Public Health L7: Health and Safety PDF

Public health L.7 Health and safety Prepared by : Dr. Mokhtar Amdeb The Royal College of Pediatrics and Child Health  Concept of health and safety : The concept : Health and safety all about preventing or mitigating any accidents or incidents at your workplace, tha...

Public health L.7 Health and safety Prepared by : Dr. Mokhtar Amdeb The Royal College of Pediatrics and Child Health  Concept of health and safety : The concept : Health and safety all about preventing or mitigating any accidents or incidents at your workplace, that may result in injury to your employees and others. Why a focus on safety and health at work? Identification of workers / occupations / sectors at increased risk of contagion Implementation of control and prevention measures based on risk assessment Dissemination of information on preventive and protective measures to reduce the spread of infectious diseases, in collaboration with public health authorities Who’s responsible for health and safety in your organization? Everyone! The employer – overall responsibility for health and safety. The chief executive – responsibility for implementing and managing the health and safety strategy and policy for the organization. Line managers – day to day responsibility for themselves, their employees and others, including members of the public. Employees – responsibility for themselves and others. OSH rights and responsibilities according to ILO standards OSH : Occupational Safety and Health Administration ILO : International Labour Organization  Employers’ roles and responsibilities  Ensure that, so far as is reasonably practicable, the workplaces, machinery, equipment and processes under their control are safe and without risk to health.  Ensure that, so far as is reasonably practicable, the chemical, physical and biological substances and agents under their control are without risk to health when the appropriate measures of protection are taken.  Provide, where necessary, adequate protective clothing and protective equipment (at no cost to workers)  Provide, where necessary, for measures to deal with emergencies and accidents, including adequate first-aid arrangements.  Ensure that workers and their representatives are consulted, informed, and trained on OSH Occupational Safety and Health Convention (No. 155) and Recommendation (No. 164) Protecting workers from the risk of contagion during an outbreak Assessment of the risk of contagion at work  Probability to be exposed to the risk of contagion, taking into account the characteristic of the infectious disease (i.e., transmission patterns) and the possibility that workers may encounter infectious persons or may be exposed to contaminated environments or materials (e.g., laboratory samples, waste) in the course of their duties  Severity of the resulting health outcomes, taking into account individual affecting factors (including age, underlying diseases and health conditions), as well as the measures available to control the impact of the infection Emergency response workers ❑Health care workers ❑Laboratory personnel ❑Death care workers ❑Emergency transport workers ❑Cleaners and waste management workers in health-care and emergency facilities ❑Others (e.g. police officers, civil protection personnel, military personnel, fire fighters) Addressing stress, psychosocial risks and violence and harassment  Stress and psychosocial factors during a pandemic Common psychosocial factors Common responses  Fear for one’s own health and well-being or that of  Stress family members and co-workers  Low mood  Lack of safety equipment for personal protection  Low motivation  Isolation  Anxiety and depression  Lack of social support  Tension between established safety protocols and the  Serious effects on mental health desire to care for or support individual  Difficulty in maintaining self-care activities (e.g. exercise, good eating habits, rest, etc.) People working from home Examples of OSH measures to prevent and reduce stress  Management commitment and support and connection with supervisors and colleagues  Clear expectations (e.g., results to achieve, tasks, etc.)  Flexibility  Disconnection from work at specified times reserved for rest and personal life  Appropriate equipment (e.g., laptops, apps for teleworking, adequate IT support) and dedicated workspace  Training  Good system of communication  Support services, including employee assistance programs Managing other OSH risks OSH : Occupational Safety and Health Administration  14 Ergonomics  Manual handling of loads  Musculoskeletal injuries  Awkward postures  Diminished work capacity … associated with longer working time,  Reduced ability to adhere to strict work practices higher work load and high-pressure  Increased absenteeism  Higher risk of workplace accidents NB Manually place “ilo.org” device in front of image OSH risks associated with the use of heavy PPE Health care workers may also face risks arising from the prolonged use of heavy PPE:  Heat stress and dehydration  Dizziness  Physical markings on faces PPE: Personal protective equipment NB Manually place “ilo.org” device in front of image  16 Social dialogue on OSH in times of a pandemic Employers and their organizations Workers and their organizations  Collaborate with government to shape policy  Participate in decision-making and policy measures that are conducive for business responses to epidemics resilience and sustainability  Actively cooperate with employers in the  Observe advice/guidance provided by public implementation of the preventive and protective authorities measures.  