Answer the questions in brief

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WHO primary health care definition ANC recommendations HIV fact sheet

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1. MCQ

Ergonomics is the study of:
(ii) Adjustment of work to the worker for comfort and efficiency.

2. Short notes

(a) Primary health care

Essential health care made universally accessible to individuals and families, with community participation and affordable cost.

Principles:

Equitable distribution
Community participation
Intersectoral coordination
Appropriate technology

Elements: Health education, nutrition, safe water, sanitation, MCH and family planning, immunization, prevention/control of endemic diseases, treatment of common illnesses, and essential drugs.

(b) Types and functions of family

Types:

Nuclear family
Joint/extended family
Three-generation family
Single-parent family
Broken family

Functions:

Reproduction and child rearing
Socialization and education
Emotional support and security
Economic support
Care of children, elderly, and sick persons
Regulation of sexual behaviour and social status.

(c) Pasteurization of milk

Heating milk at a prescribed temperature for a fixed time, followed by rapid cooling, to destroy pathogenic organisms without major nutritional change.

Methods:

Holder method: 63°C for 30 minutes
HTST method: 72°C for 15 seconds
UHT: about 135-150°C for 1-2 seconds

Milk is then cooled rapidly to below 5°C. Phosphatase test checks adequacy of pasteurization.

(d) Hardness of water

Hardness is the inability of water to form lather easily with soap due to calcium and magnesium salts.

Types:

Temporary hardness: bicarbonates of calcium and magnesium; removed by boiling.
Permanent hardness: sulphates/chlorides of calcium and magnesium; removed by lime-soda process, zeolite/permutit process, or ion exchange.

(e) Types of mental illness

Organic mental disorders: delirium, dementia
Psychotic disorders: schizophrenia, mania, severe depression
Neurotic disorders: anxiety, phobia, obsessive-compulsive disorder
Mood disorders: depression, bipolar disorder
Substance-use disorders
Personality disorders
Intellectual disability
Childhood disorders: autism, ADHD.

(f) Demographic cycle

The demographic cycle describes population change according to birth and death rates.

High stationary stage: High birth rate and high death rate.
Early expanding stage: Death rate falls; birth rate remains high, causing rapid population growth.
Late expanding stage: Birth rate begins to fall; population still increases.
Low stationary stage: Low birth and death rates; population remains stable.
Declining stage: Birth rate is lower than death rate; population declines.

(g) Rubella

Rubella is an acute viral disease caused by rubella virus and spread by respiratory droplets.

Features: Mild fever, rash, postauricular/suboccipital lymphadenopathy and arthralgia.
Importance: Infection during early pregnancy can cause congenital rubella syndrome: cataract, congenital heart disease, deafness, microcephaly and developmental delay.
Prevention: Rubella-containing vaccine, usually MR/MMR vaccine, and immunization of susceptible women before pregnancy.

(h) Benefits under ESI Act

Benefits provided to insured workers and dependants include:

Medical benefit
Sickness benefit
Extended sickness benefit
Enhanced sickness benefit for sterilization
Maternity benefit
Temporary and permanent disablement benefit
Dependants’ benefit in case of death due to employment injury
Funeral expenses
Rehabilitation and unemployment allowance, where applicable.

3. Long-answer outlines

(a) Natural history of disease

Natural history is the course of a disease from its beginning to final outcome in the absence of treatment.

Stages:

Pre-pathogenesis stage: Interaction of agent, host and environment occurs; disease has not started in the person.
Pathogenesis stage:
- Subclinical stage: incubation/latent period; pathological changes occur but no symptoms.
- Clinical stage: signs and symptoms appear; diagnosis is possible.
- Outcome: recovery, disability, chronicity or death.

Levels of prevention:

Primordial prevention: prevents development of risk factors.
Primary prevention: health promotion and specific protection.
Secondary prevention: early diagnosis and prompt treatment.
Tertiary prevention: disability limitation and rehabilitation.

(b) Protein-energy malnutrition: prevention and control

Protein-energy malnutrition results from deficiency of calories and protein, commonly affecting young children.

Forms:

Marasmus
Kwashiorkor
Marasmic-kwashiorkor

Preventive and control measures:

Exclusive breastfeeding for first 6 months.
Timely, adequate complementary feeding after 6 months while continuing breastfeeding up to 2 years or beyond.
Balanced diet containing cereals, pulses, milk/eggs, vegetables, fruits and oils.
Growth monitoring and regular weighing of children.
Nutrition education for mothers.
Immunization, safe water, sanitation and control of diarrhoea/worm infestation.
Vitamin A and iron-folic acid supplementation where indicated.
Early detection and referral of severe acute malnutrition.
Management of severe cases with therapeutic feeding, treatment of infections and follow-up rehabilitation.
Strengthening ICDS, supplementary nutrition and food-security programmes.

(c) Modern sewage treatment plant

Stages of treatment:

Preliminary treatment: Screening removes large floating materials; grit chamber removes sand and gravel.
Primary treatment: Sedimentation removes suspended solids and forms sludge.
Secondary/biological treatment: Microorganisms break down organic matter. Methods include trickling filters, activated sludge process and oxidation ponds.
Secondary sedimentation: Biological flocs are allowed to settle.
Tertiary treatment: Further filtration, nutrient removal and disinfection, commonly chlorination.
Sludge treatment: Digestion, drying and safe disposal or use as manure/biogas.

(d) Objectives and services of antenatal care

Objectives:

Ensure safe pregnancy and healthy mother and baby.
Detect high-risk pregnancy early.
Prevent, diagnose and treat anaemia, hypertension, diabetes and infections.
Prepare the woman and family for safe delivery, breastfeeding and newborn care.

Services:

Early registration and regular antenatal visits.
Detailed history and physical examination.
Check blood pressure, weight, pallor, oedema, abdominal examination and fetal growth.
Investigations: Hb, blood group/Rh type, urine examination, blood sugar, HIV, syphilis and hepatitis B testing as per policy.
Tetanus-diphtheria vaccination.
Iron-folic acid and calcium supplementation.
Nutrition, rest, hygiene and birth-preparedness counselling.
Identification and referral of high-risk cases.
Advice regarding danger signs: bleeding, severe headache, blurred vision, swelling, convulsions, fever, reduced fetal movements and leaking per vaginum.

(e) AIDS: epidemiological determinants and control

Agent: Human immunodeficiency virus, mainly HIV-1 and HIV-2.
Reservoir/source: Infected human beings; blood, semen, vaginal secretions and breast milk.
Transmission:

Unprotected sexual contact
Transfusion of infected blood/blood products
Sharing contaminated needles/syringes
Mother-to-child transmission during pregnancy, delivery or breastfeeding
Occupational needle-stick exposure

Host factors: High-risk sexual behaviour, multiple sexual partners, other STIs, injection-drug use, and lack of awareness.
Control measures:

Health education and safer sex, including correct condom use.
HIV testing and counselling.
Screening of donated blood.
Sterile disposable needles; needle-exchange/harm-reduction services.
Universal precautions in healthcare settings and post-exposure prophylaxis when indicated.
Prevention of mother-to-child transmission through testing, antiretroviral therapy and appropriate infant-feeding advice.
Early diagnosis and lifelong antiretroviral treatment.
Prevention and treatment of tuberculosis and other opportunistic infections.

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