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Good luck tomorrow!

Good luck everyone!

I hope this blog and the spots helped out some with studying.

Everyone has already put in a huge amount of work, and tomorrow is the chance to finish it all off. Best of luck to all, and I will see you on the other side!

Preventive Medicine Paper Model Answers

One of the big 3: TB, malaria, HIV will be on there

Only 70% is infectious disease– 30% will be NCDs, refugee camps

WHO and CDC guidelines are where many of the examiners turn for their questions

Preventive Medicine Paper

1. GIS Question:

What is the role in public health?
- GIS is computer aided database managemnt and mapping
- GIS adds dimension of demographic analysis to IT linking data to map
- Determining geographic distribution
- Analysing spatial and temporal trends
- Mapping populations at risk
- Stratifying risk factors
- Assessing resource allocation
- Planning and targeting interventions
- Monitoring diseases and interventions over time
Guinea worm
- Maps drawn showing regional occurrence
- Unsafe groundwater sources
- Filters
- Temephos – biodegradable larvacide
- Systematically track all villages
- Identify infected and reinfected
- Detect target resoures
- Monitor process towards eradication
- Still in Southern Sudan and Chad
- Community based surveillance – look for painful blister relieved by dipping in water

2. Polio eradication what is required (10 marks) and what are the obstacles (10 marks)?

Required
- Surveillance of AFP with virology stool samples
- Routine vaccination
- Catch-up vaccinations/ mass vaccinations
- Targeted mop-up campaigns
- Other causes AFP: Guillan-barre, WNV, novel eneterovirus
Obstacles
- Political will
- Sanitation
- Vaccine refusal
- Increased costs as cases reduced
- Violence against owkers
- Vaccine-associated polio strains
- Transition from IPV to OPV
- Financing
- Vaccine Supply
- Trouble countries: India, Syria, Pakistan, Nigeria, South Sudan
- Infrastructure
- Cultural/religious beliefs

3. NCDs. Using either Type 2 DM or epilepsy describe how you would organize delievery of care to a rural community in central Africa (20 marks)

Diagnosis
- Diagnose with fasting or glucose challenge
- Establish system to diagnose problem
Treatment
- Essential medicine list, ensure no stockouts
- Move care to Primary Health Centre
- Set targets
- Use simple regimens of cheap, effective drugs
- Nurse-led clinical algorithms
Follow-up
- Encourage and check compliance
Access to Care
Education
- Educate patients and carers
- Educate health care staff

4. HIV. Why is HAART important to take on time (5 marks)? In setting of Africa, describe strategies to ensure compliance (15 marks)?

Take all drugs on time to ensure ideal drug level. Sub-optimal drug levels may provide pressure to select for resistant strains/mutations. HIV has a rapid mutation rate and is highly prone to developing resistance so having 3 drugs at active levels at all times is critically important.
Strategies
- Avoid stockouts
- Treatment buddies (relatives)
- Educate patients
- Educate health care workers
- Mobile phones/SMS
- Simplified regimens
- DOTs if needed
- Adeherence counselling
- Standardized adherence measures
- Free drugs
- Recall systems to prevent loss to follow up
- Expert patients

5. HPV: Should you accept a donation of Cervarix or Garasil for three years

Vaccine basics
- Highly effective
- Expensive
Cost
Sustainability
Are there other health/social interventions to be given alongside?
Studies needed for acceptability, proportion of disease from 16/18
How do you market? Cancer prevention or STIs
Outside of typical vaccine target ages, how to be done?

6. Discuss 4 key messages that you would put into an information leaflet for men considering being circumcised (20 marks)?

Interventions: condoms, syndromic management, ART, cirucmcision
Shown repeatedly to prevent men acquiring HIV by almost half
Will not protect you from other means of infection
Keep using condoms
Don’t have sex for 6 weeks until wound is healed because it increases chance until then

7. 6 critical public health measures for diarrhoeal prevention

Clean water
Nutritional supplementation: vitamin A, zinc
Rotavirus immunization
Exclusive breastfeeding
Wat/san
Hand hygiene
Hygienic nutritious weaning foods (not just rice)
? Anti-helminthic
Main causes (GEMS Trial): Rotavirus, Cryptosporidium, Shigella, Enterotoxigenic E. Coli

Trachoma