Communicate critical information to workers  Strictly follow the workplace hygiene practices and  review or draw up a business continuity plan adopt a responsible behaviours  Identify and mitigate risks of contagion to workers  Promote workplace hygiene  17 A particular role for OSH practitioners  Facilitate access to reliable information  Promote understanding of the disease and its symptoms  Support in the risk assessment and management process (i.e. identification of infectious and non-infectious hazards and assessment of associated risks; adoption of preventive and control measures; monitoring and review)  Help in development or update of plans for the prevention, containment, mitigation and recovery NB Manually place “ilo.org” device in front of image  Write assessment ? Important notes: 1. Write an article that does not exceed 3 sheets 1. Write about IPC? Infection and avoid intellectual exaggeration. preventive control 2. It must include the (objective ) of the article 3. It must be supported by pictures and examples 4. Finally, the research must include (Reference)  Public health L.8 Moral and Medical Ethics Prepared by : Dr. Mokhtar Amdeb The Royal College of Pediatrics and Child Health  MEDICAL LAW & ETHICS Ethics - signifies moral values. Medical ethics – moral principles for registered medical practitioners in their dealings with each other, their patients and state. Medical etiquette conventional laws, customs of courtesy and code of conduct for doctor with his colleagues.  MEDICAL COUNCIL ❖ Recognition of medical qualification ❖Supervision of undergraduate medical education ❖ Supervision of post graduate medical education ❖ Recognition of foreign medical education ❖ Derecognition ❖ Medical register ❖ Warning notice ❖Appeal against disciplinary action  DUTIES OF MEDICAL PRACTITIONERS TOWARDS PATIENT 1. Treatment of patient is implied 7. Right to choose a patient contract 8. Duty to give proper directions 2. Duty to sick 9. Duty to offer proper regime of 3. Duty to continue treatment treatment 4. Duty to earn confidence 10. Duty to notify communicable 5. Duty to children and infirm. 6. Charge for professional service diseases. 11. Examination and consent 12. Duty as regards result of examination.  Professional secrecy Privileged communication - bonafide statement of a registered medical person on a subject matter of public interest to the concerned authority to protect the interest of the community Conditions of privileged communication 1. Infectious diseases 2. Venereal diseases 3. Employers & employees 4. Notifiable diseases 5. Suspected crime 6. Patient’s own interest 7. In courts of law  DUTIES OF MEDICAL PRACTITIONERS towards state 1. Notification of infectious diseases 2. Notice to police 3. Notification of births and deaths 4. Issuing of certificates 5. Respond to emergency military services  DUTIES OF MEDICAL PRACTITIONERS towards one another 1. Extend same honour, respect & good behavior as expected from them. 2. Should not do or utter anything to lower down the name of colleagues. 3. Should not entice patients away from colleagues 4. Free medical service to fellow colleagues  Professional Misconduct Conduct considered as disgraceful or dishonorable by professional breathern of good repute and competency Issue of false medical certificates Covering up unqualified persons Helping quacks To prescribe habit forming drugs Disclosing professional secrets of patients Failure to notify Treating patients under the influence of drink or drugs Fee splitting/dichotomy  Professional Negligence(malpraxis) Negligence - doing something that one is not supposed to do, or failing to do something that he is supposed to do. Professional negligence - absence of reasonable care and skill, or wilful negligence of a medical practioner in the treatment of patient which causes bodily injury or death of patient  Misadventure Dangerous unforeseeable effects, following use of some procedure, measures or drugs ❖ Therapeutic ❖ Diagnostic ❖ Experimental  consent INFORMED CONSENT Agreement, compliance or Nature of ailment or disease process permission given voluntarily Nature and plan of proposed line of without compulsion treatment ▪ Express Alternative form or line of treatment - verbal Nature of risks involved in both - written Relative chances of success, benefit, ▪ Implied burden or failure Freedom of choice ▪ Consent in writing ALWAYS before medico legal examination ▪ Express consent ALWAYS before any procedure beyond ordinary medical examination ▪ Open Consent ▪ A child below 12 yrs can not give valid consent ▪Father and mother ▪The adopted parents ▪Loco parentis EUTHANASIA Mercy killing the Yemeni law, Islamic and Arab countries and most of the world It is not permitted and some considered as a crime  scientific journal article??? Important notes: 1. Write an article that does not exceed 3 sheets Medical misadventure vas and avoid intellectual exaggeration. Professional Negligence? 