HEALTH EDUCATION RECORD B.

Ed 2011- 2012

- MOHANA PRIYA S
B.Ed COMPUTER SCIENCE

INTRODUCTION
The true teacher is he who can immediately come down to the level of the student, transfer his soul to the students soul and see through and understand through his mind. Such a teacher can really teach and none else
-- Swami Vivekananda

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain (as in good health or healthy). The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health. The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred to as the health triangle.

This record based on the valuable speech rendered by renowned DOCTORS of SRM Medical College. The contents are categorized into the followings topics:

Nutrition And Health Tuberculosis Adolescent Health Problems Common Air borne and Water borne diseases Water borne diseases School health problems and the role of teachers in promoting health

ADOLESCENT HEALTH PROBLEMS

BY

DR N SEETHARAMAN
ASSOCIATE PROFESSOR OF COMMUNITY MEDICINE ON 01-02-12

WHO

WHO Definition - 10 - 19 years

WHY Period of transition from childhood to adulthood. Characterized by rapid physical growth, significant physical, emotional and psychological changes. Constitute 22.8% of population of India. Habits and behaviours picked up during adolescence period have lifelong impact. Desire for experimentation. Sexual maturity and onset of sexual activity. Inadequate school syllabus about adolescent health. Misdirected peer pressure in absence of adequate knowledge.

WHAT a) Biological changes onset of puberty b) Cognitive changes emergence of more advanced cognitive abilities c) Emotional changes self image, intimacy, relation with adults and peers group d) Social changes transition into new roles in the society. WHAT 1. Anorexia nervosa 2. Obesity & overweight 3. Adolescent pregnancy 4. Micronutrient deficiency 5. Emotional problems 6. Behavioural problems 7. Substance abuse & injuries 8. Sexually transmitted infection 9. Thinking and studying problems 10. Identity problems

HOW Skill based health education Life skill education Family life education Counseling for emotional stress Nutritional counseling Early diagnosis & management of medical and behavioural problem

WHAT TO TEACH Development of secondary sexual characters & menarche Problems associated with menstrual cycle & menstrual hygiene Body image Nutritional needs (micronutrients) Managing emotional stress Early marriage RTI/HIV/AIDS Safe sex Family life including pregnancy Child rearing & responsible parenthood Stress management Substance abuse

NUTRITION
AND

HEALTH
BY

DR N SEETHARAMAN
ASSOCIATE PROFESSOR OF COMMUNITY MEDICINE ON 01-02-12

Why Do We Eat Food ? Stay alive, move and work;

Build new cells and tissues for growth, maintenance and repair; Resist and fight infections. When the body does not get enough food, it becomes weak and cannot develop or function properly

Types of Food MACRO Nutrients - Proteins, Carbohydrates and Fats.

MICRO Nutrients - Vitamins & Minerals, Iron, Iodine, Zinc, Calcium, Body building foods

Energy giving foods - Provide the energy to make our bodies work and keep active

Body building foods - Proteins for cell repair and growth. Help to fight infection and repair the body during illness.

Protective foods - Help to fight infections and to digest and absorb other nutrients. Help the body absorbs and utilize.

Carbohydrates and Fats - Staple foods: Rice, Wheat, Potato, Oil, Ghee & Sugar.

Proteins and Minerals Beans, groundnuts and nuts. Milk products. Animal foods (fish, eggs, Chicken and beef) Vitamins & Minerals - Dark green, leafy vegetables Yellow and orange fruits: mango, papaya, carrots, tomato, oranges, lemons and bananas Balanced Food:

Balanced nutrition means eating the right type of foods in the right quantities We Need To Eat A Balanced Diet

Nutritive values of common food items

National Institute of Nutrition NIN - National Institute of Nutrition, Hyderabad NNMB - National Nutritional Monitoring Bureau ICMR - Indian Council of Medical Research

Nutrition and specific diseases

Hypertension / CHD / Stroke Diabetes / Obesity Cancer Pregnancy / Lactation

Food Taboos & Food Fads

Food Taboos Food fads Prestige foods

Nutritional Advice Balanced Diet High Calorie Diet ( High Carb, High Protein) Food Safety & Personal Hygiene Eat Small amounts Frequently

Food Safety & Personal Hygiene Wash Hands Use Safe Clean Water Boil for 10 Min Store in Covered Container Dont dip ; Best with a Tap Cooking & Storing Wash Veg & fruits with safe, clean water Use Clean Dishes & Utensils Cook thoroughly but not overcook Veg Cover food Serve / eat right away Throw away any food that has gone bad Food Allergies

