PLAGUE PREVENTION AND CONTROL

IDENTIFICATION AND DEFINITION

It is a disease of rats being primarily. It comes to man as blood infection medically diagnosed as septicemia which shows in two types called bubonic is the common type occurring in epidemics, and other form is the pneumonic is a rare type occurring endemically during plague epidemic of bubonic.It is sudden onset of high fever, head ache, back ache, flushed face and delirium. It develops in the groin or armpit and toxemia develops proclaiming the fatal end. In pneumonic attack blood in sputum is found while coughing which is painful and toxemia is more seen and death is quick. The causative agent is pasteurella pestis, lives and multiplies in the tissues and blood of the infected animal or man. The incubation period of bubonic plague is about 2-3 days. Man possess no natural immunity.

SOURCE OF INFECTION

The disease is one of the established style of examples of animal borne diseases. The rat the  known reservoir of infection and always act as a source for human infection of bubonic plague. Rats suffer from and die in both acute and chronic forms. Rats most concerned in the spread of plague to human population some species of rats are supposed to be permanent reservoir in nature. Plague can infect  people by the droplet mode of transmission. There blood is also infectious. Fleas which have fed on a case of plague could also spread the disease.  The immediate source of infection to man is always the ineffective vector flea which has fed on an infected rodent host.

MOD OF TRANSMISSION

The epidemics are always preceded by an animal borne disease/epizootic in urban or rural house rats.
That is usually conveyed by epizootic in jungle rodents. The transmission cycle is in the animal borne diseases

is rat flea rat. The rat flea become infected after taking a blood meal from their infected rodent host. They leave the cooling body of the dying host and infest another rat. This cycle is repeated. The infection in house rats reduce their number and the fleas start attacking human beings and transmit infection. Wherever it occurs, plague is likely to be endemic. Plague was formally world. It was confined mainly to some parts of India, Burma, Srilanka, China, Java and parts of the African continent. An extensive use of residual insecticides has reduced the severity of plague in the endemic areas in India. At present the incidence of among population is very low.

PREVENTION AND CONTROL OF PLAGUE

Anti-rat hygiene and rat destruction and anti-rat engineering are the only long term effective measures to prevent the out breaks,in order to maintain low endemic potential. Strict all anti-rat measures at the ports, railway stations, flour mills, stores, go downs, slaughter houses, etc, and in crowded localities to prevent entry to the rats and infection an area , and maintain if free from epizootics. BHC, DDT and other organoposphurus insecticides keep flea index low. On occurrence of a case following action should be taken.

                      The patient must be admitted to hospital and isolated in a special ward and patient must wear a mask. Disinfection of ward linen,clothing, and bedding should be carried out. Sputum should be received in 5 percentage of cresol solution and all upper respiratory discharges should be treated similarly in case of plague or even on suspicious on it. Notification to higher authorities like the director of public health of the state, and liaison with the civil authorities is necessary.

       Persons working in the plague wards, houses, and disinfecting articles suspected to contain the plague bacteria, should be inoculated against plague and must wear protective clothing made of smooth strong linen. Rubber gloves should be worn on the wrist and hands. These garments must be disinfected with insecticides daily. A fresh mask should be used at each visit of the ward when nursing a case of plague. contacts living in same place/premises should be immunized and put under medical supervision for 10 days as they might have been bitten by infected fleas. Contacts of plague must be segregated and inspected daily for 10 days. Insecticidal method of control of plague is rapidly effective which is safer, cheaper and easier than destruction of rodents. Use of protective clothing. repellents and a bed with mosquito net to sleep during night increase personal protection against flea bite. When plague is found in more than 5 percent of trapped rats, there is a strong clearness to expect an out break  in the human population in that area.

CORONARY RISK FACTORS PREVENTION AND CONTROL

DEFINITION OF CORONARY DISEASES

Coronary or ischaemic heart disease occur due to lack of blood supply to heart muscle by an increased demand or decreased coronary supply. Both elements are complimentary in hastening the actual attack. Death may occur any time before the complete recovery of the damaged cardiac muscle, which may take about 6 to 8 weeks or more.

