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Showing posts with label PSM. Show all posts
Showing posts with label PSM. Show all posts

Physical activity Guidelines by WHO

WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs.
The recommendations address three age groups: 5–17 years old; 18–64 years old; and 65 years old and above.

Physical Activity and Young People (for children aged 5 - 17 years):
In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers:
  1. Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
  2. Amounts of physical activity greater than 60 minutes provide additional health benefits.
  3. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.
*For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

ü  These recommendations are relevant to all healthy children aged 5–17 years unless specific medical conditions indicate to the contrary.
ü  The concept of accumulation refers to meeting the goal of 60 minutes per day by performing activities in multiple shorter bouts spread throughout the day (e.g. 2 bouts of 30 minutes), then adding together the time spent during each of these bouts.
ü  For inactive children and youth, a progressive increase in activity to eventually achieve the target shown above is recommended. It is appropriate to start with smaller amounts of physical activity and gradually increase duration, frequency and intensity over time. It should also be noted that if children are currently doing no physical activity, doing amounts below the recommended levels will bring more benefits than doing none at all.


Physical Activity and Adults (physical activity for adults aged 18 - 64 years):
In order to improve cardiorespiratory and muscular fitness, bone health, reduce the risk of NCDs and depression:
  1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
  2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
  3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
  4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

ü  These recommendations are relevant to all healthy adults aged 18–64 years unless specific medical conditions indicate to the contrary. They are applicable for all adults irrespective of gender, race, ethnicity or income level. They also apply to individuals in this age range with chronic non-communicable conditions not related to mobility such as hypertension or diabetes.
ü  There are multiple ways of accumulating the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.
ü  Pregnant, postpartum women and persons with cardiac events may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for this age group.
ü  Inactive adults or adults with disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.


Physical Activity and Older Adults (physical activity for adults aged 65 and above):
In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:
  1. Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
  2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
  3. For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
  4. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
  5. Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
  6. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

ü  These guidelines are relevant to all healthy adults aged 65 years and above. They are also relevant to individuals in this age range with chronic NCD conditions. Individuals with specific health conditions, such as cardiovascular disease and diabetes, may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older adults.
ü  There are a number of ways older adults can accumulate the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.
ü  Older adults who are inactive or who have some disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Older adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.



Note: These recommendations can be applied to people with disabilities. However, adjustments for each individual based on their exercise capacity and specific health risks or limitations may be needed.

family health care program (FILLED UP QUESTIONNAIRE)

(NOTE:- I have changed the names to protect the identity of the family under study.)

Department of Preventive and Social Medicine
All India Institute of Hygiene and Public Health
FAMILY HEALTH CARE PROGRAMME
URBAN HEALTH CENTER, CHETLA

FILLED UP QUESTIONNAIRE




Identification Particulars:
Name of the Head of Family: SAYAN Singh
Type of family: Joint-family
Address: L/L Rama Mahato, 19B Chetla Hat Road.
Religion: Hindu
Caste: Rajput
State of origin: Bihar
Length of residence: Since birth
Mother tongue: Bhojpuri




Particulars of the family members:
Sl no.
Names

Relation with
HOF
Age
(yr)
Sex
Marital
Status
Education
Level
Occupation
Physical
Activity
Physiological
Status
CU
Re-marks

1
SAYAN Singh
HOF
30
M
M
Class 10
Group D
Worker in
UJALA
MW


1

2
Biplab Singh
Father
of
HOF
60
M
Class 5
Retired
Car driver,
Agriculture
In Bihar


SW


1.18

3
Piyali
Singh
Wife
of
HOF
26
F
M
Class 8
Housewife
SW


0.82

4
Rakesh
Singh
Younger Brother
of HOF

25
M
UM
Class 12
Worker in SUGUNA company
MW


1.18

5
Sweety
Singh
Daughter
of
HOF
5
F
UM
Class 1






0.58

6
Abhinabh
Singh
Son
of
HOF
1yr
3months
M
UM









0.46







Amenities and recreational facilities:

How does the family get information/news?

Newspaper, Radio,Television, interaction with friends and neighbors

Possession of:
Electricity, Fan, Radio, Television, Tape recorder, Mobile, Motorcycle
How do they pass their free time?
Watching TV, Catching up with Friends and Community members, Occasional trips Homeland(Bihar) mostly to attend social functions like marriage ceremony etc.







