Topnotch Medical Board Prep - Preventive Medicine & Public Health (April 2024)

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch sin...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Hypertension Screening Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum Prevention of HIV Rh(D) Incompatibility screening Syphilis Screening Tobacco Smoking Cessation 18 years or older Newborns Preexposure Prophylaxis for high-risk persons Pregnant, during first prenatal checkup Asymptomatic, nonpregnant adolescents & adults at risk; Pregnant women Adults, Pregnant Persons Recent PLE question: Most studied preventive measure to help both the mother and child -- Supplementation of folic acid. Dr. Abraham HEALTH PROMOTION • Planned educational, political, regulatory, organizational supports for conditions of living conducive to health of individuals, groups, or communities • Address & prevent root causes of ill health, not just treatment or cure. 3 BASIC STRATEGIES FOR HEALTH PROMOTION 1. Advocate 2. Enable 3. Mediate AREAS FOR PRIORITY ACTION: Build healthy public policy Create supportive environments Strengthen community action Develop personal skills Reorient health services HEALTH PROMOTION STRATEGIES EDUCATIONAL ORGANIZATIONAL LEGISLATIVE COMMUNITY/ SOCIAL ECONOMIC Stress management classes for employees Programs designed to reduce personal vulnerability to crime Annual hearing & vision screening in schools Automobile, bicycle, firearm safety programs Laws requiring use of helmets; laws requiring environmental polluters to measure pollution Organization and training of out of school youth to reduce vulnerability to sex or drug crimes Health fairs at shopping malls Tax incentives to landlords to encourage maintenance of property & reduction of pest infestation Incentives from employers to employees who stay healthy and do not miss work TANNAHILL’S MODEL OF HEALTH PROMOTION Naidoo, Jennie. Foundations for Health Promotion - E-Book (Public Health and Health Promotion. BEHAVIORAL FACTORS IN HEALTH PROMOTION • Primary causes of death in most countries: modifiable lifestyle behaviors e.g., cigarette smoking, poor diet, lack of exercise. • Most common theories for health behavior counseling: A. Health belief model B. Transtheoretical model (stages of change) C. Theory of planned behavior D. Precaution adoption process model E. Social cognitive/social learning theory A. HEALTH BELIEF MODEL Concept 1. Perceived Susceptibility 2. Perceived Severity 3. Perceived Benefits 4. Perceived Barriers 5. Cues to Action 6. Self-Efficacy Definition belief of chances of getting a condition belief of how serious a condition & its consequences are belief in efficacy of advised action to reduce risk or seriousness of impact belief in tangible and psychological costs of advised behavior Strategies to activate "readiness" Confidence in one's ability to take action B. TRANSTHEORETICAL MODEL (STAGES OF CHANGE) Not thinking about changing; active resistance to change. task of physician: 1. PRECONTEMPLATION induce awareness. e.g., Although my doctor advised a healthier lifestyle because of my diabetes, I am contented with my body image and will keep things as they are. 2. CONTEMPLATION Thinking about changing, looking for sources of support, balance pros & cons, setting goals MODEL OF HEALTH PROMOTION e.g., I found out about the negative impacts of being sedentary, but I cannot commit to exercising and decreasing my rice intake. TANNAHILL’S DESCRIPTIVE MODEL Planning to take action • Model widely accepted by healthcare workers. • Three overlapping spheres of activity: o Health education o Prevention o Health protection LEARNING DOMAINS 1. Cognitive – information & knowledge about an aspect of health ~ Knowledge 2. Psychomotor – skill acquisition and reinforcement ~ Skills 3. Affective – habit formation, new practice, behavioural change ~ Attitude SUPPLEMENT: METHODS OF HEALTH EDUCATION 1. Priming – establish mood & content, stir imagination (ice breakers, role playing, storytelling, etc.) 2. Presenting – main content 3. Probing and prying – stretching of mind by asking questions 4. Pinpointing and pondering – summary & conclusion 5. Pursuing – physician supports action and individuality among participants 3. PREPARATION 4. ACTION 5. MAINTENANCE 6. TERMINATION/ RELAPSE e.g., I have decided to cut down my intake of fast food and rice, and maybe even enroll in a gym. I’m planning to enforce changes in my daily schedule. Making a change, learning to control behavior, dealing with barriers e.g., I now go to the gym 2-3x a week and count my caloric intake. I recognize some positive changes, physically and mentally. Staying committed by listing barriers, accepting credit for accomplishment e.g., It is hard but I will keep doing it because now I am able to have my sugar levels controlled even without taking any medication. Termination of undesired behavior, may relapse with abandoning idea of change reverting to pre-contemplation Criteria: • New self-image • No temptation in any situation • Solid self-efficacy • Healthier lifestyle e.g., I now have a normal weight, normal sugar levels, and I feel much better than I did before. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 31 of 79 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. F. PRECEDE-PROCEED MODEL • • • • Most comprehensive, one of the most used Eight-phase framework PRECEDE: structure for planning a targeted & focused program PROCEED: structure for implementing & evaluating program © Topnotch Medical Board Prep STAGES OF CHANGE © Topnotch Medical Board Prep C. THEORY OF PLANNED BEHAVIOR • Key component: behavioral intent • Behavioral intentions influenced by attitude about likelihood that behavior will have expected outcome and subjective evaluation of risks and benefits of that outcome. PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation Social assessment: social problems & needs of a Phase 1 population Phase 2 Epidemiological assessment: health determinants Ecological assessment: behavioral and environmental Phase 3 determinants Administrative & policy factors that influence Phase 4 implementation and match appropriate interventions PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development Implementation: Design intervention, assess Phase 5 availability of resources Process Evaluation: If reaching targeted population and Phase 6 achieving desired goals Phase 7 Impact Evaluation: Evaluate changes in behavior Outcome Evaluation: Decrease in negative behavior, Phase 8 or increase in positive behavior WELLNESS PROGRAMS FOR DIFFERENT AGE GROUPS © Topnotch Medical Board Prpe D. PRECAUTION ADOPTION PROCESS MODEL (PAPM) • How person comes to decisions to take action and how he or she translates that decision into action. • Seven steps: o 1. Ignorance or unawareness o 2. Un-engagement o 3-4. contemplating decision to act o 5. Decision to act o 6. Implementing change o 7. Maintenance of behavior change Components • History and PE • Vaccination • Health Screening • Counselling • Chemoprophylaxis INFANTS AND CHILDREN • History/PE – growth & developmental milestone (see pediatrics handout), length, weight, height measurement, signs of hereditary disorder, hearing & vision test. • Immunizations – (discussed in a separate section – EPI) • Health Screening o Newborn Screening (discussed in a separate section – NBS Program) o Hearing Screening (see Universal Newborn Hearing Screening Program) o Developmental: Denver Developmental Screening Test (DDST-II) o Others: Blood pressure starting at 3 y/o Vision birth to less than 3 y/o, every year Urinalysis 5 y/o > 2 y/o Hyperlipidemia PPD high-risk children © Topnotch Medical Board Prep E. SOCIAL LEARNING AND SOCIAL COGNITIVE THEORY • Three personal cognitive factors affected by environment influence behavior: o Observational learning: if they