RISK FACTORS

Hypertension, cigarette smoking, diabetes, over weight and obesity, physical inactivity, stress making mental activity and psychological environment, a positive family history of premature heart and vascular diseases, for example,starting of diseases before age 40 and abnormal electro cardiogram. The other abnormalities having are thyroid dysfunction, kidney disease and sedentary living habits. The important risk factors are given below.

DIET

A habitual dietary pattern with high intake of total calories , total fats, saturated fats, cholesterol, refined carbohydrates and salt is a ischaemic risk factor. More intake of fats.especially saturated fats,contributes significantly to the growth of the 4 important coronary-risk  factors high blood pressure, diabetes, obesity and disturbance of lipid metabolism and causes thrombosis. Imbalance in lipid metabolism and katabolism leaves extra extra cholesterol and triglycerides which gets stored  in fat depots and in other organs and tissues. Arteries also share this burden and get deposits of cholesterol crystals. Coronary arteries suffer the most due to their developed  intimal layer. The thrombus contains cholesterol, calcification also shows cholesterol crystals, and individuals with thrombotic tendencies show hypercholesterolaemia. High fat contents in diet,specially the animal fats and hydrogenated fat produce hypercholestrolaemia. More people in countries and communities consuming high fat diet show high incidence of coronary diseases, as compared with people in poorer countries and communities consuming low fat in their diets.In USA where the general diet yields forty percent calories from fats has the highest incidence in the world.

SMOKING

Heavy smoking is shown to be to the occurrence of cardiac diseases in young age. Cigarette smoking is specially correlated with smoking in association of heart diseases. Nicotine causes vasospasm. A heavy smoking is associated with a high stung personality, and heavy smoking usually occurs during mental strain in otherwise light smokers.This fact may be responsible for the association of smoking with other stress diseases in addition to coronary cardiac diseases.

BODY BUILD

Obesity and overweight are considered to be high coronary risk factor. The observations have made and continues:- The incidence of coronary heart diseases is two and half times more among those who had more than twenty per cent increase on their young adult age weight. And also, insurance actuarial studies shows that overweight persons show 36 per cent higher mortality due to coronary diseases and cerebra vascular diseases. Death rates due to hypertension and diabetes are 75 per cent higher among obese persons than among those who are free from obesity. Obesity increases incidence of hypertension and diabetes ans hyperlipidaemia, the 3 ischaemic risk factors. The cardiac muscle itself gets its share of fact deposition and reduces the chance of establishing ischaeimc collateral circulation in times of physical, emotional or cardiac emergency. Obesity decreases exercise tolerance and increases cardiac demand due to the body-burden. Obesity increases peripheral circulatory resistance and predisposes the person to hypertension increasing the coronary cardiac risk.

HEREDITY 

It is also plays a part. Anatomical defects or congenital  or hereditary, specially causing disease in young age with out thrombosis or other a etiological and risk factors. The likely hood of sub lings of parents suffering from atherosclerosis or a history of coronary episodes having ischaemic cardiac diseases is observed to be much more than the others. Diabetes, hypertension and obesity are known to be transmissible.

ANATOMICAL VARIATIONS

Anatomical peculiarities and distribution of the coronary arteries may show variations in such a way that it may be easier for blood clot in arteries or it may be anatomical peculiarities which may decide the establishment of collateral circulation when thrombosis occurs.  

BODY ACTIVITY 

Sedentary work always acts as a high coronary risk due to the following reasons.

It reduces the ability of the ischaemic collateral circulation when the coronary blockage occurs or the myocardial demand increases, minute coronary occlusions occurs,very often through adult and middle age with out showing any signs and symptoms due to the simultaneous coronary capillary collateral circulations are established quickly. Constant exertion provides constant coronary circulation during a healthy life and serves well during the episodic periods when the artery gets blocked. Sedentary habits deprive the myocardium  of these stimuli. It produces and increases the obesity which decreases the ability and threshold for exertion and myocardial efficiency and creates imbalance in lipid metabolism. Physical activity and exertion balance the fat anabolic process with adequate katabolism, thus protecting the body from increasing obesity and the arteries from cholesterol deposits,etc. A habitual sedentary worker is more likely to be a person doing highly strenuous work causing 'stress'. It seems that the disease is more prevalent in urban than in rural farm workers,may be due to fat-rich diet in western countries where they show low cholosterolaemia, atherosclerosis, ischaemic diseases low rate. Regular exercise provides relaxation and freedom mental stress , at least for a few hours in the day.