2. It must include the (objective ) of the article 3. It must be supported by pictures and examples 4. Finally, the research must include (Reference)  Public health L.5 Preventive medicine and health care Prepared by : Dr. Mokhtar Amdeb The Royal College of Pediatrics and Child Health  Basic concept of preventive medicine Preventive medicine is the practice of promoting preventive health care to improve patient well-being. The goal is to ultimately prevent disease, disability, and death. Preventive medicine based on the principle of ‘prevention first’, is a science of study on the relationship between the external environment and human health, is a complete course system that consist of the environmental and occupational hygiene, nutrition and food hygiene, community medicine, medical statistics and epidemiology.  Importance of preventive medicine: By traditionally focusing on the diagnosis and treatment of disease, western medical education and medical practice have tended to obscure the importance, scientific basis, and clinical process of promoting the overall health of individuals. Diagnosis and treatment of disease will always be important aspects of health care, but increasing emphasis is also being placed on the preservation and enhancement of health. There are specialists who undertake research, teaching, and clinical practice in the field of preventive medicine, but prevention is no more the exclusive province of preventive medicine specialists than, for example, the care of older people is limited to geriatricians. On the contrary, prevention should be incorporated into the practice of all physicians and other health care professionals. ❑ Cost saving. ❑ Improved health outcomes. ❑ Empowerment and personal responsibility. ❑ Population health. ❑ Long-term Sustainability. Prevention aims to increase the likelihood that people will stay healthy and well for as long as possible.  Primary subject of Modern Medicine: Modern Medicine refers to the drugs, devices, medical Preventive Clinical procedures, and supportive systems utilized in healthcare, medicine medicine encompassing diagnostic, preventive, therapeutic, and Modern rehabilitative technologies in the context of Computer medicine Science Basic Topic of modern medicine: medicine involves the use of drugs and surgeries to help and cure the disease or solve the problem of the patient.  Preventive Medicine: Preventive medicine is that part of medicine engaged with preventing disease rather than curing it. It focuses on entire populations rather than on individuals. These can be as small as a local neighborhood or as big as an entire country Preventive Medicine vs Clinical Professionals: Preventive medicine professionals try to prevent problems from happening or re-occurring through implementing: educational programs, developing policies, administering services and conducting research. In contrast clinical professionals, such as doctors and nurses, focus primarily on treating individuals after they become sick or injured. But both go hand in hand as - at times treating a disease contributes to preventing it in others during the outbreak of an infectious disease  Preventive care / Preventive medicine Examples Preventive care examples: ❑Blood pressure tests.( one of the most important screening methods to identify risk factors for serious disease). ❑Diabetes screening. ❑Routine vaccinations. ❑Cholesterol tests ❑Cancer screenings. ❑STD screenings. Preventive medicine includes: Occupational Health Medicine. Environmental Health. Nutrition and Food Hygiene. Community medicine. The Methodology of Preventive Medicine: 1- Epidemiology: ✓Surveillance ✓Investigation ✓Analysis ✓Evaluation 2- Biostatistics. ✓Descriptive ✓Inferential.  Achievements of Preventive Medicine: Improved the quality of life. Increase in life expectancy. World- wide reduction in infant and child mortality. Elimination or reduction of many communicable diseases. Since 1900, the average life expectancy for Americans has increased by 30 years. 25 of the 30 years is credited to public health initiatives while medical advances account only for less than 4 years.  Notable public health achievements in the 20th century: 1. Vaccination –immunization. 8. Family planning. 2. Motor-vehicle safety. 9. Fluoridation of drinking water. 3. Safer workplaces. 10. Recognition of Tobacco use as a health hazard. 4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and stroke. 