MM20102 Q&A (MEQ) L1 : Pattern of disease in Malaysia and Sabah 12: Principles of demography > Define demography = Demography is the study of ponulations especially with reference to size and density, fertility, mortality, growth, age distibution, migration and vital statistics > Demography (given a graph/chart) ont Popo rom 100 BC To 180 > Give three findings from the graph/chart above > Give any two possible factors that cause an increase in poptation ~ Declins in mortality at first were due to the effects af economic development - Rising standard of living which helped to lower the exposure to disease and also to build up resistance to illness Decline in mortality was due to improvements in medical technology, especially vaccination against infectious diseases > What are the uses of population pyramid? “Ttis useful to describe + Average age of population = Dependency ratio + Growth rates by age «Trends of mortality «Trends of birth + Describe how history of the country affecting «© Comparison intra oF inter > What are the types of population pyramid and state one example of the county = Broad-base ~ Bard ~ Rectanguar L3 : Principles of Occupational Health> What are the main objectives of the occupational health? + Identifying and controlling occupational hazards ~ Educating management and workers to fulfil their responsibility for health and safety - Promoting health programs not primarily concerned with work-related injury and disease > List 4 common illnesses related with occupation = Silicosis ~ Lead poisoning ~ Asbestosis - Mesothdioma > List down 6 activities for management of worker's health, * Elimination Physically remove the hazard ~ Substitution Replace the hazard + Engineering controls Isolate people from the hazard = Administrative controls: Change the way people work: ~ PPE Protact the worker with personal protective equipment - Other measures Maintenance of equipment > Briefly explain one of the activity ~ Substitution : Replacing the dangerous with non-dangerous ~ PRE Providing PPE and instruction for PPE use/maintenance(safety shoes, hearing protection) L4 : Principle of disease control and prevention > 3 prevention levels and example each ~ Primary prevention Health promotion and specific protection = Secondary prevention: Early agnosis (health screening tests, case findings) and prompt and adequate treatment ~ Tettiary prevention Disability limitation and rehabilitation > List 4 prevention of water borne disease * Chlorination of water - Environmental sanitation Boiling the water - Filtration of the tap water LS : Morbidity and mortality statistics > What are the mortality indicators? > Explain one of them and its significance > Define mortality rate > List2 indices of mortality rate which is both age specific and cause specific list the sources of mortality data L6 : Epidemics and its management > Define case definition = A case definition is a standard set of criteria for deciding whether an individual shuld be dassified as having the health condition of interest.> Describe types of enidemics based on the graph Point source = Continuous common source - Intermittent common source - Propagated (person to person) - Mixed > Uses of the epidemic curve = Helps to form hypotheses on :- «Route of transmission + Probable exposure period «Incubation time > 10 steps to take in an outbreak investigation Prepare for field work Establish the existence of an outbreak Construct 8 working case definition Find cases systematically and record information Perform descriptive epidemiology Develop hypothesis ‘valuate hypothesis epidemiological ‘As necessary reconsider, refine, and re-evaluate hypothes's compare and reconcile with laboratory andfoc environmental studies] 8, _ Implement control and prevention measures 9. Initiate or maintain surveillance 10. Communicate findings > What ate the factors affecting disease occurence? = Water supply ~ Sanitation facilities Food climate L7:: Food and health > Features of nutrition * Healthy ~ Balanced - Vatiety ~ Moderation > Explain the component of nutrition = Catbohydrates + Manufactured by plants ‘+ Major source of energy in the diet - Fat + Essential fatty acids (0-3; o-6) + Storage form of heat and energy - Proteins* Essential amino acid + Importants in tissue building ~ Vitamins + Act as co-enzyme factor + Contval chemical reaction in cell metabolism > Malaysian Dietary Guideline 2010 “KML: Bata vatiety of food within your recommended intake ~KM2__ : Maintain body weight in a healthy range -KM3__ : Be physically active everyday -KM4 — : Eat adequate amount of rice, other