2024 Preventive Medicine & Public Health Handout (PDF)

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. SUPPLEMENT: SPIKES Model for Breaking bad news • Emotions (ADDRESSING THE PATIENT’S EMOTIONS WITH EMPATHIC RESPONSES) - could be addressed by observing, identifying, expressing the emotion. • Strategy and Summary - summary and checking the patients understanding of the illness as well as his plans. FAMILY ASSESSMENT TOOLS • Designed for a systematic way of understanding the family and aid the physician to evaluate the impact of illness on a person and his/her role in the family • Dysfunctional family – family with a chronic inability to responds to the needs of the members or to cope with changes and stresses in the environment FAMILY GENOGRAM • a graphic representation of a: o Family tree § Components of a complete genogram: 1. Information on 3 or more generations, each generation identified by roman numerals 2. First-born for each generation farthest from the left, siblings in right order of birth to the right 3. Family name is placed above each major family unit 4. Names and ages of all family members placed below each symbol 5. Index patient is identified with an arrow 6. Dates of births, marriage, separation, divorce, death, (including cause), and other significant life events 7. Family members who live together enclosed in a circle 8. Address of the index family 9. Date is indicated when chart is developed 10. Informant/s o Functional Chart – Provides a dynamic image of the family members and their relationships o Family Illness/History – can help identify heredofamilial diseases and potential problems in the family • An excellent tool to use in learning about the family structure; more dynamic image of the family, however, has a limited role in assessing family functions o Reveals more subtle information about the family – understanding of multigenerational family systems o May show possible sources of stress The genogram is a very dynamic tool which is why it is important to update / reinterview your patients on follow up since other than the ages, relationships and illnesses may change. • GENOGRAM SYMBOLS Dr. de la Rosa SAMPLE GENOGRAM MINUCHIN FAMILY MAP • Tool designed to reflect family relationships and interaction patterns • Important in identifying a therapeutic ally for healthcare delivery and whom to ask for assistance in making decisions from the patient • Facilitates the communication of information about the family system and its dynamics in order to address psychosocial issues. • Enmeshment – over involvement of family members with each other • Disengagement – members are isolated from each other or have little emotional response to each other • Triangulation – family members talk directly to each other about personal matters. • Coalition – one family member is siding with another family member FAMILY APGAR • 5-item questionnaire that has the adequate reliability and validity to measure one’s level of satisfaction with family relationship • Rapid screening instrument for family dysfunction • Has adequate reliability and validity to measure one’s level of satisfaction with family relationship • Valuable when: o Symptoms that manifest themselves as psychosomatic disorder o Difficult patients o Marital or sexual difficulties o Multiple presentations by multiple family members 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 71 of 77 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. o Drug or alcohol abuse o Evidence of sexual and physical abuse on the wife or a child o Multiple presentations of a family member – “the thick file syndrome” o Family will be directly involved in caring for the patient o Treating a new patient o Treating a patient whose family is in crisis o When patient’s behavior makes you suspect a psychosocial problem possibly due to family dysfunction • Limitations: o Restricted to what the patient is willing to disclose o Measures patient’s satisfaction with family functioning but not the family functioning itself • Components: o Adaptation – capability to utilize and share inherent resources which are either intrafamilial or extrafamilial o Partnership – solving problems by communicating, sharing of decision making and responsibilities o Growth – physical and emotional growth, satisfaction in the available freedom to grow and change o Affection – loving and caring relationship of the family; intimacy and emotional interaction within the family o Resolve – members satisfaction with the commitment made by the members of the family, how time, space, money are shared • Scoring: o 8-10 points: highly functional family o 4-7 points: moderately dysfunctional family o 0-3 points: severely dysfunctional family A dysfunctional family has chronic inability to respond to the members or to cope with changes and stresses in the environment. Dr. Mann • Almost Always (2) FAMILY APGAR Adaptation Some of the time (1) Hardly ever (0) I am satisfied that I can turn to my family for help when something is troubling me Ako’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema Partnership I am satisfied with the way my family talks over things with me and shares problems with me Growth I am satisfied that my family accepts and supports my wishes to take on new activities or directions Affection I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow, and love Resolve Ako’y nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking problema Ako’y nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad Ako’y nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot at pag-ibig. I am satisfied with the way my family and I share time together Ako’y nasisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa isa’t isa. SCREEM (Social, Cultural, Religious, Economic, Educational, Medical) • It is an