6. Safer and healthier food. 7. Healthier mothers and babies. Our Job is not Finished yet: Public health faces new challenges: New infections (such as SARS/COVID-19) Chronic disease (Obesity and Diabetes) Cancers Bioterrorism Behaviors (smoking, eating) Health access. others Actual Causes of Death:  Spread of Infectious Disease 1.Environmental Conditions Favoring the Spread of Infectious Disease: Globalization of the food supply. (Food safety standards) Development projects that alter the habitat of disease carrying insects and animals. Increased human contact with the wilderness habitat that may harbor unknown infectious agents. Increased use of antimicrobial agents and pesticides hastening resistance. 2.Demographic Conditions Favoring the Spread of Infectious Disease: Demographic mean : the statistical characteristics of human populations (such as age or income ,etc) used especially to identify markets. Population growth and movement due to man-made and natural disasters. Global travel. Human behaviors such as intravenous drug use and risky sexual behaviors.  Levels of prevention classified 4 stages: 1. Primordial prevention. 2. Primary prevention. 3. Secondary prevention. 4. Tertiary prevention.  1. Primordial Prevention Prevention of emergency or determine the development of risk factors in population groups in which they have not yet appeared. (but expected) E.g. lifestyle disease. Intervention : Health education.  2. Primary prevention: Action taken prior to the onset of disease , which removes the possibility that a disease will occur and management risk factors. Intervention : in the pre-pathogenesis phase. Elimination or modification of risk factors. e.g. Communicable disease and NCDs (non Communicable disease). Approaches for primary prevention : A. Population (mass) strategy. B. High-risk strategy. 3.Secondary Prevention Action which halts the progress of a disease at its incipient stage and prevents complications. Screening for asymptomatic early disease. Intervention in early pathogenesis phase. ▪ Early diagnosis and adequate treatment. Largely the domain of a clinical medicine. Drawbacks: ▪ Already there is suffering of mental anguish , Pain. ▪ Loss of productivity. ▪ More expensive and less effective. Examples include: Regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer).  4.Tertiary Prevention All measures available to reduce or limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote the patient’s adjustment to irremediable conditions. Intervention in late pathogenesis phases to prevent sequelae and limit disability. Improved management for patient with established disease. Examples include : Cardiac or stroke rehabilitation programs. “It's often recommended after a heart attack or heart surgery. Cardiac rehabilitation involves exercise training, emotional support and education.  Preventive Medicine Preventive medicine is the practice of promoting preventive health care to improve patient well-being. The goal is to ultimately prevent disease, disability, and death. The Aim of learning To establish the idea of prevention-first and could use the strategy of “three preventive health care ” to deal with the health-related problems. To understand the relationship between the environment and health and the harmfulness of major environmental factors. To know the basic theory and skills to prevent the disease and promote the health of the individual and the population. The Three tier system of health care in H.Fs: Levels of Health care : 1. Primary health care. 2. Secondary health care. 3. Tertiary health care. The Three tier system of health care in H.Fs:  1. Primary health care: The “first” level of contact between the individual and the health system. Essential health care (PHC) is provided. A majority of prevailing health problems can be satisfactorily managed. The closest to the people. Provided by the primary health units. Primary care providers may be: Doctors Nurse practitioners Physician assistants  2.Secondary health care More complex problems are dealt with. Comprises curative services Provided by the district hospitals The 1st referral level Specialists focus either on a specific system of the body or a particular disease or condition. Examples of specialists include: Cardiologists, who focus on the heart and blood vessels Endocrinologists, who focus on hormone systems, including diseases like diabetes and thyroid disease Oncologists, who specialize in treating cancers, and many focus on a specific type of cancer  3.Tertiary health care” Offers super-specialist care Provided by regional/central level institution. Provide training programs Examples of medicine and procedures performed at tertiary care centers include: Plastic surgery Neurosurgery Organ transplants Head and neck oncology Perinatology (high-risk pregnancies) Neonatology ICU (high-risk newborn care) Trauma surgery High-dose chemotherapy for cancer Dialysis Coronary artery bypass graft (CABG) Burn treatment PRIMARY HEALTH CARE DEFINITION/ELEMENTS /PRINCIPLLES  WHAT IS PRIMARY HEALTH CARE ? Primary health care is essential health care made universally accessible to individuals and acceptable to them, through full participation and at a cost the community and country can afford. ELEMENTS OF PHC: Promotive: Health Education Curative: Food supply & proper nutrition Treatment of common diseases & injuries Maternal & Child care Provision of essential drugs. Preventive: Immunization/vaccination. Additional elements: Prevention & control ▪ Dental care of locally endemic diseases ▪ School health Adequate supply of safe water & basic sanitation ▪ Home health care  Promotive PHC : primary health care ❑Health education: To induce changes in the peoples Knowledge, Attitudes, & Behavior to enable them to have a healthy lifestyles. Antenatal class School visit International health days ❑Maternal & Child care : ❖Maternal care: Healthy baby in a hand of healthy mother Health Education Early detection Reduce Infant & Maternal Mortality Remove anxiety and fear associated with pregnancy Promote mutual trust ❖Child care: Well baby Comprehensive health care Assess Growth & development Early referral Health Education Promotive PHC : primary health care ❑ Food supply & proper nutrition Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non- communicable diseases (such as diabetes and cardiovascular disease), and longevity. Healthy children learn better Preventive PHC : primary health care ❑Immunization/vaccination: New healthy generation Achieve 100% coverage Minimize efforts & cost ❑ Prevention & control of locally endemic diseases: Pre-school examination Sport fitness examination Screening Health Education Immunization campaign ❑ Adequate supply of safe water & basic sanitation Water analysis Curative: PHC : primary health care ❑Treatment of common diseases & injuries ❑ Provision of essential drugs. Emergency: 24 Hours emergency services Referral service Pharmacy: Provision of essential drugs Drug formulary  Continuous medical education: Training Centre Daily Education Support services: Weekly activity Medical Records Educational Programs X-Ray Nursing care: Laboratory Measuring vital sign Secretarial Prepare patient examination Maintenance Dressing Transport Health Education Computer system Sterilization Dining Attend well baby clinic Housekeeping  Additional elements of PHC: ❑Dental care "Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. ❑ School health Healthy Schools ; Promoting Healthy Behaviors · Data and Research ; Managing Health Conditions · Training and Professional Development ; Assessing School Health. ❑Home health care also known as domiciliary care, personal care or social care, is health care or supportive care provided in the individual home where the patient or client is living, generally focusing on paramedical aid by professional caregivers, assistance in daily living for ill, disabled or elderly people, or a combination thereof. Community participation: Liaison with community Leaders Friends of the Centre Committee Liaison with School Healthy Women Group Liaison with Preventive Medicine Liaison with Joint Program What Is a Community Liaison? A community liaison, or community liaison officer (CLO), interacts with a local community on behalf of an organization, such as a police department, school, or charity project. Their duties include providing information, translation, or training to people in the community.  Essential Elements of Primary Health Care (PHC): 1. Education. 2. Water and sanitation. 3. Nutrition. 4. Maternal and child health. 5. Immunization/vaccination. 6. Prevention of endemic disease. 7. Treatment & Drug availability  Primary health care (PHC) PRINCIPLLES: 1. Equity in distribution: Services to all & more services to the needy 1.Equity in 2.Appropriate 2. Appropriate Technology: distribution Technology That the people can use & afford. 3. Multisectoral approach: 3.Community 4.Community Municipalities, Ministry of agriculture, Education participation: participation: 4.Community participation: - Social awareness & community self-reliance. - The people have the right and duty to participate in the 5.Support process for the improvement and maintenance of health. from higher levels of care: 5.Support from higher levels of care: - Hospitals has to share the social goal of making essential health services. - Referral  WHO STRATEGIES OF PHC: 1. Reducing excess mortality of poor marginalized populations: PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations. 2. Reducing the leading risk factors to human health: PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations. 3. Developing Sustainable Health Systems: PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served. 4. Developing an enabling policy and institutional environment: PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy.  THE BASIC REQUIREMENTS FOR SOUND PHC (THE 8 A’S AND THE 3 C’S): 1. Appropriateness 2. Adequacy 3. Affordability 4. Accessibility 5. Acceptability 6. Availability 7. Assessability 8. Accountability 9. Completeness 10. Comprehensiveness 11. Continuity 1. Appropriateness: Whether the service is needed at all in relation to essential human needs, priorities and policies. The service has to be properly selected and carried out by trained personnel in the proper way. 2. Adequacy: The service proportionate to requirement. Sufficient volume of care to meet the need and demand of community. 