MALNUTRITION

The Vicious Cycle

Different faces of Malnutrition Intrauterine growth retardation and maternal malnutrition Protein - energy malnutrition Micronutrient malnutrition Iodine deficiency disorders Vitamin A deficiency Iron deficiency and anemia Other micronutrient deficiencies Overweight and obesity Diet and cancer

Growth Monitoring Growth Card

TUBERCULOSIS
BY DR K JOHN
HEAD OF THE DEPARTMENT COMMUNITY MEDICINE ON 01-02-12

India is the highest TB burden country globally accounting for one fifth of the global incidence. TB Burden in India Incidence of TB disease: 1.8 million new TB cases annually (0.8 million new infectious cases) Prevalence of TB disease: 3.8 million bacteriologically positive (2000) Deaths: about 370,000 deaths due to TB each year TB/HIV: ~2.5 million people with HIV; >1 million co-infected with HIV & TB About 5% of TB patients estimated to be HIV positive

MDR-TB in new TB cases 3% and ~12% in Re-treatment cases Substantial socio- economic impact DOTS Coverage by District, India 31st March 2006 RNTCP Goal and Objectives RNTCP Goal and Objectives RNTCP Performance

National network of Diagnostic facilities 12,500 designated microscopy centres External quality assurance protocol in place Intermediate reference laboratories at State level for culture and drug sensitivity tests More than 8 million patients put on treatment NSP case detection rate for 3Q07 was 70% Treatment success rate maintained over 85% Death rate has fallen from 42/lakh pop (1990) to 29/lakh pop (2005)

Structure of RNTCP at State level Lab Quality Assurance Senior TB Laboratory Supervisor (STLS) was provided to monitor quality of lab microscopy EQA protocol developed in 2001

In 2004, based on new international guidelines, External Quality Assessment (EQA) protocol was revised and implemented

Quality of treatment All patients initiated on treatment are monitored individually and treatment outcomes are reported through a system of cohort analysis DOT ensures that patients receive the right drugs in the right doses for the right duration of treatment All RNTCP patients receive drugs under direct observation by a accessible, acceptable and accountable DOT provider DOT provider may be health worker or community based volunteer, but not the family member Patient-wise drug boxes A unique feature of RNTCP are the patient-wise drug boxes (for adult and paediatric cases), which improve patient care, adherence, and drug supply and drug stock management. Paediatric patient wise boxes introduced in 2006 M&E Monitoring through routine surveillance data, review meetings, Supervision at every level of programme Evaluation by the state, central level and 3 yearly joint monitoring missions All states are implementing the Supervision and Monitoring Strategy M&E Monitoring through routine surveillance data, review meetings, Supervision at every level of programme Evaluation by the state, central level and 3 yearly joint monitoring missions All states are implementing the Supervision and Monitoring Strategy RNTCP Supervision and Monitoring strategy Strategy document developed and published in March 2005 All states and districts implementing the strategy All state/district programme staff trained in the strategy RNTCP initiatives1 DOTS Plus for MDR TB DOTS Plus services rolled out in Gujarat and Maharashtra in March 2007. Total of 74 patients put on DOTS Plus treatment. By 2010, programme plans to establish 24 DOTS Plus sites across the country Public private mix

Over 2400 NGOs, 17,000 private practitioners and 120 corporate houses involved in RNTCP

246 Medical colleges involved and contributing 10-15% of case detection in their districts RNTCP initiatives2 TB HIV coordination National framework of joint TB HIV collaborative activities developed in 2007 Expansion of TB-HIV collaboration to all states will be done in 2008 6 fold increase in number of TB suspects referred from ICTCs to RNTCP since 2005 IEC (ACSM activities) Well defined communication strategy based on audience research and other aspects Web based IEC resource centre IEC baseline document has been developed in 2007 Communication facilitators appointed to support districts in planning and executing ACSM activities RNTCP in NRHM State PIP

In the NRHM Programme Implementation Plan (PIP), the states have to incorporate the various TB control activities and budget in Part D of the PIP. The existing District Annual Action Plan/ State Annual Action Plan formats of RNTCP have to be incorporated in the NRHM State PIP. ASHA for RNTCP

The Accredited Social Health Activist (ASHA) - These community health volunteers have to be trained for DOT provision to provide affordable, accessible and quality treatment services near to patients home. These volunteers would be provided honorarium of Rs 250/- per patient on treatment completion.