acronym that represents family resources • Tool where the family physician helps the family members identify and assess their resources to meet a crisis. If there is a lack of resources, it can also serve as a kind of pathology in certain situations • Commonly used when there is a need for long-term care and for difficult and non-compliant patients • Relationship of health behavior, practices and utilization of health services SOCIAL RESOURCES Social interaction is evident among family members. CULTURAL Cultural pride or satisfaction can be identified. RELIGION Religion offers satisfying spiritual experiences. ECONOMIC Ability to meet the economic demands of normal life events and illness. EDUCATION MEDICAL Education of the family members is adequate to allow members to solve or comprehend most of the problems. Medical care is available through channels that are easily established. PATHOLOGY The family is socially isolated from extra familial groups. The family has feelings of culturalethnic inferiority or shame. Dogma and rituals are so rigid that they limit the family’s problem-solving capacity. Financial problems make it difficult for the family to meet monetary demands of crisis or illness. Limit the ability of family members to comprehend the problem or recommend solution. SCREEM-RES • 12-item self-administered family resources questionnaire based on SCREEM • Used to assess the capacity to participate in provision of health care or to cope with crisis • Scoring: o 0 to 6 – severely inadequate family resources o 7 to 12 – moderately inadequate family resources o 13 to 18 – adequate family resources FAMILY LIFELINE • Tool that summarizes the history of the family, particularly significant experiences and how the family coped • Used to show significant events among family members over a period of time in a chronological sequence. • For exploration of certain family issues • The interpretation is based on the most significant that probably affected the health of each member or influenced the healthseeking behavior or perception on health of the individual or the family SAMPLE FAMILY LIFELINE Inaccessible and under-utilized 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 72 of 77 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. ECOMAP • Pictorial representation of family’s connections to persons and/or systems in their environment, representation of family relationships in the household • Three dimensions: o Strength of connection – weak, tenuous / uncertain, strong o Impact of connection – none, draining resources or energy, providing resources or energy o Quality of connection – stressful, no stressful • Domains to be included: neighborhood, community services, social groups, education, significant personal relationships, employment • Necessary and valuable because: o Enables a structured, consistent process for gathering specific, valuable information related to the current state of a family or individual being assessed o Supports the engagement of the family in a dialogue o Identifies and illustrates strengths that can built upon and weaknesses that can be assessed o Summarizes complex data and information into a visual, easy to see and understand format to support understanding and planning o Illustrates the nature of connectedness and the impact of interactions in pre-defined “domain” areas o Provides. Consistent base of information to inform and support intervention decisions o Allows objective evaluation of progress – workers can observe impact of interventions, both on the family and on other elements of their environment o Help support integration of the concept of family assessment as an ongoing process o Reduces narrative in other parts of the family assessment process o Integrates the values and concepts – and the real power of System Theory in a practical way ILLNESS, DEATH, AND DYING SUPPLEMENT: KUBLER ROSS’ STAGES OF DEATH AND DYING DENIAL • common defense mechanism used to protect oneself from the hardship of considering an upsetting reality o Initial reaction of shock o Refusal to believe diagnosis o Thought blocking o Isolation ANGER • commonly experienced and expressed by patients as they concede the reality of a terminal illness o Frustration and irritability towards all the members of the family and even himself and to God BARGAINING • typically manifests as patients seek some measure of control over their illness. The negotiation could be verbalized or internal and could be medical, social, or religious o Attempt to negotiate (with God or the universe) in return for cure, pledge to fulfill promise or make a deal in order to get what is wanted o Guilt is the primary emotion at this stage DEPRESSION • perhaps the most immediately understandable of KublerRoss's stages and patients experience it with unsurprising symptoms such as sadness, fatigue, and anhedonia o Reaction to the effects of illness o Anticipation of the approaching death o Lack of hope o Associated with insomnia or hypersomnia, anorexia, dementia, inability to concentrate, feeling of constant fear ACCEPTANCE • describes recognizing the reality of a difficult diagnosis while no longer protesting or struggling against it. Patients may choose to focus on enjoying the time they have left and reflecting on their memories o Realization that death is inevitable o Importance of company o Going through the process is the best way to cope with a cancer diagnosis MNEMONIC: Ang walang kamatayang “DABDA” Dr. Mann © Topnotch Medical Board Prep ACUTE ILLNESS • Asymptomatic period prior to diagnosis, initial readjustment and coping takes place • It is a form of crisis in the family • Family routine is suspended • High emotions and sometimes can lead to anger especially if the family perceives that care given by the physician is not satisfactory