-biological and physiological characteristics of a person.

-behaviours, roles, expectations and activities in society of a person.

refers to male or female whereas

refers to masculine and feminine

Concepts of class:

• the capitalist state of production consists of 2 main classes: i. bourgeoisie (the capitalist who owns the means of production aka the boss) ii. And the proletariat (the working class, those who must sell their own labour power).

• concept of class: a person’s culture, level of education, hobbies and interests determine which class a person belongs to, and the difference in these lead to the differences in class.

-• “wear and tear” on the body. It grows overtime, when the person is exposed to repeated or chronic stress.

What is shame?

• Shame is a subjective emotional response characterised by negative moral judgements about oneself.

-feeling bad about something you’ve done or the way you look

- feeling bad about who you are as a person.

stigma- how we feel about ourselves.

stigma- how we are viewed and treated by others.

Refugees, Asylum Seekers and Illegal Immigrants:

: Someone fleeing persecution in their country of origin, has arrived in the UK and applied to the Home Office for asylum.

: Someone whose asylum application has been successful and has been recognised by the Home Office as being at risk of persecution on return to their country of origin.

‘Failed' asylum seeker: Someone whose asylum application has been refused by the

and who has no further legal right of appeal. Human rights campaigners prefer the term ‘refused’ asylum seeker.

Irregular or undocumented migrant: There is no generally accepted definition. This could include someone who has arrived in the UK and not made themselves known to the authorities, someone who is not complying with the terms of their leave, or someone who has remained in the UK after existing leave or temporary admission has expired. Some people may be able to regularise their status.

Illegal immigrant: Generally accepted to be an

term. Frequently used by politicians and in the media. Most irregular or undocumented migrants haven’t broken the criminal law, but have failed to comply with administrative procedures.

Economic migrant: Someone who has moved to another country to work or to find work.

Treatment tourist/health tourist: Someone who travels to the UK for the express purpose of accessing free NHS medical treatment. Migrant: Could be anyone who has moved across a border.

UK asylum process:

1-

UK Border Agency takes applicant’s personal details and checks if they have previously claimed asylum in UK or Europe

2. Few days later, the applicant will be asked to attend a

3. Within next couple of weeks, ‘substantive interview’, or ‘asylum interview’ is held. Here, applicant has opportunity to describe to case owner their story and their fear of own country.

4. Asylum seekers may be asked to attend regular reporting meetings with local UK Border Agency staff at all stages of the asylum process. The UK Border Agency also uses telephone reporting systems and electronic tagging of asylum seekers.

5. After the screening interview, some applicants are taken to Harmondsworth Immigration Removal Centre or Yarl’s Wood Immigration Removal Centre, where their application is ‘fast-tracked’. They are held in detention while a decision is made on their application within seven days. In these cases the entire decision-making and appeals process can be completed within nine days.

Refugee Status and Humanitarian Protection:

• If someone is granted refugee status: They will be granted

years leave to remain, they will be granted full entitlement to access services, benefits to work etc. I.e. they are granted the same entitlements as a UK citizen.

Instead of refuges status, a person may be granted

Discretionary Leave: • Someone applying under ARTICLE 8 (see previous slides) may be granted discretionary leave, and this is often for a lesser time, 30 months is usual. This carries lesser entitlements.

Once refugee status has ended, or discretionary leave has accrued for up to 10 years then someone can apply for indefinite leave to remain.

Homeless people:

Homeless people attend A&E

times as much, are admitted 3 times as often, and stay 3 times as long as the general public. Overall they cost

times as much

The average age of death of homeless men is just

and for women it is

•1/3 of deaths caused by drug and alcohol • Homeless people 9 times more likely to commit suicide • RTAs 3 times as likely • Infections 2 times as likely

Maslow's hierarchy of need:

safety

love/belonging

Domestic violence:

and 784,000 men between 16 and 59 in England and Wales suffered domestic violence in 2010/11

of women have experience domestic violence at some point in their lives

• 17% of men have experience domestic violence at some point in their lives • There are many causes: o Honour-based violence, forced marriage, ostracising the female o Alcohol and illicit drugs o Advocacy, perpetrator programmes, structured follow-up o Links to Mental Health system, legal system, criminal justice system

The NHS system:

£65 billion of the NHS £100 billion budget is going to organisations called

• CCGs are made of GPs, but there’s also representatives from nursing, the public and hospital doctors. Their job is to try to improve the health of their bit of the population.

