPV</td></tr>
  <tr><td>Polysaccharide</td><td>Typhim Vi, Meningococcal</td></tr>
</table>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 7 : FAMILY HEALTH & DEMOGRAPHY
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-orange">👨‍👩‍👧 SECTION 7 : FAMILY HEALTH &amp; DEMOGRAPHY</div>

<div class="sub-header sec-orange">7.1 Key Demographic Indices (India)</div>
<table class="tbl-orange">
  <tr><th>Index</th><th>Value</th></tr>
  <tr><td>Total Fertility Rate (TFR)</td><td>~2.0 (2021) | Replacement level = 2.1</td></tr>
  <tr><td>Infant Mortality Rate (IMR)</td><td>~28/1000 live births (2020)</td></tr>
  <tr><td>Maternal Mortality Rate (MMR)</td><td>~103/100,000 live births</td></tr>
  <tr><td>Life Expectancy</td><td>~70 years</td></tr>
  <tr><td>Population growth rate</td><td>~1%</td></tr>
  <tr><td>Crude Birth Rate (CBR)</td><td>~19.5/1000 (approx)</td></tr>
</table>

<div class="sub-header sec-orange">7.2 Contraceptive Methods</div>
<table class="tbl-orange">
  <tr><th>Type</th><th>Examples</th><th>Failure Rate</th></tr>
  <tr><td>Barrier</td><td>Condom, diaphragm, cervical cap</td><td>2–15%</td></tr>
  <tr><td>IUD/IUCD</td><td>Copper-T (Cu-380A), LNG-IUS (Mirena)</td><td>&lt;1%</td></tr>
  <tr><td>Hormonal</td><td>OCPs, injectables, implants, patches</td><td>&lt;1%</td></tr>
  <tr><td>Sterilisation</td><td>Tubectomy, Vasectomy</td><td>&lt;0.5%</td></tr>
  <tr><td>Emergency</td><td>ECP within 72 hours</td><td>75–85% effective</td></tr>
  <tr><td>Natural</td><td>Calendar, BBT, Billings (cervical mucus), LAM</td><td>Variable</td></tr>
</table>

<!-- ────────────────────────────────────────────────────────────────
     SECTION 8 : QUICK MCQ FACTS & MNEMONICS
──────────────────────────────────────────────────────────────────── -->
<div class="sec-header sec-gray">⭐ SECTION 8 : QUICK MCQ FACTS &amp; MNEMONICS</div>

<div class="sub-header sec-gray">8.1 Top MCQ Must-Know Facts</div>
<div class="mcq-grid">
  <div class="mcq-item"><b>Only eradicated disease</b>Smallpox (1980)</div>
  <div class="mcq-item"><b>India polio-free since</b>March 2014</div>
  <div class="mcq-item"><b>IMR best indicates</b>Socioeconomic development</div>
  <div class="mcq-item"><b>NMR best indicates</b>Quality of health services</div>
  <div class="mcq-item"><b>ASHA ratio</b>1 per 1,000 rural population</div>
  <div class="mcq-item"><b>Most common occ. lung disease</b>Silicosis</div>
  <div class="mcq-item"><b>Schmutzdecke found in</b>Slow sand filter</div>
  <div class="mcq-item"><b>Kwashiorkor hallmark</b>Edema (protein deficiency)</div>
  <div class="mcq-item"><b>Marasmus hallmark</b>Wasting (calorie deficiency)</div>
  <div class="mcq-item"><b>TFR replacement level</b>2.1 children/woman</div>
  <div class="mcq-item"><b>Most heat-sensitive vaccine</b>OPV &gt; Measles</div>
  <div class="mcq-item"><b>Most freeze-sensitive vaccine</b>DPT, TT, Hepatitis B</div>
  <div class="mcq-item"><b>Herd immunity for measles</b>92–95%</div>
  <div class="mcq-item"><b>Bleaching powder formula</b>Ca(OCl)Cl — most widely used disinfectant</div>
  <div class="mcq-item"><b>Bhore Committee year</b>1946 — father of PHC concept</div>
  <div class="mcq-item"><b>Alma-Ata year &amp; goal</b>1978 — "Health for All by 2000 AD"</div>
  <div class="mcq-item"><b>Ottawa Charter year</b>1986 — Health Promotion</div>
  <div class="mcq-item"><b>DOTS components</b>5 (Political, Detection, Chemo, Drug supply, Monitoring)</div>
  <div class="mcq-item"><b>Pellagra (Vit B3) — 3 Ds</b>Dermatitis, Diarrhoea, Dementia</div>
  <div class="mcq-item"><b>India TB burden globally</b>26% — highest</div>
</div>

<div class="sub-header sec-gray">8.2 Key Mnemonics</div>
<div class="two-col">
  <div>
    <div class="box box-gray">
      <b>RIPE — Anti-TB Drugs</b><br>
      R = Rifampicin (orange urine)<br>
      I = Isoniazid (neuropathy)<br>
      P = Pyrazinamide (gout)<br>
      E = Ethambutol (optic neuritis)
    </div>
    <div class="box box-gray">
      <b>TCHAP — Fecal-Oral Diseases</b><br>
      T = Typhoid | C = Cholera<br>
      H = Hepatitis A &amp; E<br>
      A = Amoebiasis | P = Polio
    </div>
    <div class="box box-gray">
      <b>CAVTM — Airborne Diseases</b><br>
      C = Chickenpox | A = Aspergillosis<br>
      V = Varicella | T = TB | M = Measles
    </div>
  </div>
  <div>
    <div class="box box-gray">
      <b>Ottawa Charter — 5 Action Areas</b><br>
      1. Build healthy Public Policy<br>
      2. Create Supportive Environments<br>
      3. Strengthen Community Action<br>
      4. Develop Personal Skills<br>
      5. Reorient Health Services
    </div>
    <div class="box box-gray">
      <b>SEEDS ME — Alma-Ata 8 PHC Elements</b><br>
      S = Safe water &amp; sanitation<br>
      E = Education about health<br>
      E = Endemic disease control<br>
      D = Drug supply (essential)<br>
      S = Sound MCH + family planning<br>
      M = Mental health<br>
      E = Expanded immunisation<br>
      (+) Nutrition &amp; Treatment of common diseases
    </div>
  </div>
</div>

<div class="sub-header sec-gray">8.3 Epidemiological Triad</div>
<div class="box box-gray" style="text-align:center;">
  <b style="font-size:14px;">Agent</b><br>
  &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;|<br>
  <b>Host ——— Environment</b><br><br>
  Agent factors: infectivity, pathogenicity, virulence, toxigenicity<br>
  Host factors: age, sex, immunity, nutrition, genetics<br>
  Environmental factors: physical, biological, social
</div>

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