observe others modeling that behavior and experience subsequent positive rewards. o Outcome expectations: if they believe benefits of performing that behavior outweigh costs. o Self-efficacy: if they perceive they have the capacity to do so • Counseling Birth to 6 months o Nutritional guidance o Psychological development and stimulation o Accident prevention 3-6 years o Separation issues o School readiness o Hygiene o Exercise https://sbccimplementationkits.org/sbcc-in-emergencies/social-cognitive-learning-theory/ TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 32 of 79 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 7 months to 2 years 7-12 years o Weaning o Self-concept o Toilet training o Relationship with peers o Gender Identity o Healthy lifestyle o Oral hygiene o Avoidance of high-risk o Safety issues behaviors • Chemoprophylaxis o Vitamin A for young children DENVER DEVELOPMENTAL SCREENING TEST (DDST-II) • Measure of developmental problems in young children, designed to assess child performance on various ageappropriate tasks and compares child’s performance to that of other children the same age. • 125 tasks, which broadly reflect the following: o Personal-social o Fine motor-adaptive o Language o Gross motor • Target Population: Infants & pre-school (birth to 6 years old) SUPPLEMENT: ADOLESCENTS • History/PE o Growth, sexual maturity, mental, psychological status o BP measurement, skin problems o Risk Assessment (HEEADSSS) § Home & Environment § Drugs § Education / § Sexuality Employment § Suicide / Depression / § Eating & Exercise Self-image § Activities § Safety • Immunization • Health Screening o Hgb at 15 y/o o PPD o Chlamydia for sexually active • Counseling o SAFETEENS (sexuality, accident, abuse, firearms, emotions, toxins, environment, exercise, nutrition, shots/Immunization) BASIC CHILD IMMUNIZATION SCHEDULE • AT BIRTH: BCG, Hep B • 6, 10, & 14 WEEKS: DTaP, HiB, IPV1, OPV1, PCV, Rota o Hep B second dose: 1-2 months o Hep B final dose: > 24 weeks • 6 MONTHS: Influenza • 9 MONTHS: Measles (or 6 months in outbreaks), Japanese Encephalitis • 12 MONTHS: MMR, Varicella, Hep A (inactivated) • 9 YEARS: HPV SUPPLEMENT: QUIZ When is Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine given to pregnant patients? A. 1st trimester B. 2nd trimester C. 3rd trimester D. It is not indicated during pregnancy. Answer: C. 3rd trimester (27-36 wks AOG). Influenza vaccine can also be given during pregnancy. HYPERTENSION • screening recommended for adults ≥18 years • US Preventive Services Task Force (USPSTF) guidelines recommends rescreening EVERY YEAR for o Adults ≥40 years o High-normal BP [130-139/85-89] + overweight/obese • rescreened EVERY 3 TO 5 YEARS: o Adults 18 to 39 years + normal BP + NO risk factors ADULTS • History/PE • Vaccination • Health Screening “ROUTINE” HYPERTENSIVE WORK-UP • ECG, UA, FBS, lipid profile, CBC, BUN, Creatinine, Chest XRay, Na, K, Ca IMMUNIZATIONS IN ADULTS & SPECIAL POPULATIONS RECOMMENDED ADULT IMMUNIZATION SCHEDULE https://qrs.ly/g2eh7qu (simplified version of must-knows) Influenza MMR Varicella Hepatitis A Hepatitis B HPV Tetanus Meningococcal Pneumococcal Zoster All, including pregnant High risk groups (healthcare, students entering college/postgrad) People born 1957 or later with no evidence of immunity Women childbearing age (but NOT pregnant) with no evidence of immunity All without evidence of immunity Traveling, chronic liver disease, IV drug users, HIV, MSM All 18-59 years old Up to 26 years old Every 10 years Pregnant 27-36 weeks AOG Asplenia, immunocompromised 65 years and above Asplenia, immunocompromised, heart/lung/liver/ESRD, DM 50 years and above Immunocompromised Mnemonic May high blood si Kim CHIU! Chemistry: FBS, lipid profile, BUN, Creatinine, Na, K, Ca Hematology, Heart: CBC, ECG Imaging: Chest X-Ray Urine: Urinalysis Dr. Abraham BODY MASS INDEX WHO BMI CLASSIFICATION Below 18.5 Underweight 