3. Affordability: The cost should be within the means and resources of the individual and the country. 4. Accessibility: Reachable, convenient services Geographic, economic, cultural accessibility. 5. Acceptability: Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers. 6. Availability: Availability of medical care means that care can be obtained whenever people need it. 7. Assess ability: Accessibility means that medical care can be readily evaluated. 8. Accountability: Accountability implies the feasibility of regular review of financial records by certified public accountants. 9. Completeness: Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation. 10. Comprehensiveness: Comprehensiveness of care means that care is provided for all types of health problems. 11. Continuity: Continuity of care requires that the management of a patient’s care over time be coordinated among providers. Write assessment about : -one sheet just A: Write about importance of vaccination and how can save from most serious infectious disease B: write the Immunization (vaccination) Routine used in Yemen Country , mention the types and detect the time of used with the rout of using. Vaccination Time (Age used) Rout (e.g.) IM Send your summary ,typing your name on it , to this Email below , End period 20th November : [email protected]  Public health L.6 Nutrition in health and disease Prepared by : Dr. Mokhtar Amdeb The Royal College of Pediatrics and Child Health  Background of nutrition in health and disease Nutrition is the science of food and its relationship to health. Food plays an important role in health as well as in disease. With the current increase in lifestyle disorders around the world, it is important to promote healthy nutrition in all age groups. Improving eating habits is not just for an individual but for the whole population. Nutrition is double edged sword as both over and under nutrition is harmful to health. Modern nutrition science began in the 1910s as individual micronutrients began to be identified. The first vitamin to be chemically identified was thiamine in 1926, and vitamin C was identified as a protection against scurvy in 1932. The role of vitamins in nutrition was studied in the following decades  Under nutrition is particularly harmful in early age groups i.e. childhood and over nutrition in adulthood and after-years but both forms are likely to affect all age groups in near future. Some important diseases like malnutrition are obesity caused by excess energy intake, anemia caused by insufficient intake of iron, thyroid deficiency disorders due to deficiency in iodine intake and impaired vision because of inadequate intake of vitamin. So , Nutrition is defined as the science of how we take in food and that food is utilized by our body. Disease affects all three aspects of the health triangle. Good nutrition provides a mechanism to promote health and prevent disease. Importance of good nutrition Food provides us energy to promote and maintain tissue growth, and to regulate body processes. Nutritious food is cornerstone of health. Therefore, food should supply necessary nutrients in sufficient amounts to meet the body’s needs. Nutrition is related to improved infant, child and maternal health, stronger immune system to fight diseases, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as diabetes, stroke and cardiovascular disease) and longevity. Exclusive breastfeeding in first 6 months of life is essential to lay down the foundation stone for future years. Breastfeeding has a number of advantages like lower risk of diarrhea, respiratory tract infections, sudden infant death syndrome, allergies (e.g. asthma), obesity, Type 1 & 2 diabetes in later life, etc. It offers protection to mother against breast and ovarian cancer, and hip fractures in later life. Recent evidence has demonstrated an association between prolonged breastfeeding and decrease postmenopausal risk factors for cardiovascular (CV) disease. What is Nutrition? Definition: “ Nutrition may be defined as the science of food & its relationship to health”. It is concerned primarily with the part played by nutrients in body growth ,development & maintenance. Good Nutrition means: “ Maintaining a nutritional status that enables us to grow well & enjoy good health” What are Nutrients? Definition: “ Nutrients are organic & inorganic complexes contained in food” They are classified as Macronutrients Micronutrients Types of Nutrients Macronutrients Micronutrients Proteins, Fats, carbohydrates are They are required in small called as macronutrients amounts that is why called as because they form main bulk of micronutrients. food. ▪ Protein ( 7- 15%). ▪ Vitamins. ▪ Minerals ▪ Fats ( 10-30%). ▪ Carbohydrates ( 65-80%). Balanced Diet Diet consisting of adequate amounts of all the necessary nutrients recommended for healthy growth & for efficient daily activities & Functions. A balanced diet contains the proper quantities & proportions of the needed nutrients to maintain good health. It must have balanced amounts in proper proportions of carbohydrates, fat, proteins, vitamins, minerals & water intake. WHO Recommended Dietary Goals 1.Energy intake (calories) should be in balance with energy expenditure. 