CHRONIC ILLNESS • interval between the initial diagnosis and readjustment period • It promotes prolonged continuation of fear, anxiety and desperation • Because of stress, it can lead to illness also among the other family members • On the part of the patient, feeling of guilt sometimes sets in specially if he/she is the previous breadwinner of the family • Tendency for the family members to be overindulgent towards the patient leading to feeling of overwork and over fatigue TERMINAL ILLNESS • Inevitability of death becomes apparent. Due to possible loss, grief, and mourning may occur • Disclosure is the most difficult time of the entire illness experience • It can either drawn the family members close together or it can lead to further dysfunction among them Note that these stages may occur in any order and usually peak within 6 months following a loss. Somatic symptoms of grief also include insomnia, dizziness, anorexia, nausea, restlessness, generalized weakness, and shortness of breath. Dr. Tan PALLIATIVE & HOSPICE CARE PALLIATIVE CARE • also known as palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family HOSPICE CARE • special kind of care that focuses on the quality of life for people and their caregivers who are experiencing an advanced, lifelimiting illness. Hospice care provides compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible • It is a primary concept of care not just a place of care • Quality rather than the length of life is the primary emphasis • Composed of multidisciplinary team that is available 24/7 • Provides follow up bereavement care for up to 1 year after the patient’s death. BEREAVEMENT CARE • period of mourning after a loss. The hospice care team works with surviving loved ones to help them through the grieving process 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 73 of 77 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. MISCELLANEOUS TOPICS DEATH CERTIFICATES © Topnotch Medical Board Prep MODERN PALLIATIVE CARE APPROACH (FRAGER, 1996) (A) Traditional Approach to Palliative Care. (B) Modern Palliative Care Approach. The traditional approach initiates appropriate and comprehensive palliative care late in the course of the patient’s illness. Modern palliative care is provided to the patient and family at the time of diagnosis of a lifethreatening illness, or even earlier- when it is strongly suspected or considered. Modern palliative care addresses the patient and family’s physical, psychosocial, and spiritual issues and problems that occur during the entire course of the illness, and after the patient’s death. Adapted from J Palliat Med SUPPLEMENT: HOSPICE VS PALLIATIVE HOSPICE • is offered and provided for patients during their last phase of an incurable illness or near the end of life, such as in some people with advanced or metastatic cancer. • is provided when there is no active or curative treatment being given for the serious illness. "Treatment" during hospice care involves managing symptoms and side effects. • A hospice care team coordinates the majority of care for a patient, and communicates with the patient's medical care team PALLIATIVE • can be offered and provided at any stage of a serious illness • can be provided while the patient is receiving active treatment. In other words, it can be given at the same time as chemo, radiation, or immunotherapy for cancer • A palliative care team is separate from the patient's medical care team that's giving and managing treatment for the illness, but communicates with the medical care team https://www.cancer.org/treatment/end-of-life-care/hospice-care/what-is-hospice-care.html Technically, even at the start of the management of a patient (with chronic disease, CVA, etc.), the palliative team should already be onboard para holistic ang management. Unfortunately, here in the country, hindi pa rin ito ang common practice L Dr. Tan • include name of individual, date of birth, date of death • Uses: o Prima facie evidence of death o Claim of benefits, pensions, insurance, or tax exemption o Evidence for settlement of estate o Remarriage purpose of surviving spouse o Designation of guardian or foster parent for minor o Determine health priorities for prevention of deaths o For awareness of family members o indicators of existing infectious diseases & epidemics that need immediate control measures o designing programs to promote public safety & strategies for disease prevention and eradication o administrative purposes, in clearing of files like disease-case registers, social security, military service files, electoral rolls and tax registers o design of programs in public safety, accident prevention and crime eradication o Mortality surveillance, health & epidemiologic research, health planning o Study of mortality differentials o Health decision makers & planners make extensive use of mortality statistics o certified copies of encoded civil registry documents o For burial -- EXCEPT in epidemics wherein death certificates should be secured within five days from day of burial Sanitation Code of the Philippines – P.D. 856 A) No remains shall be buried without a Certificate of Death, which shall be issued by the attending physician. B) If there has been no physician in attendance, it shall be issued by mayor or secretary of the municipality where death occurred. C) The death certificate shall be forwarded to local civil registrar within 48 hours after death. . Dr. Virata • CAUSE OF DEATH: Disease or injury that started the physiological process leading to death • MANNER OF DEATH: refers to circumstances that led to death. Accidents, suicide, homicide and “undetermined” are not causes of death CIRCUMSTANCES WHEREIN A NORMAL DEATH CERTIFICATE CANNOT BE ISSUED: 1. Suspicion of unnatural cause of death (Foul play): perform an autopsy