cereal products (preferably whole grain) and tubers KMS: Eat plenty of fruits and vegetables everyday -KM6 — : Consume moderate amounts of fish, meat, poultry, e9g, legumes and nuts -KM7_— : Consume adequate amounts of mill: and mill: products = KMS + Limit intake of foods high in fats and minimize fats and cils in food preparation = KM9_— : Choose and prepare foods with less salt and sauces = KMD: Cansume foods and beverages low in sugar KML: Drink plenty of water daily -KMI2_ : Practise exclusive breastfeading from birth untl six months and continue to breastfeed until two vyears of age ~KMI3_ : Consume safe and clean foods and beverages -KMI4_ : Make effective use of nutition information on food labels > Causes of obssity * Genetic factors Defect in LPL gane; central role in breaking down fats Psychological factors: Reactive eating from stress or anxiety; tasty food ~ Sodal factors Cultural and family food pattern, job ewironments, sedentary employment = Physiclagc factors Fat calls increase > Effects of overnuttition among adult = Excass energy intale leads to over weicht and obesity = Risk for chronic diseases - High doses of nutrient supplements will cause tissue damage > Causes = Wasting of undernutrition disease : Long term hyper-metabolic disease (cancer) = Poor food intake : Personal poverty and limited food supply = Malabsorption: Poor nutrient absorption result fram prolonged darthea and GI disease L8 : Nutrition for susceptible group > Benefits of breastfeeding to breastfed babies A) Protects the infants against infection B) The bat by learns the tastes of the family foods through the flavors of breast mill: C) Human mill: increases the maturity of immune system D) Increase level of 1Q in infants > Explain C) Decrea: one of the benefit above ised risk of childhood cancer D) Chalesteral and other type of fat in human mill: support the growth of nerve tissue > Describe two conditions that is common in dietary imbalance in children = kwashiorkor — : Absence of protein in the presence of carbohydrate ~ Marasmus Deprivation in both carbohydrate and protein> Factors causing iron-deficiency anemia among pregnant women = Worm infestation + Inadequate iron intake + Inability to absorb iron. - Endometriosis - Internal bleeding L9 : Environment and health (Water and Air) > List2 air pollutants and 2 diseases due to acute (short term) exposure related to air pollution = Air pollutants: Dust storm and forest fires - Diseases Asthma and Chronic Obstuctive Pulmonary Diseases > List’3 water-borne diseases and their pathogenic agents * Cholera trio cholera Salmonellosis: Salmonella sp. - Amosbiasis Entamoeba histolytica > What are the source of water pollution? + Industial discharges into the surface water - Discharge of untreated sewage into rivers and streams = Wastewater from human activities contaminated ground water > Give 2 methods of water purification technique in domestic and explain one of the aiven method = Chlorination : Chlorine will destroy microorganism in water ~ Fluoridation : Fluoride act as protector from dental caries > Sources of air pollution = Natural sources include forests fires, dust storms, volcanic eruptions. - Anthropogenic sources contamination produced by humans. Sources include smoke from chimneys, gases from septic tanks > Types of water quality = Physical — : Colour, smell, taste ~ Chemical: Suphate, Nitrate, Phosphate Biological: Bacteria, viruses, protozoa L10 : Environment and health (Solid Waste) > Definition of solid waste pollution ~ Any form of garbage, refuse, sludge from a wastewater treatment plant, water supply teatment plant, or a palution control faclity and other discarded materials including solid, liquid, semi-salid, ar contained gaseous material, resulting from industial, commercial, mining and agricultural processes > 4hazards ~ Aesthetical nuisance ~ Air pollution + Injuries = Water and sal pollution > 3 ways of disposal = Storage Collection + Disposal > Describe the hazards of burning of solid waste > List the benefits of composting which is popular currently11: Women health issues > List 6 common womens’ health issues in developing countries = Cancer - HIV ~ Sexually transmitted Infections ~ Mental Health ~ Reproductive Health ~ Maternal Health > Explain one of the issue = Cancer: Two of the most common cancers affecting women are the breast and cervical cancers L12 : Child health issues > "Child G80 is important’, Give reasons to explain the statement > State 4 common childhood diseases in developing counties - Malnutition and its associated illnesses ~ Malaria - Measles ~ Tuberculosis SLP1 : International classification if diseases SLP2 : Health promotion programme in Malaysia > 4health setting approach * Healthy Promoting Hospitals - Healthy Promoting Schools ~ Healthy Cities ~ Healthy Villages 5 Describe one of them = AWHO programme first launched in Eurcpe in 1991 - HPS are schools that make efforts to influence & promote health = Schools as a healthy setting fer living, learning and werlang. > List 2 importance of setting approach in health promotion? “Invalves the popuiation as a whole in their context of their everyday life and in their unique environment. ~ Hdlistic and comprehensive approach > List 6 major element of Health promoting schools = School Health Policy + Physical environment ~ Socal environment = Community involvement ~ Personal health stills ~ School health services SLP3 : National and international health regulationSLP4 : Industrial toxicology > Define toxicology, toxicodynamic and toxicity. Texicalogy ‘Generally, itis a study the stady of passons. Itis specifically the study of nature, effects and detection of toxins as wall as ‘treatment of poisoning. TToxicodynamic Te is the physiological macharisms in which the toxins are absorbed, distributed, metabolized and lastly excreted. Toxicity Ttis the dagres to which a toxin ot poison can harm humans or animals. There are 3 types of toxicity, such as acute toxicity, sub chronic toxicity and chronic toxicity. > Discuss different types of toxic responses. ‘Reuks paisoning Exposure fo @ poison on one occasion oF during a short pariod of time, It occurs immediately. Symptoms develop in lose dation to the exposure. For example: househdd products such as bleaches and detergent, It can cause headache, nausea and sweating, Chronic poisoning Tong taim repeated or continuous exposure to a poison where symptoms does not occur immediately or after such exposure as it takes months or years to become recognisable dinical damage. It can cause cancer. Local affects "Tales place at the pont or area of contact, The site maybe skin, mucous membrane, eyes, respiratory tact and gastointestinal system. Example of toxic effact is the tissue corrosion produced by strong acids, such as sulphuric acid. Systemic effects Te tales place at a location dstant from the body's inital pant of contact and presuppose absorption has. taken place, Substances with systemic effects have target organs in which they accumulate and exert their toxic effect, For example: arsenic effects when it is absorbed into the bloodstream, neutralize in the liver and remove it from the body (kidney), Cumulative effects ‘The action of 8 crug or teatment resulting fom reneated use or that happened over a long petiod of time. It can bring changes to the biophysical, social, economic and cultural environments caused by combined impact of past, present and future human activities and natural processes. ‘Synergistic effects Tris an effect that is sean when bwo or more substances combine to create and effect that is greater than either one ofthem could have manifested by itsdF. Tt can also occur By accident with drug interactions. For example, alcohol can intensify the effacts of some medication. > Explain how toxicants are classified - Based on their toxic effects, toxicants can be classified into carcinogen, mutagen and teratogen ~ Carcinogen substances are associated with causing or promoting cancer in humans and animals. Common carcinogens are including vinyl chloride, benzene and formaldehyde. ~ As for mutagen. It is actually substances that can change the genetic formation of an orgarism, usually by changing DNA. Mutagens are also carcinogen as mutations often cause cancer. Common mutagens are dioxane and ricotine, - Lastly, teratogans are substances that cause harm to the foetus or embryo during the pregnancy, which can cause birth defects while the mather does not show any signs of toxicity. For example, ethanol lead compounds and toluene, > Explain the toxicokinetic phases Exposure Te depends on the bioavailability which is the fraction of dose available for absorption, Main factors of exposure are the time and frequency for exposure and also the route of administrations. Absorption People are exposed to the numerous toxicants present in the work: and living environment which can penetrate into human organism by three main portal entry; via the respiratory tract by inhalation of polluted alr, via the gastrointestinal tract by ingestion of contaminated food and water and through contact skin by dermal and cutaneous penetration. Lipid solubility of a substance is an