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4 short notes commonly asked in Community Medicine (PSM) theory paper, answered!! (12th June 2016)

Today’s short notes: 9th Jun 2016
1. International Red Cross
2. Health Hazards of Healthcare Waste
3. Juvenile Delinquency
4. Principles of Primary Health Care

International Red Cross:
The Red Cross is a non-political, non-official, international, humanitarian organization devoted to the service of mankind in peace and war.
It was founded by Henry Dunant, a young Swiss businessman. Dunant observed the suffering during times of war and urged that voluntary national societies be founded, which in time of war would render aid to the wounded without distinction of nationality. He proposed further that these societies should have a protected emblem and trained workers and their services to the wounded should be protected by international treaty. The first Geneva Convention took place in 1864 and a treaty was signed for the relief of the wounded and sick of the army in the field. Thus came into being, the International Committee of the Red Cross or ICRC, an independent, neutral institution, the founder organization of the Red Cross. In 1919, the League of the Red Cross Society was created with headquarters in Geneva, who coordinates the work of the national societies which now number more than 90.
Role of Red Cross:
1. Humanitarian service on behalf of the victims of war
2. Natural Disasters need: In natural disasters there is need for help among nations as good neighbors
3. Other programs which would prevent human suffering: these comprise, service to armed forces, service to war veterans, disaster service, first aid and nursing, health education and maternity, and child welfare services.

Health Hazards of Healthcare Waste
Exposure to hazardous healthcare waste can result in disease or injury due to one or more of the following characteristics:
1. It contains infectious agents
2. It contains toxic or hazardous chemicals or pharmaceuticals
3. It contains sharps
4. It is genotoxic
5. It is radio active
All individuals exposed to hazardous healthcare waste are potentially at risk but the main groups at risk are:
1. Medical doctors, nurses, healthcare auxiliaries and hospital maintenance personnel.
2. Patients in healthcare establishments
3. Visitors to healthcare establishments
4. Workers in support services allied to healthcare establishment such as laundries, waste handling and transportation
5. Workers in waste disposal facilities such as landfills and incinerators including scavengers

1. Hazards from infectious waste and sharps:
Pathogens in infectious waste may enter the human body through a puncture, abrasion, or cut in the skin, through mucus membranes by inhalation or by ingestion.
Particular concern is about infection with HIV and Hepatitis virus B and C for which there is a strong evidence of transmission via healthcare waste.
Bacteria resistant to antibiotics and chemical disinfectants may also contribute to health hazards created by poorly managed waste.

2. Hazard from chemical and pharmaceutical waste:
Many of the chemicals and pharmaceuticals used in healthcare establishments are toxic, corrosive, flammable or explosive. These may cause
• Intoxication either by acute or chronic exposure and
• Injuries including burns
Disinfectants are particularly important members of this group.
• They are used in large quantities
• They are often corrosive chemicals and
• They may form highly toxic secondary compounds

3. Hazards from genotoxic waste:
The severity of the is governed by a combination of
• The substance toxicity itself and
• The extent and duration of exposure
The main pathway of exposure is inhalation of dust or aerosols, absorption through the skin, ingestion of food accidentally contaminated with cytotoxic drugs or chemicals

4. Hazards from radioactive waste:
The type of disease caused by radioactive waste is determined by the type and extent of exposure.
It can range from headache, dizziness and vomiting to much more serious problems.
Because it genotoxic, it may also affect genetic material.

5. Public sensitivity:
Apart from health hazards, the general public is very sensitive to visual impact of healthcare waste particularly anatomical waste.

For complete lecture on Biomedical waste management: click below

Juvenile Delinquency:
The Children Act, 1960, in India defines delinquent as “a child who has committed an offence”.
Who is a Juvenile?
Juvenile Justice Act, 1986, defined the term ‘juvenile’ as a “boy who has not attained the age of 16 years and a girl who has not attained the age of 18 years”.
• Later on the Parliament enacted the Juvenile Justice (Care and Protection) Act, 2000 which raised the age bar to 18 years for both girl and boy.

