Comprehensive Review in pre medicine

8/7/2019 Comprehensive Review in pre medicine

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3. SURFACE WATER

- from streams, rivers, ponds, and lakes


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- usually contaminated with various organic and inorganic impurities andwill require treatment to render it suitable and safe for drinking

- treated by slow sand filtration and chlorination

II. NON -CONVENTIONAL SOURCES OF WATER

1) Desalinated water- demineralization and removal of salts specially from brackish or salty water


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- Demineralization processes include:1.1 distillation 1.3 electrodialysis1.2 ion exchange 1.4 reverse osmosis

- Disadvantages1. costly2. requires complicated equipment and highly trained personnel

II. NON -CONVENTIONAL SOURCES OF WATER

2)R

eclaimed waste water- the reuse of treated waste water like sewage effluents after treatment

processes and disinfection


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processes and disinfection- additional treatment processes include:

2.1 rapid filtration2.2 use of activated carbon to reduce further the fine suspended and dissolved solidsand disinfected with chlorine

- Uses of reclaimed waste water 2.2. 1 for industrial processes and as industrial cooling water 2.2.2 for flushing toilets

WATER TREATMENTObjective of Water treatment: To provide a potable water supply

A. Household Method- boiling filtration and/or chlorination


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boiling, filtration and/or chlorinationB. Municipal

- purification systemStandard Water Treatment Process:

1. Coagulation2. Flocculation3. Sedimentation4. Filtration: a. sand filter

b. pressure filter 5. Disinfection: a. Chlorine

b. Iodine

WATER PROTECTION

Water Protection1 Watershed (catchment area) protection from human habitation


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1. Watershed (catchment area) - protection from human habitation2. Proper waste disposal3. Proper construction and protection of wells and springs

4. Proper distribution

Factors affecting the quantity of water required for domestic purposes:

1. its availability2. the water pressure in the distribution system3. the number of plumbing fixtures in the house


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3. the number of plumbing fixtures in the house

R ecommended water tank capacity:1. Residential area: 10 - 15 gal/day2. Industrial area: 100 - 150 gal/day

The following rates of water usage are recommended:1. For urban areas - 180 liters/person/day2. For rural areas:

a) water from public taps - 25 liters/person/day b) in households with water pipe connection - 150 liters/person/day

Health Education


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Russell F. Bernabe, MD

Health Education

- a compound word, Health and Education- should be viewed within


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a. the changing context of health and disease b. the changing health picture where lifestyles play an important rolec. accepted definition of health

Health Education

- it is leading out what people already know and believe and do about their health ; modifying those that are undesirable, and developing desirablebehaviors that are conducive to health


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behaviors that are conducive to health.

- it is a process of providing experiences to people in order that they may beable to define their health problems, personal, family and community -andto take the needed actions for solving these problems

- plays an important role in the Primary level of prevention and is anessential part of the other levels of prevention

Other definitions1. Presidents Committee on Health Education

- a process that bridges the gap between health information and health practices.


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2. Simmonds- a process of bringing about behavioral changes individuals, groups and

larger populations from behavior that are presumed to be detrimental tohealth, to behaviors that are conducive to present and future health.

Other definitions3. Green

- any combination of learning experiences designed to facilitatevoluntary adaptations of behavior conducive to health


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4. National Task Force on the Preparation and Practice of Health Educators- the process of assisting individuals, acting separately or collectively to

make informed decisions about matters affecting personal health and thatof others

Health Behavior

- central concern of Health Education- 3 categories

1 P i H l h B h i


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1. Preventive Health Behavior- for preventing or detecting illness in an asymptomatic

state

2. I llness Behavior- define state of health and to discover suitable remedy

3. Sick R ole Behavior- perception of illness and how to get well- generally involves a whole range of dependent behaviors and leads to some degree of exemptions of

ones usual responsibilities

Foundations of Health Education

1. Philosophical Foundation- serves as proper guide for health educators


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2. Biomedical Foundation- provides content of health education programs

3. Behavioral Science Foundation- theories or methods to bring about behavioral changes

1. Philosophical Foundation1. Health Education should bring about improved health and well being for all through

promotion of healthful lifestyle, community actions for health and conditions thatmake it possible to live healthful lives


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2. While health is obviously the goal, ultimately the end should be humandevelopment.

3. Health education is working with rather than for the people.

4. Intervention strategy should be tailored to address the circumstances of a given population, person or situation

5. Effective health education planning and application involves anticipation of theemerging challenges of the future not just understanding the current healthchallenges

6. The most effective health education is planned and developed by both the healtheducator and the people involved.

7. Appropriately planned health education program yield results.

1. Philosophical Foundation

8. Requirements of successful health education includes:a. financial, political and management supportb careful planning monitoring and evaluation


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b. careful planning, monitoring and evaluationc. intersectoral collaborationd. application of multiple theories and methods

e. participant involvement and qualified personnel9. 3 principal strategies to effectively achieved health education:

a. Advocacy b. empowermentc. social support

2. Biomedical Foundation

- explains illness in terms of biological malfunction rather than multifactorialcauses


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Basic Assumptions:a. The definition of disease as deviation from normal biologic functioning.

b. The doctrine of specific etiology.

c. The conception of generic diseases, that is the universality of diseasetaxonomy.

d. The scientific neutrality of medicine.