2.Intake of free sugars. 3.Salt intake. 4.Protein intake. 5.Carbohydrates intake 6.Restricted Diet. 1. Energy intake (calories) should be in balance with energy expenditure. ✓To avoid unhealthy weight gain, total fat should not exceed 30% of total energy intake. ✓Intake of saturated fats should be less than 10% of total energy intake. ✓Intake of trans-fats less than 1% of total energy intake. ✓Unsaturated vegetable oils should be substituted for the remaining fat requirement. 2. Intake of Free sugars Limiting intake of free sugars to less than 10% of total energy intake is part of a healthy diet. A further reduction to less than 5% of total energy intake is suggested for additional health benefits. 3. Salt Intake Keeping salt intake to less 5 g per day (equivalent to sodium intake of less than 2 g per day) helps to prevent hypertension, & reduces the risk of heart disease & stroke in the adult population.  4. Protein Intake Protein should account for approximately 10 – 15 % of the daily intake. 5. Carbohydrates intake Excessive consumption of refined carbohydrates should be avoided, some amount of carbohydrates rich in natural fiber should be taken. 6. Restricted Diet Junk foods such as colas, ketchups & other foods that supply empty calories, should be reduced. Sources rich in energy such as fats & alcohol should be restricted. Proteins “ proteins are complex nitrogenous compound , composed of carbon, hydrogen, nitrogen & sulfur in varying amounts” Proteins: Composition Proteins are made up of smaller units called AMINO ACIDS : Essential Amino Acids. Non-Essential Amino Acid. Sources Animal Sources: Milk, meat, eggs, cheese, fish & fowl. Vegetable Sources: pulses, cereals, beans, nuts, & oil seeds. Functions Provides amino acids which are the building blocks of body. Form collagen & have role in repair & maintenance of body tissues. Maintenance of osmotic pressure, synthesis of certain substances like antibodies , plasma proteins, hemoglobin & enzymes. Proteins are also connected with immune mechanism of body. Daily requirements 75 gm Proteins & Disease Kwashiorkor is result of protein deficiency. Delayed eruption & hypoplasia. Cementum deposition is retarded. Resorption of alveolar bone FATS “ Fat are greasy substances found in the tissues of animals & some plants. Fats & oils are concentrated forms of energy. Fats yield fatty acids & glycerol on hydrolysis ” FATS: Composition Fats are hydrophobic hydrocarbon molecules consisting of fatty acids & glycerol. Glycerol has three carbons, each of which is attached to a hydroxyl group. Most fats are formed through replacement of the hydrogen of each hydroxyl group by a fatty acid. Sources Animal Sources: Chee, Butter, Milk, Cheese, Eggs & Fat of meat & fish. Vegetable Sources: Ground nut, mustard, sesame, coconut. Functions They are high energy foods thus provide energy. Fat beneath skin provides insulation against cold. Serve as vehicles for fat soluble vitamins. Fats on the body support viscera such as heart, kidney & intestine. Essential fatty acids are needed by body for growth , for structural integrity of cell membrane & decrease platelet adhesiveness. Daily requirements 55 gm Proteins & Disease Obesity. Phrynoderma. Coronary heart disease. cancer Carbohydrates “ A large group of organic compound that includes sugars, starch, cellulose, containing hydrogen & oxygen in the same ratio as water (2:1) & used as structural materials & for energy storage within living tissues ” Carbohydrates : Composition A carbohydrate is a naturally occurring compound , or a derivative of such a compound , with the general chemical formula Cx(H2O), made up of molecules of carbon (C) , hydrogen (H) , & oxygen (O). Carbohydrates are the most widespread organic substances & play a vital role in all life. Sources Bread, beans, milk , potatoes, cookies, spaghetti , soft drinks, corn, &cherry pie. They also come in a variety of forms. The most common & abundant forms are sugars, fibers, & starches. Functions Oxidation of fats. Synthesis of certain non-essential carbohydrates. Synthesis of ground substance of the connective tissues like chondroitin, keratin & dermatan sulphates. Daily requirements 225-325gm Proteins & Disease Deficiency of carbohydrates is not experienced much as they found abundantly in most of the foods Vitamins “ vitamin is an organic molecule that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism” Types of vitamins ❑Fat Soluble Vitamin: are absorbed along with fats in the diet & are stored in the body’s fatty tissue & in the liver. They are found in many plants & animal foods & in dietary supplements. Vitamins A, D, E & K are fat soluble ❑ Water Soluble Vitamin: are carried to the body’s tissues but are not stored in the body. They are found in many plants & animal food & in dietary supplements & must be taken in daily. Vitamins C, & members of the vitamins