By Z. Delazar. Oregon State University. 2018.

Example: When a person becomes blind due to vitamin A deficiency clindamycin 150mg without prescription, tertiary prevention (rehabilitation) can help the blind or partly blind person learn to do gainful work and be economically self supporting 150mg clindamycin overnight delivery. Write the primary buy clindamycin 150 mg online, secondary, and tertiary prevention strategies for the diseases or conditions listed in the table below? Reservoirs A reservoir is an organism or habitat, in which an infectious agent normally lives, transforms, develops and/or multiplies. All infected humans, whether showing signs and symptoms of the disease or not, are potential sources of infection to others. A person who does not have apparent clinical disease, but is a potential source of infection to other people is called a Carrier. Possible portals of exit include all body secretions and discharges: Mucus, saliva, tears, breast milk, vaginal and cervical discharges, excretions (feces and urine), blood, and tissues. Mode of Transmission 22 Modes of transmission include the various mechanisms by which agents are conveyed to other susceptible hosts. Biological vector: A vector is called biological vector if the agent multiplies in the vector before transmission. Mechanical vector: A vector is called mechanical vector if the agent is directly infective to other hosts, without having to go through a period of multiplication or development in the vector. The vector simply carries the agent by its body parts( leg, proboscis etc) to convey it to susceptible hosts. When pulmonary tuberculosis patients cough, they emit many aerosols which consists the agents of tuberculosis. When another healthy susceptible individual breaths he/she will inhale the droplet nuclei and become infected with tuberculosis. Herd immunity can be defined as the resistance of a population to the introduction and spread of an infectious agent, based on the immunity of a high proportion of individual members of the population, thereby lessening the likelihood of a person with a disease coming into contact with susceptibles. Example - If 90 % of the children are vaccinated for measles, the remaining 10 % of the children who are not vaccinated might 25 not become infected with measles because most of the children (90 %) are vaccinated. The other branch of epidemiology which deals with the causes or determinants of diseases is called Analytical Epidemiology. In Epidemiologic study it is common to specify three characteristics of a person – age, sex and ethnic group or race. Ethnic group and Race: Many diseases differ markedly in frequency, severity, or both in different racial or ethnic groups. Other personal variables: There are also other personal variables that should be considered during epidemiologic studies. An area defined by natural boundaries may have a high or low frequency of certain diseases because it is characterized by some particular environmental or climatic conditions, such as temperature, humidity, rainfall, altitude, mineral content of soil, or water supply. The most common types of periodicity are in relation to seasonal changes, or in relation to changes in the number of susceptible persons in a population. Malaria is one of the example of diseases with seasonal periodicity, where high peaks occur in relation to the rainy season. Epidemic of malaria are common in October and November, when stagnant water bodies are convenient for the breeding of mosquitoes. In cross sectional studies, information about the status of an individual with respect to the presence or absence of exposure and disease is assessed at a point in time. Data can be collected by using questionnaire, interview, self- administered questionnaire, observation, applying laboratory tests etc. Health status of a community is assessed by the collection, compilation, analysis and interpretation of data on illness (morbidity), death (mortality), disability and utilization of health services. Such information is useful for public health planners and administrators for proper allocation of health care resources in a particular community. However, to investigate distributions and determinants of disease, it is also necessary to know the size of the source population from which affected individuals were counted. One of the central concerns of epidemiology is to find and enumerate appropriate denominators in order to describe and compare groups in a meaningful and useful way. It expresses the relationship between two numbers in the form of x: y or x/y X k Example: -The ratio of males to females (M:F) in Ethiopia. It is a specific type of ratio in which the numerator is included in the denominator and the result is expressed as a percentage. Example: The proportion of all births that was male Male births x 100 Male + Female births Rate Rate is the most important epidemiological tool used for measuring diseases. It is 33 the measure that most clearly expresses probability or risk of disease in a defined population over a specified period of time, hence, it is considered to be a basic measure of disease occurrence. Accurate count of all events of interest that occur in a defined population during a specified period is essential for the calculation of rate. Rate = Number of events in a specific period x k Population at risk of these events in a specified Period Example: The number of newly diagnosed pneumonia cases in 1999 per 1000 under five children.