first 2. No medical attendant present at time of death or during last illness 3. When death occurred before full recovery from surgical operation or administration of anesthesia Mechanistic Terminal Events • Terminal or pathophysiologic or biochemical derangements that are common final pathway explaining how a cause of death exerts its lethal effect. • It should never be reported in certificate as cause of death. • Examples: Respiratory arrest, cardiac arrest, asystole, ventricular fibrillation, and cardiopulmonary arrest. MEDICAL CERTIFICATION OF DEATH (handbook, nice to know) https://qrs.ly/n2bpr8w COMPREHENSIVE AND MULTI-DIMENSIONAL APPROACH OF PALLIATIVE CARE Manuel Medina Jr. Manual of Palliative Medicine, 2nd ed. 2007 Part I: IMMEDIATE CAUSE Disease or injury that directly led to death Part II: ANTECEDENT CAUSE Sequelae or complications that gave rise to immediate cause Part III: UNDERLYING CAUSE Root disease; conditions contributing to death but not actually related to immediate cause; most important of three parts* Example: 65-year-old male uncontrolled DM had a CVD which led to his prolonged confinement. During hospitalization, he developed pneumonia and subsequently died. Immediate cause: Antecedent Underlying cause: DM pneumonia Cause: CVD * If all three lines would be filled up, the “underlying cause” would be counted in the cause-of-death statistics. In case only two lines were filled up, the entry in the last line would be considered as the underlying. 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 74 of 77 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. CENSUS • Complete enumeration of a population • By virtue of Republic Act No. 10625 known as Philippine Statistical Act of 2013, censuses in Philippines are administered by the Philippine Statistics Authority (PSA) • First census was conducted 1903 • The 2020 CPH (Census of Population and Housing) is the 15th census of population and 7th census of housing in Philippines TYPES OF CENSUS Defacto Census Dejure Census physical presence is assign individuals in their usual important regardless of residence regardless of where where they usually live they were during the census The POPCEN or Census of Population made use of the de jure concept of enumeration wherein households and persons are enumerated in the area where they usually reside as of the census reference date. Dr. Mann TOTAL POPULATION OF THE PHILIPPINES 109,035,343 (2020 PSA Latest File) 118,236,859 (JANUARY 2024 Worldometer) SWOT ANALYSIS • proactive approach to identify strategies that organizations use to build on strengths, eradicate weaknesses, take advantage of external opportunities, counter threats INTERNAL EXTERNAL • Can be political, economic, sociocultural, technological • Anything outside the organization STRENGTHS Strong attributes of a healthcare team, hospital, organization which help achieve successful outcomes Examples • Skilled workforce • Qualities that distinguish from others • Established name in industry WEAKNESSES OPPORTUNITIES THREATS Characteristics that hinder success; “Achilles’ heel” Unmet needs of patients, gaps in market Things that pose risk to one’s success or growth Examples • Lack established name in healthcare industry • Limited workforce • High staff turnover • Outdated Electronic Medical Record (EMR) • Lacking in research activities Examples • Underserved markets for specific service • increase accessibility of internet services in rural communities • New technology • Social media opportunities/ads promoting practice • Good supply of sponsors & foundations that help finance health services • Positive trends (e.g. Growing popularity of telemedicine services, growing concern for health & selfprotection due to pandemic) • Opportunity to innovate practice Examples • Changes in regulations in healthcare • Financial pressures • New, more innovative competitors • Lacking support from LGU • Bad economy and economic policies PHILIPPINE HERBAL MEDICINAL PLANTS COMMON NAME Bawang Ampalaya SCIENTIFIC NAME Allium Sativum Momordica charantia USE Hypertension, Lowers cholesterol level Anti-diabetes Mentha cordifolia Dizziness, fainting spells, aromatic bath, diarrhea, swollen gum, inflammation, wound and vaginal wash Gaseous distention, rheumatism Peperomia pellucida Lowers uric acid level (arthritis and gout) Lagundi Vitex negundo Akapulko Cassia alata Fever, headache, toothache, cough, asthma Scabies, tinea, ringworm, athlete’s foot NiyogNiyogan Tsaang gubat Quisqualis indica Carmona retusa Blumea balsamifera Bayabas Yerba Buena Pansitpansitan/ Ulasimang Bato Sambong Psidium guajava ✓GUIDE QUESTIONS Michael, 29/M, came to the ER after noting a passage of fresh blood in his urine and recurrent flank pain radiating to the thighs. He is a nonsmoker but with a past medication history of excessive vitamin C use amounting to 4 (500mg) tablets every day to protect himself from COVID-19 as advertised on social media. No fever and (-) CVA tenderness. CT scan was done revealing a 0.5cm x 1cm hyperdense round lesion on the ureter. Aside from antibiotics, and increase fluid intake, what herbal medicine plant will you recommend? No need for home isolation A. Akapulko B. Niyog-niyogan C. Ulasimang bato D. Sambong Answer: D The leaves of Sambong plant has diuretic properties. Dr. Virata BIOLOGICAL WASTE MANAGEMENT DOH Health Care Waste Management Ascariasis and Trichina Abdominal pain Urolithiasis Color of Container/Bag Type of Waste Black Green Non-infectious dry waste Non-infectious wet waste (kitchen, dietary etc.) Infectious and Pathological waste Yellow Yellow with black band Orange Red Chemical waste including those w/ heavy metals Radioactive waste Sharps and Pressurized containers Remember the mnemonic “BABY PLANTS” 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 75 of 77