Contributions of Biomedical Foundation

1. Identification and repair of biological problems using surgery or medicine

2 Reduction of deaths from infectious diseases


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2. Reduction of deaths from infectious diseases

3. Increased life expectancy because of discoveries of sophisticated

technologies

3. Behavioral Science Foundation- attributes the decline in mortality to rising standard of living which gave rise

to better nutrition and improved environment or personal hygiene.- it includes


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a. The socio -economic and cultural factors associated with health and disease b. The psychological factors associated with health behavior

i. learning processii. Communication processiii. Change process

c. Strategies/interventions to bring about change to include individual,interpersonal and group intervention models

Processes of Health Education

I. Learning ProcessII. Communication ProcessIII Change Process


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III. Change Process

I. Learning ProcessElements of L earning

1. Goal - must be relevant to the needs and concern of the person2. R eadiness - require physical, mental, and emotional preparedness3 Si i id h l i h i bl l i


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3. Situation - provide the learner with viable alternatives4. I nterpretation - acceptance or rejection depends on previous experience5. R esponse - actions depends on the perception and expectation of best results

6. Consequence - result of the response would either be a confirmation or contradiction of expectations

7. R eaction to thwarting - unfavorable consequences leads to exploration of other alternatives (changes in behavior) or lose hope (give up)

Theories of Learning1. Behaviorist theories

2. Cognitive theories3. Humanist theories


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1. Behaviorist theories- Learning results from the association between stimuli and

responses.Example:


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a. Pavlovs Classical Conditioning- pairing of natural stimulus with neutral stimulus will

result to a conditioned responseb. Thorndikes L aw of Exercise and L aw of Effects

i. L aw of Exercise - > frequency of stimulus -responseconnection is used > the association and vice -versa

ii.L aw of Effects stimulus connection is strengthened

with reward and weakened with punishmentc. Skinners Operant Conditioning

- learning takes place when it is followed by reinforcement

2. Cognitive theories- A reorganization of a number of perceptions percolating in the mind of the

learner


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Example:a. Tolmans Cognitive Mapping

- learning is goal directed and needs a semblance of structure

3. Humanist theories- While some form of stimulus -response is also present, they feature the

analyses of the nature of personality and society- Active role of the learner is highlighted


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Example:a. Banduras Social Cognitive Theory

- reciprocital determinism of individual and environment

Parts of Learning Process1. Content

- relevant and meaningful issues are quickly learned2. L earning Situation


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- learning is easy in an appropriate circumstances3. Method

- learning is effective if real learning situations or thosewhich closely resemble them are provided for.

4. People- learning is effective if the individual participation is

enhanced by identifying motivations and skillful usage of

motivations of the learner

II. Communication Process

Definitions:1. The process by which information is exchanged and understood by two or

more people (Daft)


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2. The creation or exchange of understanding between and a receiver ; bothverbal and nonverbal. (Rackick)

3. A process by which people attempt to share meaning via transmission of symbolic message. (Porter and Roberts)

Elements of Communication Process

1. Source/Sender- initiates the process of communication

2. Message


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g- physical form into which the information/idea are encoded

3. Channel

- mode of transmission of the information/idea4. R eceiver

- target of the senders message5. Feedback

- reaction of the receiver

Steps in the Communication Process

1. Thinking- framing of ideas in senders mind

2. Encoding


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g- putting thought into some form

3. Transmitting

- broadcasting the message via some medium4. Perceiving

- incoming communication sensed by senses5. Decoding

- incoming communication transform into some form6. Understanding

Communication Theories

1. The Two Step Flow Theory

2. The Diffusion Process


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3. Communication -Behavior Change Model


1. The Two Step Flow Theory- ideas are disseminated through mass media are received mostly opinion

leaders in the community, who in turn play relay or reinforcement roles


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to influence others and spread ideas through their interpersonalrelationship.