Social Problems

Any unemployed member in the family?
No
Addiction?
SAYAN Singh (HOF) occasionally takes Smoke less tobacco (Khaini)
Any mother who is unmarried, divorced, or abandoned by husband’s family?
No
Any handicapped or chronically ill family member?
No
Any children above 5 years of age not going to school?
No
Is the mother working anywhere?
No, she is a Housewife
Child labour (any child less than 14 years working)?
No







Monthly expenditure of the family
http://www.easyinsuranceindia.com/images/rupee_symbol.gif
Food
6,592/-
Fuel
405/-  (gas cylinder)
Clothing
200/-
Education
700/- (tuition for children)
Electricity
 400/-
Housing
60/- (rent)
Social functions
300/-
Health and Illness
500/-
Travel/Transport
1,000/-
Recreation
58/-(cable TV)
Any other expenditure

Mobile bill
300/-
Soap/Detergent/Shampoo
300/-
Total
10,815/-



http://www.easyinsuranceindia.com/images/rupee_symbol.gifMonthly income of the family
(detailed)
SAYAN Singh
·         5,000/-
Rakesh Singh
·         6,880/-
From Agriculture by  Biplab Singh:
·         2,000/-

Total monthly income of the family
http://www.easyinsuranceindia.com/images/rupee_symbol.gif  13,880
Per capita monthly income
http://www.easyinsuranceindia.com/images/rupee_symbol.gif   2,313
Balance income over expenditure
3,065/-(deposited in SBI account as savings)








Socio-economic status based on Kuppuswamy’s modified socio-economic status scale
Criteria
Features
Score
Education
Middle-school
3
Occupation
Semi-skilled
3
Family income per month
13,880/-
10
Total score
16
Socio-economic status
Upper middle(II)






Health facility
Where do you usually go to take treatment?
·         Private sector hospital (CMRI)
·         Govt. facilities are also used occasionally

Why Govt. facilities are not used routinely?
·         Problem matching their free time with the availability of consultant(specialist) doctor
·         Govt. sector hospitals are more time consuming


Schedule for assessment of environmental condition: housing, water supply, disposal of refuse and excreta

Housing:
Site
By lane off the main road
House Type
Mixed
Number of Living Rooms
2 (1st living room inside and 2nd room created by walling and roofing the Veranda into a Kitchen cum Living room)
Total area of the living rooms (Floor Space)

151 sq feet
Per Capita Floor space
25.16 sq feet

Comment on Overcrowding
Present
Cross Ventilation
1st room –absent
2nd room-present
Lighting
Inadequate natural light
Kitchen
In the Veranda room
Smoke Nuisance
absent
Kitchen Garden
absent
Drainage System  Around the house
no open drains, Underground system drains the water into a local canal
Drainage
Of Household water
Underground system drains the water into a local canal
Breeding place for mosquitoes
Present near municipality water supply taps
Fly Nuisance
present







WATER SUPPLY
Source of Water
Drinking purpose
Kolkata Municipal Corporation Water Supply from Public Taps
Cooking purpose
Washing/Bathing purpose
Distance of Drinking water source
5 meters
Duration of Water Supply
Intermittent
Morning
7 AM to 9:30 AM
Evening
4 PM to 7 PM
Adequacy of Water Supply
adequate
Collection & Storage of water
Water is collected by buckets and stored in drums and buckets which are kept properly covered.
Treatment of Drinking Water
Boiled water is given to the children

Excreta disposal
Latrine
situated about 20 meters away from the house
Where do family members including children go to defecate
Sanitary latrine

Refuse disposal
Disposal of refuse
Collected from each house by Hand cart and transported to KMC trucks
Disposal of kitchen waste
Waste water and sullage drains into underground sewerage system through opening in the kitchen.
Solid waste transported by hand cart as mentioned above.







Assessment of knowledge, practice and utilization of health services
Knowledge regarding
Causation

Modes of prevention
Care seeking behavior
ARI
Exposure to cold
Mustard oil massage before bath
Visit doctor
Diarrhea
Eating with dirty hands & drinking unclean water
Hand-wash before eating & drinking boiled water
Give ORS at home, if no response then visit doctor
Malaria
Mosquito bite
Using mosquito repellant in the evening and sleeping in mosquito-net at night
Visit doctor
Tuberculosis
Spreads through cough of TB patient
Avoid TB patient & keep him in separate room
Visit doctor
HIV/STI
Not known
Not known
Visit doctor