STRESS

Emotional strain produces stress so the emotional strain producing experience can hasten a clinical coronary episode in persons with advanced  atherosclerosis. Continued uncontrolled stress and strain develops the rigidity of vascular system and also produces systemic hypertension. The stress effects coronaries more than any other arteries and among men more than among women. The stress mechanism makes the cardiovascular system, especially the coronaries more sensitive to autonomic and hormonal stimuli and it responds above normal to precipitate the cardiac ischaemia through an increased spasm and myocardial demand. Psychological stress is shown to increase serum cholesterol and a prolonged psychological strain and tension play a roll in the long term regulation of the serum cholesterol level.

DISEASES AND CONDITIONS

Certain diseases and conditions show a high connection with the occurrence of coronary heart disease or with the conditions leading to it. Hypertension, gall bladder diseases, diabetes, kidney diseases, thyroid diseases, decreased vital capacity, abnormal electrocardiogram such as non-specific T wave abnormalities, complete bundle-branch block and left ventricular preponderance and premature cessation of ovarian activity among women, tendencies leading to thrombosis anywhere in the body have been noted to have such a high condition with the occurrence of coronary cardiac diseases and also cause more deaths in the first attack. But also can cause among survivors more earlier and worse second attacks after the first ones. The diabetic increases the diseases more often, more severely and prematurely than the non-diabetics. A cardiac failure directly due to the primary malignant hypertension should be differentiated from development of a coronary heart condition, although other factors may co-exist. High blood pressure levels are definitely associated with the cardiac disease.In many case it is the most important single complimentary factor to produce final coronary occlusion.

PREVENTION AND CONTROL

Diet control is necessary to prevent obesity  to balance anabolism and katabolism. Serum cholesterol and triglyceride concentrations are controlled by diets moderate in total calories,with moderate carbohydrates,and total fat yielding less than 20% of total calories and with low saturated fat contents less than 5% of the total calories and low in cholesterol means less than 200 mg per day.Regular exercise against obesity. This keeps the myocardium in training to meet the additional demands in times of stress. Men who are sedentary workers must adopt habits of regular exercise like clergy men, soft ware engineers,etc. Weight regulation by avoiding obesity by diet restriction and regular exercise must be practiced as above. Moderation in drinking, and smoking should be stopped. Such persons have to be more careful and vigilant. Drugs are available to cut out smoking. The risk of cardiac arrest and infarct in myocardium is increased by heavy smoking, it is ,therefore, must be stopped among persons with existing risk factors. Persons with sedentary works continuously for more hours require relaxations of appropriate periods after sustained period of intense and intellectual and emotional activity, specially for all vulnerable groups is a valuable preventive measure against sustained strain of high intensity of work.

Regular medical check up to ensure that the cardiovascular and urinary systems are working normally. Control of thrombotic tendencies is a difficult one because we have no measure of detection of persons with such tendencies in the population and we have not therapeutic measures to find out or check thrombosis altogether. Anticoagulants make only marginal benefits in the management of frank and massive arterial thrombosis. They can not be used for prevention of coronary heart diseases. Habitual dietary controls may decrease the progression of the conditions by keeping the serum cholesterol at a low level. Among the vulnerable socio-economically well off communities, the doctors, lowers, judges, clergymen bank officials, business executives, industrial organizers, etc, show a high tendency to get disease most commonly. Therefore, the steps should be taken to detect vulnerable groups and individuals among those groups and then control the contributory factors relevant to them. Research in all aspects beginning from per-ischaemic conditions, to histopathological examination of autopsy materials is an important per-requisite to the formulation of authentic preventive measures. While the position can be summarized by saying that keeping the metabolism balanced, avoiding obesity by diet control and regular exercise, relaxation and maintenance of tranquility of mind and avoiding extra emotional stress producing activity and a control of smoking and alcohol consumption should be relied upon. Early diagnosis and treatment of all the antecedent conditions is essential to enhance of all our knowledge, to give us epidemiological data, to find out further deterioration hypercholesterolaemia to atherosclerosis, from arthrosis to thrombosis, from thrombosis to infarction, from infraction to aneurysm or rupture and death or a long period of invalided sickness.

MENTAL BREAK DOWN SYNDROMES - PREVENTION AND CONTROL

MENTAL BREAK DOWN SYNDROMES

Acute conditions are hysteria, anxiety state, confusional states, Exhaustion, psychosomatic disorders, Reactive depression, mixed reactions, psychosis, chronic reactions, schizophrenia, depression, paranoid escape, etc. Mental health is an important component of the total positive health. It comprises the wellbeing of of the intellectual and emotional components of the mind . The intellectual break down of the individual deprive him of logical and rational thinking, and the decision taken may be faulty affecting the wellbeing of the individual. Even the community or nation may suffer due to such faulty decisions if such an individual happens to be a leader. Emotional imbalance affects reactions of individual, ability to withstand the strains and stress of the life situations affecting the general health, and the ability to conform to the conventional social morale. A few of them are are given below.

Hysteria.

This may be defined as a functional disorder of the mind characterized by the unconscious production of mental and physical symptoms which enable the individual to escape from some difficulty or to gain some real or imaginary advantage. The historical syndrome may show by the development of symptoms such as paralysis of various parts of body, sensory disturbances, vomiting, deafness, hysterical seizures and somnambulism, etc. In most cases of fits no precipitating cause is apparent. 

Depression.

Individuals with depression become quiet, inactive, and not interested to take part in normal social activities, sleeplessness, anxiety dreams, fits of crying, and excessive smoking and drinking are common symptoms in severe cases.

Schizophrenia.

It is the commonest form of psychosis among the adolescents and young adults and is characterized by lack of interest, self-absorption and withdrawal. The patients may suffer also from auditory and visual hallucinations and delusions of persecution. those cases of psychosis  should be transfered to psychiatrist for admission and treatment.

Paranoid escape

In order to make their own gloom some persons make project their feelings on to others and look for evidence of evil and distrust around them. They become suspicious with out any convincing evidence and are disgruntled, cynical and bitter. They are not easily amicable to discipline. 

Psychosomatic disorders.

Due to depression and anxiety may find expression in somatic cases such as loss of physical energy, head ache, disturbance of vision, sleeplessness, feeling of vomiting, memory difficulties, and a secondary hysterical fixation of minor injuries. the commonest sign and symptoms of mental distress are as under.

Warning signal of psychiatric break down

Changes from normal behavior and habits as noticed by friends  and relatives. Sleep disturbances and nightmares to be observed. Changes in eating, drinking, and increased usage of tobacco and alcohol may be noticed. Alteration in temperament and personality may be noticed. The calm and quiet retiring person becomes garrulous and vivacious or a good humored and social man becomes morose, sullen, solitary, and apathetic, not taking interest in what is going on around him. Emotional instability is manifested by sudden out bursts of weeping for no reasons, or sudden displays of violence. Offenses of trivial nature may be committed by a person of previous good character. There is often gradual deterioration in the standard of work and efficiency. there may be inability to concentrate in normal activities and this may intensifies his sense of restlessness and depression.

Prevention and control of psychiatric breakdown.

For the conservation of manpower and promotion of working efficiency it is imperative that all possible preventive measures  to reduce morbidity from psychiatric break disorders in factories and other institutions are adopted while recruitment for employment.The important preventive measures are selection, screening, man-management, training, morale building and early recognition and early treatment of mental break down. The individual should think that he is an integral part of of his institution and also he should feel his welfare and that of his family are the active concern of the governing body and his own superior officers in particular. He should be made to feel that efficient and prompt medical aid is available at all times. Early diagnosis, proper treatment, and proper transfer to specialist hospitals, are important measures for the maintenance of mental health of the such cases.