SCHOOL HEALTH SERVICES AND THE ROLE OF TEACHERS IN PROMOTING HEALTH

BY DR KUBERAN ON
03-02-12

SCHOOL HEALTH PROGRAMME School Health Programme is an important teaching of Community health . Economical and Powerful uses of raising community health. 1st time Medical examination of School children was done in Baroda city. Bhore Committee in 1946 declared the non existence of School Health Services in India.

In 1953 Secondary Education Committee insisted Medical Examination of pupils and school feeding programmes. In 1960 School Health Committee was formed to assess health standards and nutrition status of pupils. In 1961 A report was submitted and useful recommendations were received.

Health Problems of School Children

School Health Services are to be based upon :1. Local Health Problems of the School Children.

2. Culture of the Community. 3. Available resources of money, materials and man power.

Main emphasis of School Medical Services will fall in the following categories.

1. Malnutrition 2. Infectious Diseases. 3. Intestinal Parasitic infection. 4. Diseases of skin. Eye and Ear. 5. Dental Care.

Main emphasis of School Medical Services will fall in the following categories.

1. Malnutrition 2. Infectious Diseases. 3. Intestinal Parasitic infection. 4. Diseases of skin. Eye and Ear. 5. Dental Care. Aspects of School Health Services:-

The tasks of School health services are manifold and vary according to priority.

Mainly the aspects are :-

1. Health appraisal of School children and School personnel. 2. Remedial measures and follow up 3. Prevention of communicable diseases. 4. Healthy School environment. 5. Nutritional Services. 6. First aid and emergency care. 7. Mental health. 8. Dental health. 9. Eye health 10. Health Education 11. Education of Handicapped children. 12. Proper maintenance and use of school health records.

Health appraisal

1. Students 2. Teachers 3. Other School personnel. 4. M.I at 1. School entry. 2. Every 4 Years. - May be more frequently.

Medical Examination:-

1. Complete History taking. 2. Physical Examination. 3. Vision Examination. 4. Hearing 5. Speech. Routine 1. Motion 2. Urine Exam

Clinical examination for nutritional deficiency.

What should the teacher look for? Remedial Measures Special clinics High prevalence of Dental, Eye, ear, nose and throat problems

Healthy School Environment

Location Site Structure Class room 40 , 10 sq. ft Furniture -minus Doors and windows -25% of floor area, ventilator -2 % Color Lighting Water supply Lavatory Eating facilities Nutritional Services Midday School Meal Applied nutrition program

First Aid and Emergency Care Mental Health Dental Health Health Education School records

COMMON AIR-BORNE & WATERBORNE DISEASES

BY

Dr K Mani
on 03-02-12

An arthropod or other invertebrate which transmits infection by inoculation into or through skin or mucous membrane by biting or by deposit of infective materials on the skin or on food or other objects.

Arthropods of medical importance

Insecta mosquitoes flies human lice fleas reduviid bugs

Arachinda ticks mites ( chiggers) Crustacea cyclops

Transmission by flies Flies transmit mechanical transmission

vomit drop defecation

House flies Transport micro organisms on their feet and hairy legs . from the bodies

Pathogenic organisms , ova and cysts have been recovered of the common house fly.

House fly The regurgitated By its frequent transmits disease. stomach contents o r vomit drop is a bacterial culture. habit of vomiting, the house fly infects food and thereby

Mosquito borne diseases Malaria Shaking chills, followed by high grade fever and sweating (Cold stage, Hot stage and Sweating stage). Shaking chills lasts from 15 minutes to 1 hour (The cold stage), Followed by high grade fever, even reaching above 1060 F, which lasts 2 to 6 hours (The hot stage). Followed by profuse sweating and the fever gradually subsides over 2-4 hours. Malaria Filariaiasis Japanese encephalitis Dengue Dengue hemorrhagic fever Chikungunya fever Chikungunya hemorrhagic fever Affects all age group and both sex More common during rainy season ( July to November) All tropical countries including India ( tropic of cancer and tropic Capricorn) Also in Tamilnadu Malaria -Tamilnadu Occurs both in urban and rural areas 75% of cases occur in urban area and 25%in rural areas Nearly 60% of the cases of Tamilnadu occur in Chennai ( more commonly in north Chennai)

Other typical presentation of malaria Head ache and body ache Vomiting and diarrhoea( P. falciparum)

Breathlessness: Severe anaemia associated with P. falciparum malaria or chronic P. vivax malaria. Chest pain: Rapid enlargement of spleen Complications- cerebral malaria, kidney failure, diarrhoea, anaemia (P. falciparum )

Prevention of malaria Early Diagnosis and Prompt Treatment Mosquito Control Measures Source Reduction Larvicides - chemical, biological Adult insecticides

Personal Protection Repellants Bed nets Chemoprophylaxis

Health education

Source reduction The breeding places should be looked for and abolished by appropriate engineering measures. In Chennai all open overhead tanks should be abolished common to find puddles of water everywhere during the rainy season. This is the reason why malarial transmission is at its peak during the monsoon

Construction Sites At construction sites, care should be taken to avoid collection of water at one place for more than a week. The layer of water on the surface of the concrete, used for concrete curing, should be cleared at least once a week and allowed to dry for half an hour. All other puddles should be cleared regularly. Collections of water in the toilets and closets under construction should also be cleared. All tanks should be kept snugly closed.

All labourers should be frequently checked and adequately treated. They should also be provided with mosquito nets.

Polyesterene Beads

All unused wells and tanks should be closed or destroyed. Another method to prevent egg laying on unused wells is by adding EPS polyesterene beads onto the surface of water. These beads are non-toxic, cheap and long lasting. They coat the water surface and prevent the mosquito from laying eggs.

Salinity of water Salinity of water in canals and stagnant pools is increased by adding sea water. The experiment was successful and mosquito larvae were found morbid in the canal portions where salinity was increased.

Larvicides - chemical, biolog Use of larvicides Chemical mosquito larvicidal oil, diesel oil, , fuel oil, kerosene and various fractions of crude oil, on stagnant water collection In case of over head tanks Abate is used at a rate of 1ppm or 1mg / liter of water Fenthion, being more toxic, is used on non-potable water collections.

Biological larvicides use of biological agents that eat or destroy the larvae. Guppy and Gambusia fish are known for their larvivorous habits. These fish can be introduced into all collections of potable water like wells, tanks, ponds and lakes. They can also be put into the paddy fields

Space sprays These insecticides instantly kill the mosquitoes, but lack any residual effects. Net reduction in the mosquito population. Space sprays must be repeated often, at least once every week. Pyrethroids are commonly used for this purpose. Sprayed in the form of fog or mist

House-to-house application using portable equipment Portable spray units can be used when the area to be treated is not very large or in areas where vehicle-mounted equipment cannot be used effectively. Congested low-income housing areas, multistoried buildings, godowns and warehouses, covered drains, sewer tanks and residential or commercial premises. Vehicle-mounted fogging

Vehicle-mounted fogging can be used in urban or suburban areas with a good road system. One machine can cover up to 1500-2000 houses (or approximately 80 ha) per day. An educational effort may be required to persuade the residents to cooperate by opening doors and windows. The best time for application is in the early morning (6am-8.30am) or evening (5pm-7.30pm). Insecticide formulations for space sprays Organophosphate insecticides Malathion Undiluted technical grade malathion (active ingredient 95%+) for ULV spraying (0.5 liters per hectare for vehicle-mounted operations) One part technical grade diluted with 24 parts of diesel for thermal fogging respectively

Fenitrothion Pirimiphos methyl Pyrethroids Permethrin Deltamethrin Lambda-cyhalothin Low dosages of pyrethroid insecticides are usually more effective indoors than outdoors.

Genetic Methods: Sterile male release has been successfully applied in several small-scale areas. However, the need for large numbers of mosquitoes for release makes this approach impractical for most areas. Genetic modification of malaria vectors aims to develop mosquitoes that are refractory to the parasite. This approach is still several years from application in field settings.

Chemoprophylaxis Travelers to endemic areas and high risk individuals living in endemic areas (pregnant, elderly, patients with end organ failure) should be started on chemoprophylaxis against malaria. This involves taking antimalarial drugs every week (some drugs may have to be taken everyday) so as to suppress malaria.

Personal Protection Against Mosquitoes Preventing the mosquitoes from entering the house: The female anopheles mosquitoes enter the house in the evenings, between 5PM and 10PM, and also early in the morning, between 5AM and 7AM. To prevent their entry, all the doors and windows should be kept closed during these hours.