2. The Diffusion Process- acceptance of an idea goes through five stages:a. Awareness


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b. Interestc. Evaluation

d. Triale. Adoption


3. Communication-Behavior Change Model- based on an input output factors relevant for communication

programs in health


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a. Input factors

i. awarenessii. interestiii. evaluationiv. trialv. adoption

Communication Theories3. Communication-Behavior Change Model

a. Output factorsi. exposure to the messageii Attending to it


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ii. Attending to itiii. liking, becoming interested in itiv. comprehending it

v. skill acquisitionvi. acceding to itvii. memory stage of content or agreement to bothviii. information search and retrievalix. deciding on basis of retrieval

x. behaving in accord with decisionxi. reinforcement of desired actsxii. post behavioral consolidating

Principles of Communication

1. People select what they see or hear.2. Interpret selectively what they see and hear.3. Choose what they want to remember and what they want to


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forget.4. Words do not have meanings

5. Meanings are in the people.6. Meaning are in contexts7. Meanings are in relationship

Barriers to Communicationa. Environmental Barriers

i. noiseii. competition for attentioniii time


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iii. timeb. Terminology and Complexity of the Message

- Familiar terminology tend to minimize misunderstanding- more complex message the greater the misunderstanding

c. Personal Barriers- encoding and sending or decoding and receiving message

depends on:

i. frame of referenceii. Beliefsiii.selective perception

Ways to Overcome Barriers to EffectiveCommunication

a. Regulate the flow of information b. Encourage feedback c. Simplify message language


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d. Listen activelye. Restrain emotions

f. Use nonverbal cues

III. Change Process

a. Cognition change- a change in knowledge and/or perception of a person


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b. Attitude change- a change in individuals belies, predispositions, intentions

and tendencies

c. Behavior change- an alteration in an individual/groups knowledge, attitude

and practices

Levels of Change Occurrence

a. I ndividual- a change in knowledge , attitudes, values and behavior of

the individual


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b. Group

- a change in normative beliefs, values and behaviors of thegroup.

c. Society- can be accomplished by a major or pervasive change,

such as legislation, technical innovations and massivemovements.

Elements of Change Occurrence

a. I nnovation- idea, behavior, new technology to affect change

b. Targets of change


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- an individual, group of people, or a communityc. Change agent

- a person or group of person introducing the innovationd. Strategies of change

- deliberate actions, set of activities, approaches, tactics, or processes designed to effect change

Motivation to Change

a. Desire for Prestige- emulation of behavior of prestigious individuals

b. Desire for Economic Gain


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- economic gain is the most important considerationc. Competitive Situation

- competition motivates changed. Obligation of Friendship

- usually a friend cannot be turn downe. Play Motivation

- satisfaction is derived from innovation in the form of playf. R eligious Appeal

- provide emotional attachment to it as sacred undertaking

Strategies/Methods of Health Education

Dominant Dichotomies of Health Education:1. Stress on environmental versus individual change.

- environmentalist places emphasis on the structural factors


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- individualist place emphasis on the responsibility of theindividual

2. Stress on high risk individuals versus whole populationwhere risk is evened out- emphasize the prevention paradox: a large number of people at small risk

may give rise to more cases of disease than a small number who are at high

risk

Classification of Strategies/Methods of HealthEducation

Dominant Dichotomies of Health Education:1. Stress on environmental versus individual change.

- environmentalist places emphasis on the structural factors


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- individualist place emphasis on the responsibility of theindividual

2. Stress on high risk individuals versus whole populationwhere risk is evened out- emphasize the prevention paradox: a large number of people at small risk

may give rise to more cases of disease than a small number who are at high

risk

Family Medicine


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Family Medicine- a discipline in Medicine with distinct core knowledge and

characteristics of care which refers to individuals, family andcommunity;


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- functions with economic, cultural and social environments andresources

Characteristic Family Medicine Care

1. Primary care- first contact

2. Continuing care


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- chronologically- geographically

- interdisciplinary- interpersonal

3. Comprehensive- ecologic factors

Characteristic Family Medicine Care

4. Prevention- emphasis on health education

5. Curative


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- relieve symptoms through early diagnosis and prompt treatment6. R ehabilitative

- enable highest possibility for the patient to return to their usualroutine.

Family Medicine as a Specialty1. Distinguishable body of knowledge

- integration of biological, clinical, and behavioral sciences- curricular framework integrates the elements of traditional clinical

di i li


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disciplines- emphasis on :

a. prevention b. modern epidemiologyc. physiological medicined. socio -cultural factors

Family Medicine as a Specialty2. Unique field of action

- patients cases are undifferentiated and not categorized- encompasses:


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a. all ages b. both genders

c. each organ systems

Family Medicine as a Specialty3. Active area of research

- Potential areas for researcha. Clinical

d l f d


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- Epidemiology of common diseases- Screening for diseases

- Alternative treatment for commondiseases

b. Health Care Delivery- Cost effectiveness of care- Utilization of health services

Family Medicine as a Specialty

c. The Family in Family Medicine

- Family epidemiology- Impact of Illness in the family


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- Effect of family on illness

d. Family Practice Approach- Family therapy- Patient education

Family Medicine as a Specialty4. I ntellectually vigorous training

- emphasis on continuity- multi - and/or inter - disciplinary orientation of training


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Family Medicine- as an academic discipline :