Sreebny correlated the dental caries experience of primary dentition (dmft) of 5 and 6-year- where caries had decreased sugars supply had increased olds with sugar supplies data of 23 countries discount 150 mg clindamycin, and the and in 3 countries sugars declined and caries increased discount clindamycin 150 mg line. For both age groups order clindamycin 150mg with visa, confounding factors such as frequency of intake and use of significant correlations were observed: þ0. In countries with an intake of sugar below 18 kg/person/yr (equivalent to ,50 g/person/d) (n ¼ 21) other than sucrose are contributing to total sugars intake. The countries with sugar supplies in corn syrup (similar to invert sugar) and in other excess of 44 kg/person/yr (120 g/person/d) had signifi- industrialised countries the use of glucose syrups, fruit cantly higher levels of caries. This point is use of fluoride dentifrice and availability of adequate well demonstrated by a later analysis by Woodward and amounts of fluoride in water supplies within countries, Walker who did not find such a strong association confounds the data. In this analysis where one can availability of dietary sugars presume that fluoride was present in the community, no Populations that had reduced sugar availability during the association was found between sugar availability and Second World War years showed a reduction in dental caries levels in developed countries. However, Nada- caries which subsequently increased when the restriction 56 58–60 59 novsky pointed out that the reason for an absence of was lifted. Marthaler analysed availability of sugar in these countries, changing the level data from Switzerland and reanalysed wartime data from of sugar intake by a few kg/yr does not influence the caries Norway and New Zealand to look at annual caries 55 challenge. Woodward and Walker found that sugar increments rather than absolute whole mouth caries availability accounted for 28% of the variation in levels of experience and likewise found that caries increments dental caries. These analyses reported on amount considering the crudeness of the analysis which amount of sugar consumed only and did not investigate relates to different examiners and accuracy of sugar supply the effect of frequency of sugar consumption on caries. Their oral dental caries between 1943 and 1949 in areas of North hygiene was virtually absent and fluoride exposure was England with both high and low water fluoride low. More recently, Miyazaki and Morimoto the same age and socioeconomic background attending reported a significant correlation (r ¼þ0. However, after World War, a reduction in intake of sugar was not an 12 years of age when the children’s association with the isolated dietary change and that intake of other home ended the rate of caries increased to levels observed 75 carbohydrates, e. The evidence concerning intake of starch A weakness of the data from observations of and dental caries will be considered in Section 3. As economic levels in such societies rise, the caemia; hence, all foods containing fructose and sucrose amount of sugar and other fermentable carbohydrates in are excluded from the diet. There is evidence to show that many groups of people with habitually high consumption of sugars also have Human intervention studies levels of caries higher than the population average, for Human intervention studies where intake of sugars has example, children with chronic diseases requiring long- been altered and caries development monitored are rare, 69 term sugar-containing medicines. Environmental partly due to the problems inherent in trying to prescribe 70 exposure to high sugars has also been studied: Anaise diets for the long period of time necessary to measure found that confectionery industry workers had 71% higher changes in caries development. Those that have been dental caries experience than factory workers from other reported are now decades old and were conducted in the 71 industries. Such studies would not be possible vations were made in an era prior to widespread use of to repeat today because of ethical constraints. The study investigated the tooth loss than ship-yard workers, after controlling for effects of consuming sugary foods of varying stickiness confounding factors. Despite reports by parent dentists of restricted intake of sweetened bread), (3) refined sugars with a strong sugars by their children, the low dental caries experience tendency to be retained in the mouth, in-between meals of these children cannot be assumed to be due to low (e. The dietary regimes were given in two sugars intake as other preventive care is likely to be greater periods. It was found that sugars, even when consumed conclusions of the Turku Study are that substitution of in large amounts, had little effect on caries increment if sucrose in the Finnish diet (a high sugar