Preventing the mosquitoes from hiding: Anopheles mosquitoes tend to hide in the dark corners and amidst the clothes and other linen left hanging in the rooms. During the night, they come out of their hiding to seek human blood. This should be avoided and all the clothes and linen should be preferably kept inside wardrobes and cupboards.

Protection from mosquito bites: Protective Clothing Protective clothing helps to keep the mosquitoes away when the individual is relaxing either indoors or outdoors, particularly between 6PM and 10 PM. Treating the clothing with permethrin or etofenprox provides extra protection by repelling the mosquitoes Label instructions should be followed to avoid damage to certain fabrics.

Mosquito Repellents

These are substances applied to exposed skin or to clothing to prevent human - mosquito contact. The repellent only repels but does not kill mosquitoes Essential oils from plant extracts that act as natural repellents are citronella oil, lemongrass oil and neem oil.

Mosquito repellants DEET (N,N-diethyl-m-toluamide) 3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester (IR3535) 1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-, 1-methylpropylester (Bayrepel)

Permethrin is an effective repellant when impregnated in cloth How to apply mosquito repellents? Apply during the biting time of the mosquitoes Take care to avoid contact with mucous membranes Do not allow young children to apply this product; Avoid over-application. Wash the hands after applying the repellent. Repeated applications (every 34 hours) may be needed, especially in hot and humid climates.

Strictly adhere to the manufacturers instructions and do not exceed the dosage, especially for young children.

III. Insecticide vaporizers

mosquito coils, vaporizing mats and liquid vaporizers and aerosols. Most of these products contain synthetic pyrethroids, like d-allethrin and d-transallethrin, as the active ingredient. nets

Mosquito Insecticide treated bed nets (ITNs)

Mosquito nets are the best and safest means of protection against mosquito bites during nights. Currently, only pyrethroid insecticides are approved for use on ITNs

Health education It is impossible to achieve this without the participation of the general public. Education of the people is thus very important for any meaningful action.

DENGUE FEVER Sudden onset of high fever Severe headache (mostly in the forehead) Pain behind the eyes which worsens with eye movement Body aches and joint pains Nausea or vomiting DENGUE HAEMORRHAGIC FEVER AND SHOCK Symptoms similar to dengue fever plus, any one of the following: Severe and continuous pain in abdomen; Bleeding from the nose, mouth and gums or skin bruising; Frequent vomiting with or without blood; Black stools, like coal tar;

Excessive thirst (dry mouth) Pale, cold skin Restlessness, or sleepiness

Chikungunya fever High fever Joint pain, swelling and stiffness- wrist, elbow, shoulder, knee, ankle and metacarpal and tarsal( may persist for months and even years) Rash in trunk and limbs. No death due to Chikungunya fever

Aedes-dengue Breeding of Aedes mosquitoes however begins in June itself Dengue cases generally start to increase from august onwards, which is post monsoon season. Control measures supported by community mobilization for behavioural change activities need to be taken before June and sustained throughout the rainy season

PREVENT MOSQUITO BITES: Dengue mosquitoes bite during the daytime. Protect yourself from the bite. Wear full sleeve clothes and long dresses to cover the limbs; Use Repellent; Use mosquito coils and electric vapour mats during the daytime to prevent Dengue; Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes.

PREVENTION MULTIPLICATION OF MOSQUITOES Drain water from coolers, tanks, barrels, drums and buckets, etc.; There should be no water in coolers when not in use; Remove from the house all objects, e.g. plant saucers, etc. which have water collected in them; Remove water from refrigerator drip pans every other day; All stored water containers should be kept covered all the time;

Discard solid waste and objects where water collects, e.g. bottles, tins, tyres, etc.

Lymphatic filariasis Lymphatic filariasis, more commonly known as elephantiasis, (Lymphoedema of the limbs, genital (hydrocele, chylocele and swelling of the scrotum and penis. The disease is usually acquired in childhood its visible manifestations occur in adults leading to temporary and permanent disability The vast majority of infected people are asymptomatic and have sub clinical lymphatic damage Japanese encephalitis It affects children, and is known to cause headache, fever, neck rigidity, convulsions, coma, mental retardation, and even death.