1. centered on the family as a basic social unit.2. it is health oriented


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- emphasizes on

1. disease prevention.2. health maintenance3. curative medicine

Requisites for a Family MedicinePractitioner

- personal attributes of Family Medicine practitioner are perhaps of equal

importance to scientific knowledge

1. Interest in people 7. Sensitivity2 G d j dg t 8 Thi k d d


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2. Good judgment 8. Thinker and doer 3. Broad interest 9. Flexibility

4. Decisiveness 10 .Ease w/ interpersonal relationship5. Assume responsibility 11 .Comprehensive6. Stability

Misconceptions on Family Medicine1. Field of Family Practice

a. Family practice is what any family -oriented practice specialist does b. Patients usually prefer a super specialist when they get sick c. The Family Medicine Practitioner is not well -respected by other


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y p yspecialists

d. Anyone can practice good family medicine without residency training.

c. Degrading attitude in university medical center towards primary andcomprehensive care

Misconceptions on Family Medicine1. Field of Family Practice

a. Family practice is what any family -oriented practice specialist does


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Family physician attends to all members at any stage of illness andrefers to specialty consultants particular problems beyond his range of

competence.

Misconceptions on Family Medicine b. Patients usually prefer a super specialist when they get sick.

Patients evaluate doctors based on availability and personalityrather than on certificates on the walls.


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Attributes patients look for in a Physician (4 Cs)

1. Compassion 3. Competence2. Convenience 4. Cost

Misconceptions on Family Medicinec. The Family Medicine Practitioner is not well -respected by other

specialists

R espect can be earned and acquired.


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d. Anyone can practice good family medicine without residency training.

c. Degrading attitude in university medical center towards primary andcomprehensive careReflects:1. lack of awareness on major objective of medicine2. relative isolation from the needs of the community

Misconceptions on Family Medicine2. Nature of Family Practice

a. Family Medicine physician spends all his time with minor illnessand has to refer the patient who really get sick

b. The Family Medicine Physician will not be given hospitall


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privilegesc. It would be too busy in Family Medicine practice

d. The Family Medicine Physician is for rural areas and not for larger communitiese. Family Medicine Physician earn income below other specialist.

FAM IL Y LI FE CYC L E- represents:

a. composite of the individual developmental changes of the familymembers

b. evolution of the marital relationship


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c. the cyclic development of the evolving family unit.- it provide a predictable, chronologically oriented sequence of events in

family life.- it involves a sequence of stressful changes that requires compensating or

reciprocal readjustments by the family if it is to maintain viability.

STAGES OF THE FAM IL Y LI FE CYC L E

I. Unattached Y oung AdultII. The Newly Married CoupleIII. The Family With Y oung ChildrenIV The Family With Adolescents


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IV. The Family With AdolescentsV. Launching Family

VI. Family In Later Y ears

Family Health Care


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Periodic Health Examination

Periodic Health Examination- a group of tasks designed either to determine the risk of subsequent diseases

or to identify disease in its early, symptomless statebased on the premises that


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- based on the premises that1. asymptomatic individuals can harbor disease

2. examination can detect disease can decrease morbidityand mortality

Periodic Health Examination Protocol20 to 39 years old patients:

1. Physical Examination - every 5 years2. Blood Pressure - annually3. Cholesterol - every 5 years


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4. Breast & Pelvic Exam - every 3 years5. Pap Smear - every 3 years (after 2 yearly negatives)6. Mammography - baseline at 35 years old7. Immunizations - Tetanus/Diphtheria every 10 years


1. Physical Examination - every 3 years

2. Blood Pressure - annually3. Cholesterol - every 5 years


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y y4. Breast & Pelvic Exam - annually

5. Pap Smear - every 3 years (after 2 yearly negatives)6. Mammography - every 2 years7. Occult Blood in stool - every 3 years


1. Physical Examination - every 2 years2. Blood Pressure - annually3. Cholesterol - every 5 years


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4. Breast and Pelvic Exam - yearly5. Pap Smear - every 3 years (after 2 yearly negative)6. Mammography - annually7. Occult Blood in stool - annually8. Proctosigmoidoscopy - every 3 years (after 2 yearly negative)9. Immunizations - a) Influenza - yearly after age 65 years

b) Pneumovax at age 65

Periodic Health Examination Protocol70 years old and over patients:

1. Physical Examination - annually2. Blood Pressure - annually3. Cholesterol - every 5 years


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4. Breast & Pelvic Exam - yearly5. Pap Smear - every 3 years after 2 yearly negative6. Mammography - annually7. Occult Blood in stool - annually8. Proctosigmoidoscopy - every 3 years after 2 yearly negative

Family Health Care- A process encompassing:

a. screening for abnormalities b. early detection of disordersc. prevention of ill -health


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p

Principal Objectives of Family Health Care1. To alert and educate individuals about their roles and responsibilities in

maintaining their own health.2. To detect disease at an early stage to alter its progression.3. To provide entry into health care system4 T i h lth i ll i ll di d t


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4. To improve health care especially among socially disadvantage5. To gain understanding of disease trends both in population and in

individuals.6. To make the best use of proven, cost - beneficial techniques, especially in

screening and early detection.

Components of Family Health Care

I. PreventionII. ScreeningIII. Periodic Health Examination/Early Detection


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Prevention

Categories of Prevention:1. Primary Prevention2. Secondary Prevention3. Tertiary Prevention


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Primary Prevention

- Clinical manifestation of disease is prevented through health promotion andspecific disease protection.

1. Life style


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y- healthy diet - basic living habits

- non -addictive behavior - leisure activity2. Health maintenance

- screening activities - immunizations3. Family life education

- sexuality - marriage

- prenatal care - problems of aged members- personal hygiene and sanitation

Secondary Prevention

- Implies early intervention to detect and treat asymptomatic disease1. Monitoring of well - being by physician and patient.2. Encouraging sick members to sick appropriate help3. Compliance monitoring regarding specific management.


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3. Compliance monitoring regarding specific management.

Tertiary Prevention- Consists of intervention in the setting of established disease to avoid

complications and disability and to assist in rehabilitation.1. Balanced support between compliance monitoring and the appropriate

independent activity of members with chronic illness.d f ll b h d b h ll


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2. Adjustment of all members to changes necessitated by chronic illness in onemember.

3. Coping with crisis created by a serious illness such as congenital anomaly or by a dying family member.

Health R isk

1. Health behavior a. Tobacco use e. Injuries/accidents

b. Alcohol f. Exercisec. Caffeine g. Infectious disease


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gd. Nutrition, diet, and obesity h. Stress

2. Family determinants- family history can help predict future problems

3. Environmental and Community determinantsa. Socio -economic factors

b. Sanitation

Screening- Patients are well or asymptomatic individual.

Criteria for Screening (Frame and Carlson)1. The condition must have a significant effect on quality and quantity of life.2 A t bl th d f t t t t b il bl


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2. Acceptable methods of treatment must be available.3. The condition must have an asymptomatic period during which detection and

treatment significantly reduce morbidity and mortality.4. Treatment in asymptomatic phase must yield a therapeutic result superior

to that obtained by delaying treatment until symptom appear.5. Tests that are acceptable to patients must be available at reasonable cost to

detect the condition in the asymptomatic period.6. The incidence of the conditions must be sufficient to justify cost of screening,

Medical Conditions Appropriate for Screening1. Hypertension

2. Hypercholesterolemia3. Glaucoma4. Hearing deficit5 C i


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5. Carcinomasa. Breast e. Prostatic

b. Cervical f. Endometrialc. Lung g. Ovariand. Colon h. Testicular

6. Infectious Diseases

a. Rubella c. Hepatitis b. Tuberculosis d. STIs

Early DetectionEarly Detection

1. Case finding by survey and selective examination2. use of all available laboratory procedures3. use of consultant specialist in communicable disease


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4. adequate notification of cases5. examination of contacts

Impact of

Illness on the Family


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Disease versus I llness

Disease- primary biologic and psycho - physiologic disorder.

I llness


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- includes the sufferers experience of the disease and the

broad range of dislocations felt by both the sufferer andhis family.

- deeply embedded in the social, cultural and family contextof the person who is ill.

I mpact of I llness1. Sickness of patient causes suffering and severe disruption for the

patients family.

2. Particular illness sets in motion processes that are disruptive of familylife and hazardous to health of family member


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life and hazardous to health of family member.

3. Patients disease is embedded in a whole matrix of difficult family problems that contribute to the disease process itself.

Meaning of I llness for the Family- To discover the meaning of illness:

1. I nvestigate disease examining of the clinical and laboratory evidences of biologic and psycho - physiologic dysfunction.

2. I nvestigate illness exploring the meaning of illness to the patient andpatients family


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patients familya. patients understanding of etiology of his disease

b. its pathophysiology and appropriate treatmentc. trajectory and outcome of his illness

The Family I llness Trajectory

- normal course of the psychosocial aspects of disease for the patient and thefamily

Uses :1. Allows Family physician to predict, anticipate, and deal with a familys


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response to illness.2. Indicates normal and pathologic responses thus enabling family physicians to

formulate special therapeutic plan .

The Stages in Family I llness TrajectoryI. Onset of Illness

II. Impact PhaseIII. Major Therapeutic EffectsIV. Recovery PhaseV Adjustment to the Permanency of the Outcome


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V. Adjustment to the Permanency of the Outcome

I . Onset of I llnessAcute Disease

1. Nature of Onset- rapid and clear onset

2. Characteristics of Experiencea. provide little time for physical and

Chronic Disease

1. Nature of Onset- gradual and insidious onset2. Characteristics of Experience

- suffer from state of uncertainty over meaning and symptom


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psychological adjustment

b. short period between onset,diagnosis and treatment leaveslittle time to remain in a state of uncertainty

3. Impact on Family

- caught up in suddenness to dealwith immediate decision.

meaning and symptom3. Impact on Family

- vague apprehension, anxiety andfearful fantasies over denial of seriousness of

symptom and possible implication

Dysfunctional Family reaction to illness

1. Mistrust and Hostility toward the medical profession2. Issue on legitimacy of sufferers symptoms

Corrective measure:


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1. Explore routinely the explanatory model and fear that patients bring to the

clinic visits2. With inappropriate label of illness, acknowledge and explore conflict the

patient may be suffering.3. Explore several aspects of pre -diagnostic phase of patients and families.

II . R eaction to Diagnosis: I mpact PhasePlanes of R eaction

1. Emotional Planea. Initial phase denial, disbelief, and anxiety

b. Succeeding phase anger, anxiety, and depressionc Last phase accommodation and acceptance


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c. Last phase accommodation and acceptance2. Cognitive Plane

a. Initial phase tension and confusion b. Succeeding phase exacerbation of tension and distressc. Last phase - acceptance

III . Major Therapeutic EffortsCritical I ssues in Choosing Therapeutic Plan1

. Psychologic states of the patients and family determine the choice of therapeutic plans as well as the alternative choices.2. Assumption of responsibility for care early in the treatment plan.3. Economy of treatment plan.


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4. Lifestyle and cultural characteristics of a family

5. Effects of hospitalization, surgery and other therapeutic methodsa. Father special economic burden

b. Mother greatest impact on other family membersc. Children special syndrome of emotional problems

i. children hostility, abandonmentii. Parents helpless, guilt, frustrated, hurt

d. Geriatric vulnerable to fears of death, rejection, abandonment, loneliness

III . Major Therapeutic EffortsR esponsibilities of the Attending Physician:

1. Openness of the Attending Physician to the family.2. Deal with multiple variables3. Work with harmony with patient and family4 Coordinate all aspects of therapy


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4. Coordinate all aspects of therapy5. Anticipate pathologic response which occurs

I V. Early Adjustment to Outcome - R ecovery

Adjustment varies according to the type of outcome anticipated1. Return to full health

- simplest outcome- gains from illness experience


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- patient nurtured and allowed to take over abandoned obligation, new

responsibilities and privileges when sick.2. Partial Recovery

- constant sense of vulnerability due to long period of waiting.3. Recovery is quite different if it requires acceptance of known permanent

disability

I V. Early Adjustment to Outcome - R ecovery

Appropriate reaction of the Attending Physician:1. Deal with the immediate effect of trauma.2. Alleviate anxiety and assure adequate rest3. Provide psychologic support through understanding and repeated reassurance


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4. Explore level of understanding of patient and family (labeling)

V. Adjustment to the Permanency of the Outcome

1. The familys adjustment to the initial crisis.2. The second crisis occurs as family realizes that they have to accept and adjust

to permanency of disability.3. Finally, the family begin and gives up hope for the patients full return to

health and have to accept that life must go forward and the pattern believed to


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health and have to accept that life must go forward and the pattern believed to be temporary must be accepted as permanent.

Economic I mpact of I llness1. Emotional trauma

2. Social dislocation3. Economic catastrophe


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Family in Crisis

- Family is in crisis when it moves into a state of disequilibrium in response toany situation or event that it can not resolve by the use of available problemsolving skills, behavior or response.


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Evaluating Family in Crisis

1. Assess family history of coping with problem or stressor.- boiling point at which crisis response is set in motiona. affected by uniqueness of internal and external factors

b. stresses are sufficient in number or intensity to disturb family equilibrium


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c. family psychosocial history provides information regarding capacity of

family to cope with illness and other missionsd. quality of family life

Evaluating Family in Crisis2. Determine the style of family development

a. Anticipatory guidance issue b. timeliness of illness or problem

3. R ole of patient in the family


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a. Member providing financial support

b. Member plays a critical role in family emotional life

4. Monitoring role disruptiona. assesses and monitors effects of role disruption

b. identifies gap in the family that exists or has resulted from illness

c. sick role as perceived by patient and family

Evaluating Family in Crisis5. Nature of I llness

a. For acute illness- potential for crisis especially when family routines are suspended

b. For chronic illness- prolonged fear and anxiety leads to higher incidence of illness in other


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members of the family

c. For terminal illness- highly emotional and devastating

d. Hospitalization- conflict between the family and hospital staff (intrusion)

e. Family reaction to death- initially denial , then anger, after which there is bargaining, then

depression, finally acceptance

Segmental Phase of R eactionEmotional Plane

a. Onset state of response of protectivedenial, disbelief and numbness

b. Emotional upheaval strong emotionalternately express anxiety or rage,sadness depression

Cognitive Plane

Phase I - tension may be observedobjectively

Phase II - result from proven method of tension reduction

Ph III i i t d


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sadness, depressionc. Accommodation phase emotional

climate moves towards hopefulnessand acceptance

Phase III - increasing assessment andreceptivity of the family to newapproach for relief of distress