B complex are water soluble Deficiency Fat soluble vitamins Night Blindness Failure of bone Reduced calcification, rickets in children ,osteomalacia resistance to in adult infection A D E K Degenerative lesion of Scurvy. skeletal muscles & heart. Hemolytic & hypoplastic Poor wound anemia. healing. Anatomic changes in nervous Bleeding gums system Water soluble vitamins Vitamin Actions Sources Deficiency B1 Co-enzyme in carbohydrate Enriched breads, cereals, Beri-Beri metabolism legumes, seeds, nuts Wernicke’s Korsakoff. Syndrome in alcoholism. B2 (Riboflavin) Co-enzyme in fat & protein Enriched & whole grains, Ariboflavinosis with glossitis, metabolism meats, liver, eggs, dairy cheilitis & seborrheic products, fish, poultry, dark dermatitis. leafy vegetables. B3 (Niacin) Co-factor to enzymes Meats, poultry, fish, whole & Pellagra, toxicity leads to involved in energy enriched breads, cereals , vasodilation , liver damage, metabolism glycolysis & milk. gout & arthritic syndromes. tricarboxylic acid cycle B6 (pyridoxine) Coenzyme in energy Meats, poultry, fish, whole & Altered nerve function. metabolism, antibody & enriched breads, eggs. hemoglobin formation Folic Acid (Folate) Coenzyme metabolism, fetal Green leafy vegetables, Megaloblastic Anemia neural tube formation. legumes, citrus fruits  Fat Soluble Vitamins A D E k Vision Strengthen bones Reproduction Calcium Immune system. Bone Health absorption Flushes Toxins Immune system Blood Clotting Immune system Bone Health Skin  Minerals “ Minerals make up about 4 % of body weight. There are more than 50 chemical elements found in the human body which are required for growth, repair & regulation of vital body function” Minerals Major Elements Trace Elements These are required from dietary These are required by body in sources in amounts greater than quantities of less than a few 100g per day milligrams per day Calcium, phosphate, sodium, Iron, iodine, fluorine, zinc, coper, potassium, magnesium, cobalt, chromium, manganese, molybdenum, selenium, nickel, tin, silicon & vanadium.  Nutritional problems in public health 1.Low Birth weight. 2.Protein Energy Malnutrition. 3.Iron Deficiency Anemia(type of Nutritional Anemia.) 4.Iodine Deficiency Disorders (IDD). 5.Xerophthalmia. 6.Dental Fluorosis. 1- Low Birth weight. Low birth weight ( i.e. birth weight less than 2500g) is a major public health problem. Causes of low Birth weight Maternal malnutrition and anemia. Physical labor during pregnancy Illness especially infection, etc. The proportion of infants born with LBW has been selected as one of the nutritional indicators for monitoring progress towards” Health for All “ by the year 2000. 2-Protein Energy Malnutrition. This condition was recognized in the middle of the last century and attributed to dietary deficiency of proteins as well as total caloric intake. The current concept of PEM is its clinical forms – Kwashiorkor & Marasmus Causes: Inadequate intake of food both in quantity and quality. Infections notably diarrhea, respiratory, infections, measles etc. Other contributary factors are poor environmental condition ,large family size, poor maternal health, failure of lactation, premature. 3-Iron Deficiency Anemia Iron is present in foods of both animals and vegetable origin, but it is absorbed well from those of animal origin. Foods relatively rich in iron include red meat (especially liver), dark green leafy vegetables, pulses, and tubers. Absorption if iron can be greatly enhanced by consuming foods of animal origin and also by increasing dietary vitamin C content. The presence of certain substances in cereals and in tea and coffee seriously inhibits iron absorption. Tea and coffee contain significant quantities of absorption-inhibitors and should therefore be drunken 2 hours before or after meals rather than with them. Iron supplementation is needed to reduce the prevalence of iron deficiency anemia  4-Iodine Deficiency Disorders (IDD). Iodine is an important micronutrient. A lack of iodine in the diet can lead to Iodine Deficiency Disorders (IDD), which can cause miscarriages, stillbirths, brain disorders, and retarded psychomotor development, speech and hearing impairments, and depleted levels of energy in children. Iodine deficiency is the single most important and preventable cause of mental retardation worldwide. The diet is likely to be deficient in iodine wherever the soil content of iodine is low such as mountainous regions. In addition, certain foods contain goitrogens – substances that inhibit iodine absorption or utilization – and need to be detoxified before being consumed. Simple measure to prevent IDD is use of iodized salt. Disorders of over nutrition 1- Obesity. 2- overweight  scientific journal article??? Important notes: 1. Write an article that does not exceed 3 sheets 1. Write about the deference and avoid intellectual exaggeration. between Kwashiorkor & 2. It must include the (objective ) of the article Marasmus (at less 5 3. It must be supported by pictures and examples differences? 4. Finally, the research must include (Referrence)