important factor affecting the degree of absorption. Distibuton ‘The substances are mosty dstibuted in the organisms by the bloodstream to other areas of the body. Excretion Teis the final mean of chanical dimination afta undago biotransformation. Excretion through lung is the major route for gaseous substances. As for the water-soluble toxicants, kidneys are the most important routes for excretion. Additional routes indude sweat, saliva, tears, milk and hair. > Describe the phases of biotransfermation process lead poisoning Phase I reaction,+ Includes oxidative, reductive and hydrolytic reactions, In these types of reactions, a polar group is either introduced and unmasked, so the drug molecules become more-water soluble and can be excreted, ~ The reactions are non-synthetic in nature and generally produce more water soluble and more actve metabolites. ~ The majority of metabolites are generated by a common hydroxylating enzyme system which Inown as Cytochrome P450. Phase II reaction = These reactions involve covalent attachment of small polar endogenous molecules such as glucuronic acid, sulphate or glycine to form water soluble compounds. ~ This is also Known as 2 conjugation reaction. ~ The final compounds have a larger molecular weicht, SLPS : Environmental health programme in Malaysia ‘SLP6 : Occupational health programme in Malay > What law(s) is applicable in this case? = Occupational Safety and Health Act 1994 (OSHA 1994) > What is the hazard(s) in this work that you have identified? “Harmful and explosive > Suggest control measure(s) for this worker = Employees shall act safely and notify employee or officers of potential hazard Responsibility of manufacturer to provide information to the public> From a doctor's point of view, what preventative action can you take? ~ Advice and assist employer and carry out instructions pertairing OSH ~ Conduct workplace inspections and investigations + Collect, analyze and maintain relevant statistics > Ifin the worst case scenario, what compensation is the worker likely to be eligible for? ~ Employment Injury Insurance Scheme + Invalidity Pension Scheme SGD1 : Health and diseases in Malaysia > Describe and explain emerging disease and give an example ~ Diseases that have not occurred in humans before outbreak: that occurred only in small numbers in isolated places + Example : + Severe Acute Respiratory Syndrome(SARS) ‘+ Malaria caused by Plasmodium /nowes! > What environmental factor can affect emerging disease? = Deforestation ~ Road buldng ~ Climate change > Explain what is reemerging infectious disease ~ Diseases that once were major health problems globally or in a particular country, and are again becoming health problems for a significant proportion of the population > State 2 emerging disease and 2 reemaraing disease + Emerging Severe Acute Respiratory Syncrome(SARS), Malaria caused by Plasmodium knowies! + Reemarging —: Tuberculosis, measles SGD2 : Health care system > Explain 2-Tier system Rural Health Service 2 TIER SYSTEM. an PEJABAT KESIHATAN DAERAH+ Since 1973 the Three-tiar Rural Health Service was Upgraded to two tier service which consist of Health, centres and community Clinics where as formally Sub Health Centre is Upgrade to Health Cente, - Health Centres are build to cater for 15,000 to 20,000 populations where as Community Clinics are for 3000 to 4000. = Mean while the midwife clinic was upgrade to Community Clinic which provide bath Maternal and Child Health and Out-Patient Department Services, > Difference between 2+tier system in Peninsular, Sabah and Sarawak > List and describe 8 essential services of PHC services = Maternal and Child care -Family planning and immunization - Out Patient (QPD) —Curative Care ~ Clinical Laboratory ~ Safe water and basic sanitation (erwironmental) = Control of Communicable diseases -prevention and control - Nutrition -Food and proper mutton - Dental Health ~ Health education > Describe levals of Health care delivery system in Malaysia LEVELS OF HEALTH CARE DELIVERY SYSTEM IN MALAYSIA LEVEL OF CARE Olé Fal Home 1: Epidemic investigation > Calculate attack rate > Calculation of relative risk and odds ratio Cross Tabulation of Ice cream eating and Iliness Exposed ness Total Yes To. Yes cy I, Eg lee cream eating % 6% 20.8% 100%We 3 Te a % se EA 00% Total Count cd 2 75 % a3 7% 00% Calculate Odds Ratio and Relative Risk (Risk Ratio) of Ice cream eating and illness. Interpret the results you have calculated. Which Ratio is appropriate to interpret the risk in this study and why? xd/bxe Relative risk: = a/n + cfn0 73.6/100) 5.56