Phase I V - quality of family reorganization

Tools in Family Assessment


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Tools in Family AssessmentSteps:

1. Recognize Family Structure2. Understanding Normal Family Function3. Learn to Assess Family Structure and Function in Clinical Practice


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Family Assessment ModelI . Family I dentification

a. Composition b. Social Historyc. Community and Neighborhood

II . I ndividual Family Data


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a. Health History

b. Family Dynamicsi. Techniquesii. Recording

OCCUPATIONA

LMED

IC

INE


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R ussell F. Bernabe, MD

L uminaries of Occupational Medicine

Bernardino R aizzini- father of Industrial Medicine (Occupational Medicine)


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Gregorio Dizon- father of Occupational Medicine in the Philippines

Important Conditions in O.H.

I njury- a condition which has occurred after a short/single period of exposure

to an unsafe act or condition.


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I llness

- a condition which has occurred as a consequence of long exposure tounsafe act or condition.

Definitions

Occupational Health

- concerned with the promotion and maintenance of highest degree of physical, mental as well as the social well being of workers in alloccupations.

Occupational Medicine


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Occupational Medicine

- a branch of Preventive Medicine concerned with adaptation of man tohis job and the job to each man.

Occupational Hygiene- the applied science concerned with

1. Identification risk factors2. Measurement risk factors3. Appraisal of risk and control to acceptable standards of physical well

being4 Ch i l bi l i l f i i i f h k l


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4. Chemical biological factors arising in or from the workplace

Basic Components of Occupational Medicine1. Treatment of occupational injuries and illnesses

2. Conduction of pre - placement and fitness -for -duty examinations3. Performing executive health maintenance examinations4. Periodical Assessment of workers health5. Ocular inspection of workplace


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6. Consultation with and counseling employees

7. Participation in management teams

Goals of Occupational Health

1) Promotion of Health

2) Prevention of Disease

3) Control of work environment and work condition


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3) Control of work environment and work condition

4) Rehabilitation

R esponsibilities of the Occupational Medicine Practitioner

1) Knowledge of the work environment

2) Pre - placement, periodic, special examinations3) Administrative responsibility4) Treatment/rehabilitation5) Health education/advice6) Effi i d k i


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6) Efficient record keeping

7) Surveillance of High risk groups8) Liaison with outside organizations9) Reassurance of workers

Work-related Disease Syndromes by W.H.O .

1. Purely occupational/Occupational Diseases

- diseases that exclusively affect the working population- factors in the work environment are essential and predominant in the disease causation

2. Work-related Diseases- disorders other than and in addition to recognized occupational diseases that occur

among working populations


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g g p p- where work environment and performance contribute significantly, but in varying

magnitude.a) occupation as one of the causal factors

b) occupation as a contributing factor c) occupationally aggravated pre -existing disease

3) General Diseases

- diseases among the general population which workers may be equally or moresusceptible

10 Leading Occupational Diseases and Injuries

1. Occupational Lung diseases

2. Musculoskeletal injuries3. Occupational cancers (other than lung)4. Severe traumatic injuries5 Cardiovascular diseases


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5. Cardiovascular diseases

6. Reproductive disorders7. Neurotoxic disorders8. Noise -induced hearing loss9. Dermatologic conditions10 . Psychological disorders

Classification of Factors in the Causation of Occupational Disease

1) I ntrinsic : Host

- genetics- personality- Socioeconomic class- Age

S


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- Sex

- Nutrition- Susceptibility

2) Extrinsic : Environment

a) Biological

- infectious diseases agents- reservoirs- vectors- fomites

b) Social


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b) Social

- social customs- organizational set up

c) Physical- Noise- Extremes of temperature

- Pressure- Vibration

Basic Component of Occupational Hygiene

1) Recognition of Health Hazards

2) Evaluation of Workplace

3) Control


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Basic I ndustrial Hygiene Control Methods

1) Substitution

2) Changing the process


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Changing the process1) Isolation

2) Wet method3) General ventilation4) Personal Protective Equipment5) Personal hygiene6) Housekeeping/Maintenance


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6) Housekeeping/Maintenance

7) Waste Disposal8) Special Control Method9) Medical Control10 ) Education and Training

NATIONAL HEALTH

INSURANCE PROGRAM


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National Health I nsurance Program (NH I P)- formerly Medicare now popularly known as the National Health

Insurance Act of 199 5

- instituted in March 4, 199 5 by virtue of R.A. 7875


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- it is the Philippine's largest and premiere social health insurance program

Aims of NH I P- to effectively provide health care services that is

1. accessible2. affordable

3. acceptable

4 adequate (accredited 1574 hospitals and 2 0000 MDs)


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4. adequate (accredited 1574 hospitals and 2 0000 MDs)

Philippine Health I nsurance Corporation (PhilHealth)

- a government owned and controlled corporation mandated by the NHIP

- Functions of PhilHealth:

1. to administer and manage a sustainable program


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2. to extend quality and relevant health care services to a broader membership.

Functions of NH I P1. Accelerate Universal Coverage

2. Enhance and expand the benefits to include more outpatient services

3. Consolidate the Medicare program


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4. Ensure a sustainable National Health Insurance Program for All

Coverage of NH I P

1. Employed sector

2. Individually - paying members

3 Non -paying members


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3. Non paying members

a) Retirees and pensioners b) Permanent and partial disability pensioners and death pensioners

4. Indigent members

Extension of Coverage1. Legitimate spouse not an NHIP member

2. Children below 2 1 years old, unmarried and unemployed

3. Children over 2 1 years old suffering from congenital or acquired debilitating


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diseases

4. Dependent Parents > 6 0 years old

Declaration forms usedM1a - used by employed members

M1 b - used by Individually - paying members

M1c used by indigent/sponsored members


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Personal Health Services Benefit Package :Inpatient hospital care:1. Room and board (45 days for the insured and another 45days to be shared

by the extensions per year)2. Services of health care professionals3. Diagnostic, laboratory, and other medical examination services4. Use of surgical or medical equipment and facilities5 P i ti d d bi l i l bj t t th li it ti t t d i


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5. Prescription drugs and biologicals, subject to the limitations stated inSection 37 of RA 7875

6. Inpatient education packages.7. Maternal Care Package for the 3 rd NSD8. Newborn Care Package

Personal Health Services Benefit Package :Outpatient care:

1. Services of health care professionals2. Diagnostic, laboratory, and other medical examination services

3. Personal preventive services

4. Prescription drugs and biologicals, subject to the limitations described inSection 37 of RA 7875


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Section 37 of RA 7875

5. Emergency and transfer services

6. HIV/AIDS Benefit package

7. Malaria Benefit Package

Compensable Outpatient Services1. Chemotherapy

2. Radiotherapy3. Cataract Extraction

4. Hemodialysis

5. Minor surgical procedures done in operating room complex


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5. TB DOTS

Non-compensable Services1. Non - prescription drugs and medicines

2. Outpatient psychotherapy and counselling for mental illness3. Drug and alcohol abuses and dependency treatment

4. Cosmetic Surgery

5. Home and rehabilitation services


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6. Optometric services7. 4 th Normal Spontaneous Deliveries of women

8. Other cost ineffective procedures as defined by NHIP

Unified Medicare Benefits under NH I PBenefit I tems Hospital Category

Primary Secondary TertiaryR oom and Board 200 300 400

Drugs and Medicines

Ordinary case 1,500 1 ,700 3,000

Intensive 2,5 00 4,000 9 ,000


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Catastrophic 0 8,00016,000

X-ray, L aboratories, etc

Ordinary 35 0 850 1,700

Intensive 7 00 2,000 4,000

Catastrophic 0 4,000 1 4,000

Professional Fees under the NH I PGeneral Practitioner = Php 150.00 /day Specialist= Php 25 0.00 /day

Ordinary: Primary Secondary Tertiary

General practitioner 6 00 600 600

Specialist 1,000 1 ,000 1 ,000I ntensive


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I ntensive

General Practitioner 900 900 900

Specialist 1,500 1 ,500 1 ,500 2,500*

Catastrophic

General Practitioner 900 900 900

Specialist 1,500 1 ,500 2,500

Professional Fees under the NH I POthers: Operating R oom

a. RVU 3 0 and below 385 67 0 1,060

b. RVU 3 1 to 8 0 0 1,140 1,35 0

c. RVU 8 1 and above 0 2,160 3,490


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Surgeon Maximum of 16,000Anesthesiologist Maximum of 5, 000

R VUs of selected proceduresP R OCEDU R ES R VU

Mastectomy, partial 75

Mastectomy, simple, complete 90

Mastectomy, radical (Urban type operation) 2 00

Appendectomy 100

Ruptured appendix w/ abscess or generalized peritonitis 150


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Cholecystectomy w/ exploration of common duct 3 00Dilation and curettage 4 0

T.A.H.B.S.O 25 0

Vaginal hysterectomy ; 200

Vaginal delivery only (w/ episiotomy) 5 0

Breech extraction 8 0Caesarian delivery 150

Family Planning Procedures

Primary Secondary Tertiary

Vasectomy 900 900 900

Tubal L igation 1,125 1,125 1,125


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Benefit Entitlement1. Paid 3 monthly contribution within the immediate 6 month prior to the month of

confinement

2. Confinement to any accredited hospital for not less than 24 hours

3. The 45 days allowance for room and board has not been consumed yet


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y y

NH I P Benefits Forfeiture1. Confinements in non -accredited hospitals except in emergency cases

2. Confinements less than 24 hours except:a) Case is emergency

b) Patient is transferred to better equipped hospital

c) Patient expired during confinement


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End

Comprehensive Review in pre medicine

Documents