Again in present times, there is demand that juveniles and specially juveniles in the age group of 16 to 18 years should be treated as adult for conviction in heinous crimes such as rape, gang rape, murder, dacoity
The reason is that that in several of the recent incidents as described above, it has been found that the juveniles of 16-18 age group are involved in serious crimes and they are doing such criminal acts with full knowledge and maturity

Juvenile delinquency embraces all deviations from normal youthful behavior and includes
• The incorrigible, ungovernable, habitually disobedient and
• Those who desert their homes and mix with immoral people
• Those with behavioral problems and indulge in antisocial practices

Incidence: in the United States, it is reported that 2% of children between 7 and 17 years attend juvenile courts. Comparable statistics are not available in India, but it is agreed that juvenile delinquency is on the increase in India during the past few decades due to changes in the cultural pattern of the people, urbanization and industrialization.
The highest incidence is found in children aged 15 and above. The incidence among boys is 4 to 5 times more than among girls.
1. Biological causes:
a) Hereditary defects
b) Feeble mindedness
c) Physical defects and
d) Glandular imbalance
e) Chromosomal anomaly might be associated with a tendency of delinquency and crime, XYY men suffer from severe disturbance of the whole personality.
2. Social causes:
a) Broken homes, example death of parents, separation of parents, step mothers and
b) Disturbed home conditions
• poverty,
• alcoholism,
• parental neglect,
• ignorance about childcare,
• Too many children etc.
3. Other causes: absence of recreation facilities, cheap recreation, sex thrillers, urbanization and industrialization, cinemas and television, slum dwelling etc.
Preventive measures:
1. Improvement of family life: A well-adjusted family can stem the tide of delinquency. The needs of children should be appreciated and met.
2. Schooling: the school comes next to home in the community in ordering the behavior of children.
• There should be a healthy teacher pupil relationship.
• The school teacher can play an important part by detecting early signs of maladjustment.
3. Social welfare services: these comprise recreation facilities, parent counselling, child guidance, educational facilities, and adequate general health services

Principles of Primary Health Care
1. Equitable distribution
2. Community Participation
3. Inter-sectoral coordination
4. Appropriate technology

Equitable distribution:
Health services must be available to all irrespective of their ability to pay, i.e. rich or poor, urban or rural. Presently health services are concentrated mainly in urban area. In the urban areas too, the slums are underserved. Hence there is inequality and the worst hit areas are the rural and slum populations. This has been termed as social injustice.
Primary health care aims to redress this imbalance by shifting the center of gravity of the health care system from cities to rural areas where the majority of people live and bring these services near people’s homes

Community Participation
The responsibility of health rests not only with government but also with individuals, families and communities themselves. Universal coverage by primary health care cannot be achieved without the involvement of the local community.
The community should be involved:
1) In the planning, implementation and maintenance of health services and
2) Maximum reliance should be on local resources for the above. Resources include;
• Manpower
• Money and
• Material
The examples of community participation for healthcare in India are:
Village Health guides, trained dais, ASHA, Anganwadi workers (AWW). They are selected by the local community and trained locally in primary healthcare.
• This overcomes cultural and communication barriers
• These provide primary health care in ways that are acceptable to the community

Inter-sectoral coordination
The declaration of Alma Ata states that ‘primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication etc.”
This means that to achieve a state of health, not only medical care is needed. There is a need to provide adequate food, safe water, healthful housing etc. Therefore these departments need to be involved in attaining health for all.
This cooperation requires:
1) Strong political will
2) Adapting the administrative system to enable such coordination
3) Making suitable legislation to ensure this
4) Development planning should be together, involving all the sectors to avoid duplication of activities

Appropriate technology
It has been defined as ‘’technology that is scientifically sound, adaptable to local needs and acceptable to those who apply it and to whom it is applied and that can be maintained by people themselves in keeping with the principle of self-reliance with the resources the community and country can afford’’
It means using cheaper, scientifically valid and acceptable equipment and techniques if these are available instead of costly and more sophisticated ones if the community cannot afford those.
Examples of appropriate technology:
• Oral rehydration fluid instead of I/V hydration for mild and moderate dehydration
• Standpipes instead of piped water supply

For complete lecture on Primary Health Care click below: