INFECTIOUS HEPATITIS AND ITS PERVENTION

Identification and definition of Jaundice

A sub-acute or sudden febrile infectious  disease due to virus, characterized by a sudden onset abdominal discomfort, nausea, feeling to vomit and symptoms to hepatitis which is the main feature of this disease. Jaundice is normally present in this disease but may be absent. Serum hepatitis is transmitted through transfusion, vaccination,  and inoculation and not give to rise to initial gastrointestinal symptoms. Case fatality is low but case mortality is high and prolonged. The diagnosis is confirmed by various serological tests or even biopsy by liver puncture; serum enzyme and biopsy are the most reliable tests.

Causative organism 

It is due to a virus, out of them two are important. The virus of infective hepatitis is called virus A, and that of serum hepatitis is called virus B, and they are indistinguishable from each other in any away. However, sufficient evidence on clinical and epidemiological grounds to suggest that two infections are caused by 2 different members of the same family of viruses or different strains of the same virus affecting the liver cells. Virus of the serum hepatitis never find in faeces; but in a more or less close community. Serum hepatitis is spread by using an unsterilized needle for injecting the person after the inoculation of the carrier. Man possess no natural immunity, and incubation period is 25 days with a range of 15 to 50 days.In the case of serum hepatitis 90 days, may be prolonged to 60 to 160 days. Pregnant woman and alcoholics are more vulnerable to high morbidity and high mortality. One attack or childhood exposure to endemic infection confers immunity to certain extent. Virus hepatitis has a world wide distribution and during past years a number of out breaks occurred in India and other countries. Few cases occur throughout the year, but more incidence is in fly breeding seasons.

Prevention and control

A very high standard of environmental sanitation, control of fly breeding and personal hygiene are to be strictly maintained. Protection of water supply and its purification and efficient diary management to avoid unpolluted milk supply and attention to disposal of waste including sewage disposal. Sterilizing needles and syringes every time  when it used for injections.

On occurrence of a case patient should be admitted to hospital for correct diagnosis between infectious or serum hepatitis. So that correct control measures, specially in controlling the constant prevalence of sporadic cases in locally and prevent out breaks. It is not important to isolate the patient. he is kept apart and precautions are taken as for other food and water borne diseases. A case of infectious hepatitis never should be taken to a ward where there are acutely ill patients admitted. Flies should not gain access to stools, urine, sputum,etc.which are to be disinfected. A separate ward or wards are to be set apart in case of a epidemic out break occurs. Current and terminal disinfection should be carried out.

For families immune gamma globulin is good as a preventive measure. Personal hygiene should be maintained at high level. Strict anti fly measures are to be enforced. Attendance should take all precautions as required for the food and water borne diseases. As anything which damages the liver like alcohol should be avoided. Alcohol may increase the disease, it is advisable to with hold them from close contacts. Control food and drink. All source of water supply should be taken to protect, all sources of water from any likely pollution. Water should be taken from sources that are not liable to contaminate with excreta. Even super chlorination is not suppose to kill the virus, unless water is very efficiently clarified and an half hour contact is necessary before supply. Water should be boiled during an out break of jaundice. Strict inspection of sales of ice creams including manufacture and distribution,specially near to educational institutions.

ANIMAL BORNE DISEASES

Definition.

Zoo-noses is the state in which the infections initially affecting animals are transmissible to human beings and also some times the process may be reversed and some infections may pass from man to animals. WHO defines to those infections and diseases which are naturally transmitted between vertebrate animals and man plague, rabies/hydrophobia, anthrax, yellow fever, relapsing fevers, etc, are the some typical examples of such infections originally affecting animals and transmitted to human beings.

Type of reservoirs.

Most of the animal borne diseases start with host-sensitivity and through the stages of achievement of success in parasitism is the genesis of zoo-noses. Parasitism aims at self-preservation and a species propagation by obtaining sustenance from the host. So it attains tolerance and symbiosis to make zoo-nosies progressively more successful. More often the host is partially sensitive. When some vertebrate animal hosts are sensitive to parasites, some other animals are likely to be a tolerant or symbiotic host, so as to permit perpetuation of the parasite in nature. For example dogs are intensely sensitive to rabies virus; the wild Candida like the wolf , jackal or fox, which transmits this infection to dogs also suffer from rabies. The search for more tolerant host which can permit perpetuation of rabies virus in nature, with out themselves succumbing to the infection, has led to the discovery that Vampire bats, etc and some rodent species act as such hosts for rabies virus. Similarly, the urban rodents, who acquire plague infection sylvatic rodents, themselves die of the disease. Tolerant or symbiotic animal hosts are the permanent reservoirs of zoo-noses; the ones either sensitive or only partially resistant are semipermanent reservoirs of zoo-noses; and the ones which are more sensitive are the temporary reservoirs of zoo noses.

Important of the knowledge of animal borne diseases.

When an infection is known to be  animal borne and its temporary or permanent carrier is known, its control in human population becomes easy by either veterinarily controlling it among animals, by destruction of animals themselves, or by interrupting its transmission to the human population. The negative information is also important as it enables us to definitely exclude certain vertebrate from the possibility of being natural reservoirs. The knowledge of animal borne diseases enables us to study the parasite. and reactions and the behavior caused by it in the animal host during the pathogenic process. It is there after, leads us to form a picture of the natural history, remedy and how the disease affect  on the mankind. It also helps in finally diagnosing the otherwise intractable infection. For epidemiological studies, the search for animal borne diseases can be extended infinitely experimental transmission in a laboratory for determining the host range.

Some common animal borne diseases.

WHO has numbered more than 100 diseases constituting animal borne. 40 of them involve dogs and cats and 20 involve rodents of different types. The important examples of zoo-noses generally met with are the rodent borne infections such as plague, relapsing fever, rickettsiases, salmonelloses, worm infections, melloidosis, laptospirosis, rat bite fever, toxoplasmosis, tularaemia, etc.and so on. The primate infections like yellow fever and infective hepatitis and non pulmonary tuberculosis due to drinking of milk of an infected cow, brucellosis, Q fever and taeniasis, canine infections like rabies, leishmanaisis, and echinococcosis.Trypanosomiasis in Africa is also a zoo-noses. Taxoplasmosis is widespread in natural and its disease producing organism is symbiotic with many animal hosts. How man gets this infection is not yet known certainly, but dog is closely associated with man is implicated. Orinithosis is originally a disease of birds, specially in parrots, hawks, kites, etc. Psittacosis is the ornithosis of parrots transmitted to man. The virus of lymphocytic choriomaningitis is spread widely among mice but is transfered to man through a dog or cat due to his proximity to these animals. Anthrax is common farm animals and cattle and its spread to man may be due to the use of wool, hide or meat of infected animals. Some animal borne diseases are transmitted by arthropod vector species is more important means control the transmission of those diseases to human beings.

Prevention and control 

It is to eradicate the disease from human population by controlling natural ranges of animal borne diseases easier and earlier. For e,g.the bovine/intestinal tuberculosis strain was discovered to be the cause of human non-pulmonary tuberculosis infection and a search proved that the natural range for this infection was extremely narrow and almost confined to cows.A wide drive in the U.K. for raising non tuberculosis herds has been very successful that  at present there is no infection among the milking cows and hardly any bovine infection in human beings in that country. Similarly rabies and hydrophobia in many western countries have been almost eradicated by efficient caniculture. The larger the host range the wider should be the spread of infections and more difficult to eradicate. If it is confirmed definitely that there is no animal borne disease exists in respect of a particular human ailment, it leaves us free to concentrate all attention on the measures to control,prevent or eradicate the human reservoir,has happened in the case of malaria.

The general scheme of prevention and control of animal borne diseases may necessary to emphasis on one or more measures written below. We can control arthropod vector, protected the domestic animal from sylvatic disease, protect man from contact with the reservoir, domestic source and arthropod vectors or ectoparasites, protect food of man, water or other relevant articles of use from getting contaminated, destroy sylvatic or domestic sources,cure the domestic reservoir or source to the point of eradication enzootic or epizootic, search for the permanent reservoir in nature and and ruin it, and check the  migration of such reservoir or susceptible animals. Each of these methods has special application in a particular animal borne disease. In addition the international surveiliance is also required to control international transmission of animal borne infections.

PEPTIC ULCER PREVENTION AND CONTROL

INTRODUCTION.

The ulcer in gastric mucosa is called gastric ulcer and that in duodenal mucsa is called duodenal ulcer. Peptic ulcer is benign, circumscribed loss of tissue of the gastric or duodenal mucosal wall by the digestive action of acid gastric juice. A recent increase in its incidence has occurred in years chiefly in the civilised or modernised part of the world, where an increased tempo of life experts stress producing influence on the population. It is, therefore, peptic ulcer is considered to be one of the 'stress diseases'. Peptic ulcer or duodenal ulcer manifests itself by typical syndrome and known as 'peptic syndrome'. The main symptom is the burning, aching, or growing pain in the epigastrium coming on 2 or 3 hours after food, that is when the digestion is in its full swing and the food is ready for passing from stomach to the intestine.This pain is reduced by eating bland food or drinking milk. So it is called hungur pain. Pain is relieved by taking antacids.Diagnosis is confirmed by a gastric juice analysis on a fractional meal test in old days and now a days by radilogical or gastroscopic examinations.

PHYSIOLOGY OF STOMACH.

The main function of stomach is to digest proteins by the pepsin in the presence of 2 percent hydrochloric acid secreted by by the glands in its mucos memberene , up to the stage of polypeptides. It holds the food for four hours and then passes it on the intestine through the pylorus via duodenum. The food in the stomach has an acid reaction, while digesting by alkaline trypsin in intestine going up to the stage of aminoacids, it becomes less and less acidic as it proceeds onwards in the small intestines. The gastric and pyloric mucos memberene is highly resistent to the digestive action of gastric juice which can digest any proteins taken in food. sometimes certain ulcers get heald up rapidly with out causing any symptoms. When certain abnormalities are present in  human system such ulcers persist, get enlarged and produce symptoms. The exact cause is not known. The valnerability of gastric mucosa to ulcerate is due to effects of emotional changes engendered by daily life on gastric secretion, vascularity, and motility. Anxiety, irritability, or hostility, makes the gastric mucosa thickened and hyperaemic rendering the mucosa more valnerable to mechanical injury so that small erosions with bleedings could be produced. Stress and tension  thus can give rise to nervous dyspepsia and other gastric disorders , creating a highly favourable local environment for ulceration.

EPIDEMIOLOGICAL FACTORS.

Age-The vulnerable decades of life for peptic ulcers are from 20 t0 50, earlier in females than in males;high incidence is in 30 in females and 40 in males.They are not absent  in earlier ages,may be rare. Sex distribution is almost the same up to the adolscence and then rise in men. At the highest vulnerable age mentioned above, the duodenal ulcers are 10 to 15 times more common and gastric ulcers are 5 times common in males than women. After meno-pause the incidence in women rises. 

Duodenal ulcer is commenest amongst the higher socio-economic class while gastric ulcer is common amongst the low socio-economic class in the western countries. In India duodenal ulcer is commenest amongst poor people. The duodenal ulcer is more common between doctors, engineers, lawyers, clerks, etc. It is more common in western world than in eastern world, which is also showing an increase. gastric ulcer is quite common with out class or sex distinction in south India, and etc. Heridity also a factor in the family. When present in one member they are commonly found in the other members of the identical twins. It is associated with disease and conditions, habits and life situations, personalities, nutrition, drugs, alcohol, smoking, and beverages,etc.

PREVENTION.

As it is now almost certain that the peptic or duodenal ulcer happens in certain types of personalities  the preventive measures should be adopted among such groups or ulcer type of persons, such as, regularity of food habits, avoidance of drinking and smoking, relaxation following acute of mental activity of a high calibre and peridical physical and mental relxations are necessary for vulnerable people in the vulnerable age groups, avoidence of anxiety, worry, exitement, early diagnosis and proper treatment, mainly adequate rest and diet regulations. Avoid hurry, worry and curry.

MILK BORNE DISEASES AND PREVENTION

Introduction.

Comparing the nutritive value of one foodstuff with that of another, milk is the the best fluid secreted by female mammals.It contents almost all nutrients except iron.It can become a carrier of many diseases like tuberculosis ,Brucellosis, septic sore throat, cholera, typhoid, jaundice, poliomyelitis,etc. Milk borne out breaks are common like food poisoning may occur where milk from various source is pooled to provide to large feeding establishments like student hostels or large hotels and restaurants.