Serial number of wife in the family
1
Age at marriage(years)
16
Age at first pregnancy(years)
21
Total number of live births
2
Total number of abortions/still births
1  (3 years back)
(spontaneous abortion)
Total number of current living children:
                                                                       
girl
1
boy
1
Interval between last two deliveries
2yr,1m,3weeks
Birth spacing/ limiting methods
(if currently used, specify )
·         Condom
·         Coitus Interruptus(currently practiced)
Utilization of the following services during last pregnancy :
·         Ante-natal check-up

·         Tetanus toxoid


·         Iron and folic acid tablets consumed

·         Diet


·         Place of delivery

·         Delivery conducted by

Yes
        
1 (booster)


Yes( 5 months before delivery and 2 months after delivery)
 Increased



Chittaranjan Seva Sadan Hospital,  Kolkata
Health Personal

Knowledge and practice
Topic
Knowledge
Practice
Infant feeding practice
·         Colostrum
Should be given to the baby
Both the children received colostrum
·         Exclusive breast feeding
Should be done for 1st 6 months and nothing else should be given without asking the doctor
Both the children received EBF for 1st 6 months of life
·         Complementary feeding
Should be started after 6 months along with breast feeding
Started with mashed rice and vegetables from 6 months onwards along with breast milk.
·         Feeding during illness
Should be done
Gives breast milk during illness.
Antenatal/Natal/Postnatal care
·         Regular checkup
Should be done both during and after childbirth
Visited her doctor as advised
·         Delivery practices
Delivery should be done in hospital
Both her children were delivered at Chittaranjan Seva Sadan Hospital, Kolkata
·         Iron and folic acid prophylaxis
Should be taken if advised by doctor
Took IFA tables(full course not done because she had constipation and a bad taste in mouth)
·         Tetanus toxoid
Should be taken
Received 2 injections during her 1st pregnancy and 1 injection each during the subsequent episodes.
·         Diet
More food should be taken because it will make baby healthy
Used to eat more quantity of food during each of her meals
·         Rest
Needs rest because mother becomes tired easily
Would lie down and watch TV or sleep for sometimes during the afternoon when the household work was done.
Utilization and practice of preventive reproductive health services
A)    Knowledge of family planning
Desirable age of marriage
20 years for both male and female
Have you heard about Family Planning
Yes
Which methods do u know?
Condom / Coitus Interruptus
What is the source of your knowledge?
Husband/Neighbors’ wife
Do you know where MTP serves are available?
Yes , in big hospitals like Chittaranjan Seva Sadan Hospital and Nursing homes
B)    Attitude towards family planning
1)    Number of children the family desires
Husband
Wife
2
2
2)    Suitable spacing between children
3-4 years
3)    From where are the contraceptives procured?
Nearby Pharmacy shops
4)    Do you have any plans for permanent methods?
No
5)    If needed will you avail MTP services?
Yes
6)    Are you practicing any family planning method?
Yes (condom followed by Coitus Interruptus)
Regularity of use
After delivery for 1st 4-5 months Condom was used, later they practiced Coitus Interruptus
Since when
Exact date Not recalled
Any method used previously and discontinued
Condom (husband doesn’t like using it)
Any H/O induced abortion?
No(she has a history of spontaneous abortion)
Name of the child
Sweety Singh
Birth history
Date of birth
24/09/06
Sex
Female
Birth weight
3.2kg
Full term/ Pre-term
Full-term
Place of delivery
Chittaranjan Seva Sadan Hospital, Kolkata
Birth attendant
Present
Type of delivery
Normal Vaginal delivery with episiotomy
Any congenital malformations
No
feeding
Type of food 1st offered
Colostrum
Was colostrum given to the baby
Yes
When was breastfeeding started after delivery
2hrs
Breastfeeding continued exclusively for
6months
Breastfeeding discontinued from
1and2 years of age because she could eat hear meals properly.
Semisolid/solid food supplementation started from
6months
What type of food was given to the child during weaning
Kheer/Khichdi/Milk & biscuit
Child feeding pattern during episodes of diarrhea/ other illness
Khichdi with Mashed vegetables are offered to the child.
































































Health checkup of under 5 children:





Immunization status of the child: Sweety Singh (24/09/06)


vaccine
Age at vaccination
From where obtained
remarks
BCG
Hep-B
2nd day of life,(25/09/06)
2nd day of life,(25/09/06)
UHC, Chetla