diet) with xylitol ingested up to a maximum of four times a day at mealtimes resulted in a markedly lower dental caries increment for only. It was also found that the increase Cross-sectional comparisons of diet and dental in dental caries activity disappears on withdrawal of caries levels in populations sugars. The study noted that dental caries experience When considering the findings of cross-sectional surveys it showed wide individual variation. The study obviously is important to consider that dental caries develops over demonstrates an effect of frequency of intake which will time and therefore simultaneous measurements of disease be discussed in more detail later. The significance of levels and diet may not give a true reflection of the role of mealtime consumption of sugars is also that salivary flow diet in the development of the disease. It is the diet and rate is greater at mealtimes due to stimulation by other other factors several years earlier that may be responsible meal components and therefore plaque acids may be for current caries levels. This phenomenon The study had a complicated design and subjects were is less of a problem in young children, whose diet may not not randomly assigned to groups (as groups were have changed significantly since the eruption of the determined by wards, to separate dietary regimens). The fluoride concentration in the compared sugars intake with dental caries levels in many drinking-water was 0. All studies varied the complicated nature of the study the conclusions are widely in methodology and means of reporting the valid yet apply to the prefluoride era. Nine out of 21 studies that compared weight of study that was a controlled intervention study carried out sugars consumed to caries increment found significant 26 in Finland in the 1970s. Twenty-three out of effect of almost total substitution of sucrose in a normal the 37 studies that investigated the association between diet with either fructose or xylitol on caries development, frequency of sugars consumption and caries levels found but evidence from the control group can be used as significant relationships and 14 failed to find an indirect evidence for the impact of sugar consumption on association.

Thiocholine then reacts with dithiobisnitrobenzoic acid to form the yellow-colored 2- nitro-5-mercaptobenzoate (23) cheap clindamycin 150mg online. This module aims at providing them with some of this information so as to enable them to recognize food-borne illnesses and outbreaks buy clindamycin 150mg on-line, refer cases for proper therapy (in the mean time providing basic treatment) buy cheap clindamycin 150 mg, and to prevent them from occurring. Early and proper treatment of patients with food-borne diseases helps to reduce the spread of the diseases. Which one of the following statements is true regarding the management of patients with food-borne diseases? If all patients who ate from a similar dish or in similar ceremony got ill with a similar kind of illness, then the problem has high likelihood of being related to: A. Patients who are infected with worms but are not excreting worms in their stools cannot be sources of infection for other individuals. Proper disposal of human excrement helps to reduce the transmission of food-borne diseases by flies to prepared food and also by preventing contamination of soil and vegetations with infective organisms. There are many factors that contribute to this condition, some of which are poor personal hygiene and environmental sanitation, grossly inadequate safe water supply, poor food preparation and storage of food items, and others. Ingestion of poisonous plants intentionally as food items (“guaya”, mushrooms) or unknowingly (mushrooms, etc. Ingestion of food kept in an unsuitable condition for long time after preparation (this creates conducive environment for the flourishing of micro-organisms on the food), especially if it has remained exposed to flies, roaches, etc. Food products are rich in nutrients required by microorganisms, which may lead to multiplication of the organisms to great extent if contaminated. Major contamination sources for foods include (4,7,19): ¾ Water: If a safe water supply is not used in processing and preparation of food it then becomes a source of contamination of the food (chemical or biological agents). Of all the viable means of exposing microorganisms to food, employees are the largest contamination source. These animals transfer contaminants to food through their waste products; mouth, fur, intestinal tract, feet, and other body parts; and during regurgitation onto clean food during consumption. Meat of animals can get contaminated during slaughtering, cutting, processing, storage, and distribution. Other contamination can occur by contact of the carcass with the hide, feet, manure, dirt, and visceral contents. Like wise drugs