The live-stock of milking cattle is initially healthy, free from infections and protected against any of the illness; sick animals are isolated and contacts are separated, to spread if inspection, and ill animals are not milked. Surroundings are maintained at high sanitary standards, milk handlers are healthy, free from and protected against infections and prohibited from handling milk if evidence of diseases are seen;water supply is pure and protected, containers are clean, regularly washed, sterilized  and protected from contamination; and also milk is protected against contamination of flies, dust or other extraneous matters from its production, through processing and bottling up to its delivery to the consumers ; and milk is treated to destroy disease producing organisms and thereafter kept protected.

Preventive measures.

Care of cattle.. The quality of and the quantity of milk depend upon the particular breed. but mainly upon the care that is devoted to the milk cattle. The milk yield is also sensitive to their comfort, feeding, watering, cleanliness. Hence a clean , airy, cool, and sufficient space of cattle shed is of the first importance. Water supply to wash the cattle sheds and the cattle should be available.The arrangements made for washing of the cattle be sufficient. It is healthier to wash the cattle daily with cool water in extreme summer and with warm water in extreme winter. But in any case a wash must be given twice a week at least. Cattle should be groomed and their udders washed and then wiped with a damp cloth every time the the animal is milked. Ample water supply for drinking is necessary. Fodder and other eatable items like cotton seed, oil cake, bran and meal consisting of a crushed mixture of grains must be given to each animal.Meal, cotton seed and fodder stores should be rat proofed. Rat and flea nuisance are as much detrimental to the health and comfort of animals as they are for human beings. Sick animals must be immediately isolated and contacts segregated. Those animals should be inspected by veterinary doctors at least once in a month or often to ensure,if required. Isolation sheds must be available.
Preventive inoculation against common diseases must be ensured. In well developed farms, tuberculin tests followed by segregation, examination, treatment and sacrificing of sick and infected animals according to their stage of disease, is resorted to. So that herds free from tuberculosis have  been raised and the prevalence in a  majorities of firms in countries like Holland, U.S.A, U,K, etc, is nil. Good care of the animal, and affection shown to it increases the milk yield , reduces non-milking days and reducing ailments.

The cow sheds.. Properly constructed cow shed and its cleanliness is one of the main requirements for production of safe milk. The side should be well drained, higher than the surrounding ground , and the approaches to the shed never cross a manure yard. The flour area per cattle head  should be a minimum 6 sq meters.The space allowed per cow should be 18 cubic meters if the cows are allowed to graze, or 24 cubic meters if the cows are not turned out.  The shed must be washed every day and cleaned twice a day. They should be sprayed with insecticide once a week. An isolation shed for sick animal must be provided.

Disposal of manure and sullage..All manure should be removed from the depot. It is a potent source of fly breeding and pollution of milk.All channels carrying liquid manure and sullage should be made of concrete and continued for some distance beyond the shed to a convenient place of disposal out side,like vegetable garden, septic tank with large soak age pits  or broad drainage.

Health and hygiene of workers..There are people working in farm, out side the plant houses, those working inside the plant houses and the administrative staff or disposal of manure,etc. those persons not engaged with milk. All employees except administrative staff should be permanent,and selected after a medical inspection and issued with identity cards. medical examination of such persons be carried out regularly often and strict attention being done to personal cleanliness. They should be free from diarrhea, dysentery, infected fingers or boils, running ears, sore throat,typhoid group of fevers or cough among employees. All workers inside should remove their clothes on arrival for work and keep in a cupboard.They should wash and scrub with nail brush their hands thoroughly with soap and water and put on their working clothes which should be clean and suitable for duties. Milkers should change into their milking suits and overalls and must wear cotton milking caps. Workers handling milk should wear gauze masks. All workers sanitary and washing facilities and should be made to use them by education. When a pail is full it should be covered soon as a protection against flies and dust and removed to the milk room immediately.

Pasteurization..Boiling kills the microorganism in any liquid. It is likely to affect its quality, taste and flavour,if the components of such a liquid are heat-labile, such as are found in milk.Theory of pasteurization is that, rapidly heating a liquid to a degree of temperature lower than the required for boiling it and maintaining it uniformly for a certain period destroys most of the disease producing organisms, reduces the total quantity of the microorganisms and makes all of them less viable with out affecting its inherent qualities or its taste and flavour. It may not sterilize the liquid but make non-infective, retains its nutritive and improves its keeping quality. The important pathogenic organism are destroyed by pasteurization of milk are Bacterium tuberculosis, strep to and staphylococci  and the non-lactose fermenting pathogenic organisms of salmonella-shillelagh group. The rapid cooling of the heated liquid to such a low degree as to destroy the multiplication of any viable residual microorganisms. It is, therefore, a complete process of pasteurization comprises;rapid heating with out boiling, uniformly maintaining that temperature for a definite period, and rapid cooling. Its fat, protein, calcium, phosphorus, and vitamin contents are not affected. The tests for nutritional ingredients, adulteration, bacterial contamination, pasteurization and keeping quality should be carried out before distribution and sales.