DPT-1
DPT-2,Hep-B
DPT-3,Hep-B
BPT-B, Vit-A(2)
Vit-A(3)
Vit-A(4)
Vit-A(5)
6weeks,(8/11/06)
11weeks,(13/12/06)
15weeks,(17/01/07)
13/02/08
09/11/09
30/06/10
27/01/11
UHC, Chetla

OPV-1
OPV-2
OPV-3
OPV-B
6weeks, (08/11/06)
11weeks,(13/12/06)
15weeks,(17/01/07)
13/02/08
UHC, Chetla

Measles ,
Vit-A(1)
9month2weeks(4/07/07)
UHC, Chetla


















































Findings on history and clinical examination including anthropometry and nutritional assessment (Sweta Singh)



Present illness ,if any
(chief complaints)
No
History of significant past illness
Absent
Anthropometry
Weight
20kg
Height
108cm
Mid-arm circumference
13.7cm
Clinical
General appearance
Normal
Hair
NAD
Face
NAD
Eyes
NAD
Lips
NAD
Tongue
NAD
Teeth
NAD
Gums
NAD
Glands/Thyroid
NAD
Skin
NAD
Nails
NAD
Edema
Absent
Rachitic change
Absent
Hepatomegaly
Absent
Calf tenderness
Absent
Ankle and Knee jerks
Normal
Psychological changes
Normal






Name of the child
Abhinabh Singh
Birth history
Date of birth
07/06/10
Sex
Male
Birth weight
3.1kg
Full term/ Pre-term
Full-term
Place of delivery
Chittaranjan Seva Sadan Hospital, Kolkata
Birth attendant
Present
Type of delivery
Normal Vaginal
Any congenital malformations
No
feeding
Type of food 1st offered
Colostrum
Was colostrum given to the baby
Yes
When was breastfeeding started after delivery
4hrs
Breastfeeding continued exclusively for
6months
Breastfeeding discontinued from
Continuing till date
Semisolid/solid food supplementation started from
6months
What type of food was given to the child during weaning
Kheer/Khichdi/Milk & biscuit
Child feeding pattern during episodes of diarrhea/ other illness
Breast milk given, Khichdi with Mashed vegetables also offered to the child.








Immunization status of child (Abhinabh Singh, DOB-07/06/10)



vaccine
Age at vaccination
From where obtained
Remarks
BCG
Hep-B
2nd day of life(08/06/10)
2nd day of life(08/06/10)
UHC, Chetla

DPT-1
DPT-2
DPT-3
8weeks4days(11/08/10)
13weeks(15/09/10)
23weeks(01/12/10)
UHC, Chetla

OPV-0
OPV-1
OPV-2
OPV-3
2nd day of life(08/06/10)
8weeks4days(11/08/10)
13weeks(15/09/10)
23weeks(01/12/10)
UHC, Chetla

Measles , Vit A
9 months 9 days
(16/06/10)
UHC, Chetla











Findings on clinical examination including anthropometry and nutritional assessment (Abhinabh Singh)



Present illness ,if any (chief complaints)
No
History of significant past illness
Absent
Anthropometry
Weight
13kg
Height
85cm
Mid-arm circumference
13.5cm
Clinical
General appearance
Normal
Hair
NAD
Face
NAD
Eyes
NAD
Lips
NAD
Tongue
NAD
Teeth
NAD
Gums
NAD
Glands/Thyroid
NAD
Skin
NAD
Nails
NAD
Edema
Absent
Rachitic change
Absent
Hepatomegaly
Absent
Calf tenderness
Absent
Ankle and Knee jerks
Normal
Psychological changes
Normal









Health check-up of individual family members

Identification
Name
Piyali Singh
SAYAN Singh
Rakesh Singh
Sex
Female
Male
Male
Age
26yrs
30yrs
25yrs
Presenting complaints
No present complaint
No present complaint
No present complaint
Significant past illness
Absent
Absent
Absent
Examination
Height
161cm
170cm
168cm
Weight
45kg
68kg
65kg
BMI
17.36
23.53
23.03
Pulse
82/min
80/min
76/min
BP
100/60mm Hg
110/78mm Hg
116/74mm Hg
Respiration
16/min
17/min
18/min
Pallor
Mild
Absent
Absent
Respiratory System
NAD
NAD
NAD
CVS
NAD
NAD
NAD
Abdomen
NAD
NAD
NAD
Provisional Diagnosis
Mild Anemia
Normal
Normal
Lab investigation
Suggested but not done
……………………..
………………………
Advice on management
Suggested Iron Tablets
………………………
………………………