used to prevent disease and promote growth in animals may also become potential risk for human health due to persisting of these drugs in the meat or milk products. The major ones are: ¾ Preparation of food more than half a day in advance of needs ¾ Storage at ambient temperature ¾ Inadequate cooling ¾ Inadequate reheating ¾ Use of contaminated processed food (cooked meats and poultry, and the like) ¾ Undercooking ¾ Cross contamination from raw to cooked food from utensils, and unhygienic kitchen environment ¾ Infected food handlers or poor personal hygiene of food handlers ¾ Unsanitary dishware, utensils and equipment ¾ Improper food handling procedures such as unnecessary use of the hands during preparation and serving of food ¾ Improper food storage that may lead to cross contamination by agents of diseases (micro-organisms, poisonous chemicals), or exposure to moisture that may facilitate microbial growth ¾ Insects and rodents (4,13). Bacterial Typhoid fever Salmonella typhi and Raw vegetables and fruits, salads, parathyphi pastries, un- pasteurized milk and milk products. Parasitic Taeniasis Taenia species Raw beef, raw pork Amoebiasis Entameba histolytica Any food soiled with feces Ascariasis Ascaris lumbricoides Foods contaminated with soil, specially foods that are eaten raw such as salads, vegetables Giardiasis Giardia lamblia Foods contaminated with feces 131 2. Mushroom Phalloidine and alkaloids Poisonous mushrooms such as species of poisoning found in some poisonous Amanita phalloides and Amanita muscaria mushrooms. Staphylococcal Entero-toxin from Milk and milking products, sliced meat, food poisoning staphylococcus aureus poultry, potato salad, cream pastries, egg salad 2. Botulism food Toxin of Clostridium Home-canned foods, low acid vegetables, poisoning botlinum corn and peas. Bacillus cereus Entero toxin of Bacillus Cereals, milk and dairy products, vegetable, food poisoning cereus meats, cooked rice. Ergotism A toxin (ergot) produced Rye, wheat, sorghum, barley by a group of fungi called clevises purpurea 2. Aflatoxin food Aflatoxin produced by Cereal grains, ground nuts, peanuts, poisoning some groups of fungus Cottonseed, sorghum. Lead, - Fish, canned food poisoning poisoning mercury, cadmium) - Foods contaminated by utensils made or coated with heavy metals Pesticides and - Residues on crops, vegetables, fruits. Diarrhea (watery/mucoid/bloody), tenesmus (painful straining at defecation with sensation of inadequate emptying), abdominal pain, nausea, vomiting, bloating , belching, flatulence, abdominal distention 2. Loss of appetite, loss of general sense of well-being, weakness, unusual hunger sensation, altered taste sensation 3. Symptoms of fluid loss like thirst, weakness, dizziness, low blood pressure, fast pulse rate, poor skin turgor, sunken eyeballs, 6. Passage of worms in the stool and sometimes through the mouth, itching and discomfort in the perianal area 8. Assess the level of dehydration and the presence or absence of visible blood in the stool in all patients with diarrhea; if there are evidences of significant fluid loss or if there is visible blood in the stool, refer the patient immediately to the nearby health center for proper treatment. If a patient has diarrhea, advice him/her to take more of the fluid diets prepared at home such as gruel (“atmit”), tea, soup, boiled milk, etc. If a patient has fever, advice him/her and the family to use mechanical means of cooling the body such as tepid sponging; 4. Advice patients and their families on the importance of proper personal hygienic measures at home, particularly during food preparation, in order to prevent the infection from disseminating to other individuals 3. Provision of information and education on the means of transmission of food- borne diseases and their methods of prevention at household levels such as Proper disposal of human excrement and other wastes, Proper hand washing always after using the toilet and before and during food preparation and serving, Keeping compound sanitation so as to prevent the breeding of flies, rats and roaches, Keeping already prepared food items in the proper place and environmental conditions, Proper cooking of animal foods before consumption, Boiling of milk, 134 Proper washing and cooking of vegetables Other important methods that facilitate the safety of food include the following: - Health education - Good personal and environmental hygiene - Availability of safe, ample and convenient water supply - Training of food handlers and managers on hygienic food preparation and handling - Stringent inspection and control actions - Legislative support (ordinances and codes), licensing - Good-house keeping practices including separate storage and care of toxic chemicals. Education of the public at large on the above issues as well as avoidance of consumption of potentially harmful plants 3.