PREVENTION AND CONTROL OF HIGH BLOOD PRESSURE

Definition of hypertensin.

Hypertension or high blood pressure means raised arterial blood pressure above normal. It is a symptom and not a disease. It is one of the variety of disorders like kidney failure, lead poisoning, toxaemia of pregnancy, rough of aorta, etc. but in the most of the cases, causes is not known.

Varieties of hypertension.

Hypertension or hypertensive disease when accompanied with clinical manifestations of blood pressure, the condition is said as hypertention or hypertensive disease. Hypertensive heart disease means if the cardiac function is disturbed or myocardiu is involved. If the blood pressure is due to renal disease or any other condition is known as secondary hypertension, or other wise any other condition of blood pressure raises,it known as primary or esential hypertension. Primary hypertensive disease progress soon to heart enlagement and failure and also towards a fatal end, it is called malignant hypertension.It will vary above 180/120 mm of hg and patient should be admitted to hospital for reducing blood pressure to avoid damage of organs like kidney, heart,liver, etc.PAH means pulmonary arterial hypertension.  which can be diagnosed through ecko cardiogram. To find out the gradation of conditions are give below.
1. Ascertain BP at variuos times during day, while resting in bed and when uder treatment with antihypertensive medicines. Find any primary cause like kidney dieases, diabetes, pregnancy or albumen in blood. Finding out any change in heart functions, pulse rate, electro-cardiographic changes, etc. And also ascertain secondary hypertensive complaints such as blood in urine, albumen, and disturbed kidney functions.
2. Hypertension is a socio-medical problem due to its high incidence with hypertensive heart diseases. It is increasing in the world with modern living conditions such as industrailisation, etc, high morbidity and mortality involving disability and economic loss.Next to heart disease and cerebral disease, it has the highest mortality rate.out of over the one fifth of all deaths over the age of 50. Above 30 percentage of population over 50 years of age may be suffering from it. Malignant forms of this disease are less common in eastern than western countries.
3. When hypertension is found out to a specific primary condition, some of the following factors believed to be responsible in the causation of high blood presure,is known as hypertensive risk factor like overweight and obesity,smoking,genetic factors,etc. Salt restriction brings down high blood presure levels,but if an excessive salt intake raises normal blood presure or not and if so whether it is one of the causes of persistant hypertension,is not known.

Preventive and control measures of hypertension.

Detection and treatment of early cases is an important measure due to even established hypertension may remain uncompliated for long time. Early,mild and uncomplicated high blood pressure with a view of arresting further progression of the disease and to increase long life under the category of secondary prevention of essential primary hypertension.By the care of certain factors like mode of life, habits, diet and body weight and treatment of antihypertensive medicines and psychotherapy,it is possible to obtain partial or complete cure in such cases towards longer and healthier lives so that the passive attitude based on high blood pressure is incurable. Certain secondary hypertensions are primarily preventable.Corrective surgery  in early childwood for coarctation, early intensive treatment of urinary infections,prevention and early treatment for throat infections in children, quick detection and removal of adrenal tumour, efficient antenatal or prenatal care for detection and treatment of the toxaemia arrest for the development of secondary hypertension. The object of prevention and control of hypertension should be to get rid of, arrest, undo or impede the progress of
the primary and secodary hypertensive disease in its early and late stages with complications. Other measures are the treatment of advanced cases and rehabilitation of the affected persons and health education of public,etc.The preventive approach to hypertension was grasped and professed long back in 1876 Handfield Jones when he said 'If I were bold enough to be a prophet, I should point to the time when the elder folks,instead of waiting till they had a stroke of apoplexy or a touch of paralysis....and then hurriedly summoning a physician to do impossibilities, will seek his advice, asking him to supervise their vital functions, regulate their mode of life and teach them to stay the morbid changes which they know may be silently progressing'

LEPTOSPIROSIS AND PREVENTION.

The disease and identification.