18.5 – 24.9 Normal weight 25.0 – 29.9 Overweight 30.0 – 34.9 Obese Class I 35.0 – 39.9 Obese Class II Above 40.0 Obese Class III SUPPLEMENT: ASIAN BMI CLASSIFICATION Below 18.5 18.5 – 22.9 23.0 – 24.9 25.0 – 29.9 Above 30.0 • • • • • Underweight Normal weight Overweight Obese Class I Obese Class II Mnemonic for METABOLIC SYNDROME: “W.E.I.G.H.T.” Waist Expanded (≥90 cm in M, ≥80 cm in F) Impaired Glucose (FBS ≥100mg/dL or on meds) Hypertension (SBP ≥130 or DBP >85) HDL low (<40 in M, <50 in F) Triglyceridemia (TG ≥150) Dr. Abraham TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 33 of 79 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. DIABETES MELLITUS • Screening as part of cardiovascular risk assessment is suggested for o adults with hypertension or hyperlipidemia o adults 40 to 70 years with BMI ≥25 kg/m2 • ADA 2022: screen all > 35 years every 3 years o earlier if overweight (BMI>25) + 1 more risk factor for DM • Most common pattern of dyslipidemia in DM: 1. HIGH triglyceride 2. LOW HDL DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS ANY OF THE FOLLOWING: HbA1ca ≥6.5% Fasting Plasma ≥126mg/dL (7.0 mmol/L) Glucose (FPG)b 2-hour plasma glucose ≥200mg/dL (11.1 mmol/L) during 75-g OGTT ≥200mg/dL (11.1 mmol/L) with Random Blood Sugar classic symptoms of hyperglycemia a Perform HbA1C with an assay-standardized method b Fasting: defined as no caloric intake for at least 8 hours c Random: defined as without regard to time since last meal For FPG, 2-gour PG, or A1C criteria: in the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day. IM Platinum. 4th ed. RISK FACTORS FOR DIABETES • Family history of diabetes • Obesity (BMI > 25 kg/m2) • Physical inactivity • Race (Asian, African American) • Previously identified prediabetes state • History of GDM or delivery of baby > 4 kg • Hypertension (BP >140/90) • HDL <35 mg/dl &/or triglycerides >250 mg/dl • Polycystic ovary syndrome or acanthosis nigricans • History of cardiovascular disease • HLA DR3 & DR4 (for Type 1 DM) RECOMMENDED DIETARY ALLOWANCES (RDAS) FOR CALCIUM IN MILLIGRAMS (MG) AGE MALE FEMALE PREGNANT LACTATING 0-6 mos 200 200 7-12 mos 260 260 1-3 yrs 700 700 4-8 yrs 1000 1000 9-13 yrs 1300 1300 14-18 yrs 1300 1300 1300 1300 19-50 yrs 1000 1000 1000 1000 51-70 yrs 1000 1200 >70 yrs 1200 1200 National Institute of Health MALIGNANCIES CANCER PREVENTION • Avoid tobacco (also secondhand smoking) • Physical activity • Healthy weight • Diet rich in fruits, vegetables, whole grains, low in saturated / trans fat • Limit alcohol consumption • Protect against STIs (including HPV vaccine) • Avoid excess sun exposure SUPPLEMENT: MOST COMMON CANCER TYPES • Most common cancer OVERALL: BREAST • Most common cancer in MALES: PROSTATE • Most common cancer in FEMALES: BREAST • Most common cause of cancer DEATHS: LUNG PROSTATE CANCER SCREENING • leading cause of cancer death in men • variability in expert recommendations about age to start screening • Average-risk men o initiate discussion of screening at 50 y/o for average-risk men as long as life expectancy is >10 years HYPERLIPIDEMIA • patients 17 to 21 years undergo one-time screening for hyperlipidemia with a non-fasting non-HDL cholesterol o non-HDL cholesterol: difference bet. total cholesterol & HDL • patients with normal screen before age 21 at HIGH risk*: suggest screening starting at o age 25 for men o age 35 for women *High risk if with >1 risk factor (e.g., diabetes, hypertension, smoking, family history) or 1 risk factor that is severe (e.g., several siblings with coronary heart disease in their 40s or a very heavy smoker) Dr. Mann • patients with normal screen before age 21 & NOT high risk: suggest screening starting at o age 35 for men o age 45 for women OSTEOPOROSIS • Screening for fracture risk: o appropriate history & PE to assess for risk factors o measurement of bone mineral density (BMD) CLINICAL RISK FACTORS FOR FRACTURE • Advancing age • Previous fracture • Glucocorticoid therapy • Parental history of hip fracture • Low body weight • Current cigarette smoking • Excessive alcohol consumption • Rheumatoid arthritis • Secondary osteoporosis (e.g. hypogonadism or premature menopause, malabsorption, chronic liver disease, IBD) • Osteoporosis Screening: BMD Assessment o all women > 65 years o postmenopausal women < 65 years if with risk factors o suggest using dual-energy x-ray absorptiometry (DEXA) of axial sites over peripheral measurements There is some variability in the age at which expert guidelines recommend initiating discussion about screening for prostate cancer, mostly at age 50 or 55 years or, less commonly, age 45 years Dr. Mann • BRCA carriers o BRCA1 or BRCA2 mutations are at increased risk; screening for prostate cancer may begin as early as 40 y/o • Other higher-risk men o initiate discussion of screening at 40 to 45 y/o including: § Black men § Men with family history of prostate cancer, especially 1stdegree relative diagnosed at <65 y/o • PSA testing o alone, as DRE is generally not used as a screening test for prostate cancer ANATOMY/SURGERY CORRELATE PROSTATE CANCER: • Most common lobe: POSTERIOR • Most common zone: PERIPHERAL (Mnemonic: PPP!) SUPPLEMENT: BENIGN PROSTATIC HYPERPLASIA: • Most common lobe: MEDIAN • Most common zone: TRANSITIONAL (Mnemonic: Benign ka pag nag Trans sa Med!) COLORECTAL CANCER SCREENING • average-risk patients 50 years and older be screened for colorectal cancer, suggest screening be continued until life expectancy for patient is estimated as < 10 years • Annual FOBT: greater reduction in mortality rates • Colonoscopy: every 10 years; based on natural history of adenomatous polyps • Sigmoidoscopy, Double contrast barium enema: every 5 years due to lower sensitivity The most frequent site for occurrence of colon cancer: SIGMOID COLON! Dr. Abraham TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 34 of 79 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. CERVICAL CANCER SCREENING • 21–29 y/o: Pap smear every 3 years • 30–65 y/o: Pap smear + HPV (co-testing) every 5 years • It also is acceptable to have a Pap smear alone every 3 years • <21 y/o: Do NOT screen regardless of age at sexual initiation • Post-hysterectomy with removal of cervix and with no history of high grade precancer or cervical cancer: Do NOT screen The most common gynecologic cancer: ENDOMETRIAL! The most common gynecologic cancer causing DEATH: OVARIAN! Dr. Abraham BREAST CANCER SCREENING Average risk women: from age 20, optional; awareness of breast changes is encouraged Monthly breast selfexamination (BSE) Annual clinical breast examination (CBE) Annual mammography from age 25 from age 40 OCCUPATIONAL HEALTH PROGRAMS OCCUPATIONAL HEALTH • evaluation of potential health risk of toxic substances and physical factors for purposes of prevention, treatment, palliation in living & working environments KEY ELEMENTS OF OCCUPATIONAL HEALTH PROGRAM • Health protection o health risk management at work • Health promotion o health risk assessment associated with the environment and lifestyle • Health surveillance o collection of data for detection and evaluation o assist in checking effectiveness of control measures Note: This is a past board exams topic! While Nutrition should be promoted among employees, it is not one of the key elements under the Occupational Health Program. Dr. Tan Women with family history: Monthly breast selffrom age 20, optional; awareness examination (BSE) of breast changes is encouraged every 3 to 6 months no later than Clinical breast ten years before earliest diagnosis examination (CBE) in family 10 years prior to earliest Annual mammography diagnosis in family (but not < 25 y/o & not > 40 y/o) Consider MRI and mammography Annual MRI at alternating six-month intervals The most frequent site for occurrence of breast cancer: UPPER OUTER QUADRANT! (greater amount of glandular tissue) Dr. Abraham QUIZ PREVENTIVE MEDICINE SCREENING What is the best AGE to start screening for the following diseases/populations? _____1. Annual mammography in most women _____2. Osteoporosis _____3. Diabetes mellitus in a patient with BMI 22.5 _____4. Hyperlipidemia _____5. Prostate cancer _____6. Colon cancer _____7. Monthly breast self-exam Anwers: 1. 