Japanese encephalitis Japanese encephalitis, is more commonly occurs regularly in eight districts in Tamil Nadu. These districts are Perambalur, Villupuram, Virudhunagar, Cuddalore, Madurai, Tirunelveli, Thanjavur and Tiruchi. The Government launched a campaign to vaccinate 24 lakh children in the age group of 1-15. In the three districts where the project is already running, Japanese Encephalitis has been incorporated into the regular immunisation schedule. the number of cases has come down significantly in the three districts Fight against mosquito borne diseases will not be successful unless there is community participation

WATER BORNE &AIR BORNE DISEASES BY DR.M.LOGARAJ

PROFESSOR OF COMMUNITY MEDICINE ON 03-02-12

Water borne diseases

POLIOMYELITIS VIRAL HEPATITIS A & E CHOLERA TYPHOID ACUTE DIARRHOEAL DISEASES DYESENTRY AMOEBIASIS FOOD POISONING WORM INFESTATIONS

Hygiene Saves Lives

1.8 million people die every year from diarrhoeal diseases. Hygiene interventions including hygiene education and promotion of hand washing can lead to a reduction of diarrhoeal cases by up to 45%. HAND WASHING WHY WE DIRTY OUR HANDS MILLIONS OF GERMS GERMS CAUSE DISEASE

WHEN AFTER PLAYING AFTER PLAYING WITH PETS AFTER USING THE TOILET BEFORE EATING FOOD

HOW

SOAP 20 SECONDS SPREAD THE WORD NOT THE GERMS

The two most common methods to kill microorganisms in the water supply are: oxidation with chemicals such as chlorine, chlorine dioxide or ozone, and irradiation with Ultra-Violet (UV) radiation VACCINE PREVENTABLE WATER BORNE DISEEASES POLIOMYELITIS HEPATITIS A TYPHOID

AIR BORNE DISEASES SMALL POX CHICKEN POX MEASLES GERMAN MEASLES MUMPS DIPTHERIA INFLUENZA / SWINE FLU WOOPING COUGH MENINGITIS ACUTE RESPIRATORY INFECTIONS TUBERCULOSIS

CHICKEN POX

Mild to moderate fever Malaise Headache and backache Prodromal symptoms are mild in children and last for 24 hours In adult the prodromal symptoms are severe Rash advances quickly the stages of macule, papule, vesicle and scab. They are superficial and surrounded by area of inflammation Scab beings 4 to 7 days after the rash appears. Pleomorphism: all stages of rash ( papule, vesicle and crust ) are seen simultaneously Transmission Person to Person by droplet infection / Droplet nucleus. Portal of entry Respiratory track Role of fomites Little role Virus is extremely heat labile Cross placental barrier and infect foetus ( congenital varicella

VARICELLA VACCINE Age : one dose after 12 months

Dose :0.5ml Site Route : outer aspect of upper arm :S.C

Storage Temp: +2 to +8 C Adverse Effects: Mile headache, Fever & Paraesthesia

Measles Clinical Features Incubation period 10-12 days Prodrome Measles Rash 2-4 days after prodrome, 14 days after exposure Maculopapular, becomes confluent Begins on face and head Persists 5-6 days Fades in order of appearance German measles Rash in German measles are not confluent Stepwise increase in fever to 103F or higher Cough, coryza, conjunctivitis Koplik spots (rash on mucous membranes)

Mumps Clinical Features Incubation period 14-18 days Nonspecific prodrome of myalgia, malaise, headache, low-grade fever Parotitis in 30%-40% Up to 20% of infections asymptomati

MMR vaccine One dose (as MMR) for preschool-age children 12 months of age and older and persons born during or after 1957 not at high risk of mumps exposure Second dose (as MMR) for school-age children and adults at high risk of mumps exposure (i.e., healthcare personnel, international travelers and students at post-high school educational institution

CONCLUSION
A teacher can never truly teach unless he is still learning himself. A lamp can never light another lamp unless it continues to burn its own flame. The teacher who has come to the end of his subject, who has no living traffic with his knowledge, but merely repeats his lessons to his students, can only load their minds. He cannot quicken them.
-- Tagore Thus Teachers are among the most important influences in the lives of school-aged children, yet relatively little emphasis has been placed on examining. A potential role has been played general academic teachers in facilitating health promotion efforts, according to a study conducted by researchers at Columbia University's Mailman School of Public Health and published in the Journal of School Health. The study results indicate that teachers provide valuable information to school personnel about what health issues are important to adolescents, in particular, because they hear feedback from them on a daily basis.