The disease due to leptospirosis is normaly known as Weils disease and also known as spirochaetosis, icterus gravis, etc in various parts of the world. In kerala, in Malayalam it is known as ELIPANI(rat fever) not rat bite fever. It is a sudden febrile animal borne infection charecterised in human beings by fever , icterus, albumen in urine,bleedings , severe headache and pain in the body, skin rashes, enlargement of liver, prostration and passing of bile in urine and faeces and loose motions and abdominal pains and continiues with irregular fever which starts from 4 th day onwards and lasts for a week or upto 10 days after that fever comes down and after 14 the day the healing starts.

Causal organism.

Leprospira icterohaemorrhagiae is the organism. It is a slender, closely wound, very actively motile spirochaeta varying in length from 1m to 4m. The spirals are shallow and regular , each half m in length, thin and acutely bent as a crook. It is found in the blood, urine, ceribrospinal fluid and sputum of the patient. They can be demonstrated by a dark ground illustration by the day in the urine.It can be cultivated on Naguchi's medium or in a mixture of peptone. Besides these types of Europeon strains,there are fifty named strains of Leptospira with varying invasive potentialities.

Source and reservoir of infection.

The natural reservoir of infection are the rats and the field mice. These rodents are tolerent to the spirochaeta and not suffer from the disease. The organism is excreted in their urine  and faeces,The disease also occur in dogs but the sudden source of infection to man is through the soil contaminated with infective excereta, specially urine.

The incubation period and period of infectivity.

The normal incubation period is one week with a range of six to eight days rarely and may go upto 13 days. Route and mode of transmission to man is through microscopic abrasions occured during work in soil,drains.sewers, etc. Bathing in contaminated water has a given rise to outbreaks. It may occur among farmers, sewer workers,miners,fishmongers and other workers during out breaks. Urine of the patient can be infective from the end of first week onwards from 10 to 25 th day, may extend upto 2 months. Rats are infective during their life. Man possess no natural immunity. Aquired immunity is not solid or remains for long time. The disease occure as severe or mild attack depending upon the type of infecting organism.

Geographical prevalence of the disease.

The disease is virulent in warm countries. The disease was early thought to be prevalent in Japan.  It is endemic in Holond, Congo, coastal Germany, Africa, Sudan, Indonenesia, Malayasia and other countries.

PREVENTION AND CONTROL.

Rat control in vulnarable areas like coastal side and sorrounding areas,sewers in towns and urban areas, etc. Protective clothing for workers, in vulnerable trades like sewer workers and divers,etc. Swimming in infected pools should be avoided. Attendants in hospital should wear protective clothing. Disinfection of items used by patient including urine,faeces, etc, and terminal disinfection also carried out. Naguchi prepared a vaccine for giving to persons enggaged in hazardous professions.

HEALTH CARE

PREVENTION IS BETTER THAN CURE.

Personal hygiene: Regular bowel habits are important for maintaining good health. It is cultivated by regularity in its act. A daily bath is essential to maintain a healthy skin and to avoid communicable skin diseases. Using of too much soap is not good always. Hair should be washed regularly and should be kept short to avoid dirt accumulating in it. Nails accumulate dirt and pathogenic organisms and introduces them dirt to food if hands are not washed properly and in the skin also if one happens to scratch it. They should be kept short. Eyes,ears,nose and throat should be cleaned before before brushing the teeth. Cold and hot baths respectively cool down the body in summer and warm it in winter. Teeth should be brushed after every meal,but at least after the last meal of the day. A proper brush should be used for cleaning the teeth. Eyes should not be rubbed always or wiped with dirty hands. A clean handkerchief should be used for wiping the eyes and another for cleaning the nose,and while sneezing or coughing. Fingers should not be used for cleaning nose and ears. It is a dirty habit and may damage the ear drum or nasal mucosa. The nose should not be blown too much violently as it results in driving the mucous discharge up the Eustachian tube and may rupture the ear drum. Communal shaving by a barber may cause sycosis or tenia infection or other skin diseases. Spitting indiscriminately or coughing,sneezing with out use of handkerchief are bad habits which help to spread the respiratory infection,and such habits should be discouraged. Tobacco or betel chewing in public places must be prohibited and the habit of spitting can be curbed.

FOOD HABIT.