40y/o, 2. 65y/o, 3. 35y/o, 4. 17-21y/o, 5. 50y/o, 6. 50y/o, 7. 20y/o, FOUR MANDATORY HEALTH PROGRAMS IN THE WORKPLACE • TB in workplace • HIV policy • Hepatitis B policy • Drug-free workplace OCCUPATIONAL DISEASES • Most common occupational diseases (PSA, 2015) o Back pain o Essential Hypertension o Neck-Shoulder pain HAZARD • Any source of potential damage, harm or adverse health effects on something or someone under certain conditions at work HEALTH HAZARDS • Environmental factors, agents, or situations that create potential harm or injury to physical well-being (Talbott & Gunther, 1995) • Often, latency between exposure and disease CLASSIFICATION OF HEALTH HAZARDS Workplace Health Hazards A. Physical Hazard B. Chemical Hazard C. Biologic Hazard D. Ergonomics E. Psychosocial stressors Workplace Safety hazards A. Vehicles B. Workplace violence C. Pressure system D. Fire and explosion hazards E. Slipping/tripping hazards F. Ejection materials TYPES OF HAZARD PHYSICAL CHEMICAL Exposure to various forms of energy Solid, liquid, gas • • • • Noise Vibration Extremes of temp, atmospheric pressure • Defective Illumination • Radiation • • • • Particulate Matter, Gases Vapors BIOLOGICAL Living organisms that adversely affect health • Microbes, parasites, viruses, fungi insects, snakes, dogs, etc. ERGONOMIC By interaction between worker & his/her working environment • Repetitive motions • Improperly designed facilities at work, • awkward positions or postures at work, • speedy physical exertions • static monotonous work • prolonged standing PSYCHOSOCIAL Affects worker’s mental health • High level of concentration, Monotony, Boredom, • low salary, lack of recognition, lack of participation in planning, underuse of skills, • Work overload or underload, shift working, • Poor communication, Poor relationship with superiors, Interpersonal conflict, Bullying, • Harassment Recent PLE question: Jackhammers can cause hand-arm vibration syndrome which affects: PHYSICAL (other choices: chemical, psychological) Dr. Abraham HIERARCHY OF CONTROLS TO HAZARDS • system used in industry to minimize or eliminate exposure to hazards; widely accepted, promoted by safety organizations ELIMINATION SUBSTITUTION ENGINEERING CONTROLS ADMINISTRATIVE CONTROLS Physically remove hazard; should be implemented before all other methods; considered most effective • Designing / Planning a workplace free of hazard if possible Replace material or process with less hazardous process or material Isolate workers from hazard • Water-based paints in place of leadbased paints • Install machine guards that shield workers from airborne emissions • Ventilation systems • Sound dampening materials • Safety interlocks • Radiation protection Change way people work Related to work practice controls or changes in procedures through safety policies & supervision Limits exposure rather than removing hazard • Employee training, signs, warning labels, procedure changes • Working clothing rules • Personal cleanliness • Washroom time allowance • Good housekeeping • Proper waste disposal • Adequate sanitary facilities • Comprehensive information to workers regarding rules and supervision PERSONAL PROTECTIVE EQUIPMENT Easiest, most common; may result in workers being exposed if equipment fails • • • • • • • Gloves Hard hats < 0.45 kg Foot & eye protection, Protective hearing device Respirators Full body suits Safety belts & lifelines National Institute for Occupational Safety and Health (NIOSH) TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 35 of 79