The habit of eating food at fixed times,from healthy sources where it is well and hygienically cooked,preserved,protected and served. It should be eaten in a sanitary surroundings with out fly or dust nuisance or bad odours. It should be served by hygienic food handlers in a hygienic manner. Personal hygiene before and after eating is very important. Hands and mouth must be washed before and after eating. Teeth should always be cleaned with a brush or finger while washing the mouth after eating. The habit of using  a toothpick is not good as it harms teeth and gums. Eating between should be avoided by persons of advancing age. Over consumption of oils, vanaspathi or pure ghee is not beneficial as it usually believed.When people get into good food habits detest eating in unhygienic places and unwholesome food.

WATER HYGIENE.

Water should be consumed from an authorized or a known safe source in adequate quantity. Laziness in adhering to this habit may  cause infections of gastrointestinal disease,specially during rainy season and extreme summer while journeys by train or road. Arrangements should be made to facilitate these habits by the persons themselves while traveling. Pure cool drinking water should be carried to maintain fitness and to prevent effects of heat during long journey.

EXERCISE.

The human body requires regular exertion. lack of exercise leads to obesity, muscular laxity, low vital capacity, low katabolism, low cardiac tolerance and low threshold for physical and emotional stress. Physical activity is a stimulus to the growth of children and adolescence and promotes mental relaxation in adults. It produces and enhances resistance against heart diseases,respiratory infections, prevents obesity and mental and physical well beings. Exercise should, but, not to be so excessive as to cause extreme fatigue, as like all other stimuli, it becomes a stress producing factor if it is excessive. It should be enough to produce pleasant fatigue demanding relaxation. Relaxation and sleep are necessary for recovery of the body from fatigue by vanishing biochemical products and psychological effects of physical and mental exertion. Sleep should be sound with out any artificial aids. A sound sleep is necessary from ill health, good feeding and sufficient physical and mental exercises,comfortable thermal environments and also freedom from pests like bed bugs, mosquitoes,rats and so on ; comfortable garments, bed, and bed linen and freedom from noise. Men get used to sleeping with open windows and uncovered faces. During winter and rainy season adequate clothes and blankets must be put for warmth while sleeping.

RECREATION.

Healthy out door and indoor games, recreational outings, visit to places of historical and cultural interests, hobbies like music, photography or handicraft , and  other re-creative pastime engagements for using leisure in healthy habits produces a healthy attitude of life,those prevent temptation to indulge unhealthy activities, aimless loitering,quarrelsome behavior and provides relaxation with out dullness or drowsiness. Ethical,religious,moral teaching keeps the mind of people geared to healthy thought and action.

DRINKING AND SMOKING.

It is not necessary in any form for nutrition. The higher regular consumption may lead to diseases of liver, stomach, kidneys,heart and nervous system causing alcoholic cirrhosis, stomach ulcers, psychic ailments and cancers of mouth, throat, food pipe and stomach. Regular consumption leads to compulsive drinking and further on to addiction and later confirmed 'alcoholism' its classical stage which is harmful to the body and mind. Alcoholism is a disease needing psychological treatment. Chronic alcoholism may lea to obesity and its effects. Heavy smoking is another unhealthy habit. Tobacco is not essential for a healthy or happy life. Excessive smoking started in early life causes addiction and increased incidence of lung cancer and higher incidence heart diseases. It also causes peptic ulceration, gastric cancer and tremors. Withdrawal symptoms or denial of smoking to a person used to it are similar to withdrawal of any other material of addiction like irritability, lack of concentration, restlessness,etc.

OBESITY.

An excessive deposit of fat in the body with an increase in body weight  more than 10 percent above normal for the age,sex,height,etc. Fat in the body is deposited in the fat depots such as over the abdominal wall, buttocks,thighs and over the shoulders and the back. In addition to this deposition extra fat in intestinal tissues in the body, bone marrow, around the heart, spleen and liver and kidneys and also higher lipids circulating in the blood. Obesity is associated with serious disease processes. Premature death rate is more amongst obese persons. It is one of the major factor of heat diseases. Obesity increases the rate amongst diabetes 4 times who get cardiovascular diseases about 1.5 times. The most important and most universal cause for obesity is over eating and lack of exercise. Obesity decreases exercise tolerance. The only 2 ways of preventing it are regular exercises and a restricted dietary specially the fat producing items like ghee, oil, sugar. Active preventive measures against diseases and change in mode of life becomes necessary under certain conditions. Care of family and school children's' health care is a link between the maternity and child health care and the general community health care.