• They can commission services from a range of different organisations including hospitals, community health services, and the private and voluntary sectors.

• All of these have to be registered with the health care regulators, the Care Quality Commission and Monitor.

• Two different bodies that support them. o 20 commissioning support units: crunch data, they can do contract negotiations and some technical contract management. o Clinical senates is to bring together a whole range of medical professions to offer advice to CCGs on particular patient groups or conditions.

NHS does

enough money to continue to act as it does currently

QALY: (Quality Adjusted Life Year) is a generic measure of disease burden, including both the quality and quantity of life lived.

DALY: (Disability Adjusted Life Year) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

What is health?

Positive definition of health = A state of

in psychological, social and

aspects

Negative definition of health= The absence of

Ability to live well - to cope with everyday activities; fitness

Access to services, health care

Human, civil, occupational rights & world citizenship

Disease, Illness and Sickness :

Biological-

Social - a social performance, which may be legitimate and elicit responses from others -

Psychological - the subjective state involving the experience of symptoms-

The Sick Role - functionalist perspective - illness as a deviance

The Sick Role identifies two rights: Exemption from normal social roles Removed from responsibility for their own state

Pathways 3 Sectors of Healthcare: Popular, Folk and

There is more than one way of explaining and treating illness- this is known as

'Normal' in Medicine:

The concept of normal and deviance from the normal is based on the ability to

Provides scientific basis for: Diagnosis of disease Assessing individual and population's risk of disease

3 dimensions of medicine (FSI):

Any consequence of medical treatment or advice to a patient is called

Stigma and Labelling

Stigma Definition: The situation of an individual who is disqualified from full social acceptance

The Local Population :

Densely populated, Rapidly growing, Age:

Unequal, Diverse and Mobile

High proportion of people living on their own and young adults, this means that there is a high burden of: mental illness, alcohol and drug abuse

High median full time income but

% of children in Westminster live in poverty

Greater than 50% of people living in Westminster are born

the UK

Measurement of Socioeconomic Status (PSDE):

Index of Multiple Deprivation (LEECHIB):

Social Class:

Higher managerial and professional Lower managerial and professional Intermediate (clerical, sales, service) Small employers and own account workers Lower supervisory and technical Semi-routine occupations Routine occupations Never worked and long-term unemployed

Poverty:

poverty - people lack the basic necessities for survival (food, sanitation, proper housing, clothing or medicines)

Relative Poverty - people's way of life and income is much worse than the general standard of living in their country. They struggle to live a normal life and participate in ordinary economic, social and cultural activities.

Education: 53% of adults in Westminster have degree level education

Race, Ethnicity and Health :

Race - a powerful idea that we ascribe to biology (a social construct)

Ethnicity - individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behaviour, form an ethnic group

In short, Race is biological and Ethnicity is cultural

Racism can have biological consequences

Institutional Racism : Disparities in

Whitehall Study :

Established in 1967, 18000 men in the British Civil Service

Men in the lowest grades have a

times higher mortality rate than men in the highest grade. The gradient occurred across all grades. Whitehall II study conducted in 1985 Investigate social class differences in health

Illness Behaviour:

What determines how people act when they have symptoms:

Severity and Frequency of Symptoms, Social Factors-

triggers and Lay Referral Systems

Zola's Triggers:

Social factors which influence people's decision to consult a health professional

Interpersonal Crisis Interference with social or personal relations Sanctioning (pressure from other people to consult) Interference with vocational or physical activity Temporalising (setting a personal deadline)

Symptoms Iceberg - Identified by the Peckham Experiment

Many people do

Mental Health: Mental health problems affect 1 in

people over their lives Physical illness is a major risk factor for mental illness Psychiatric patients have poor physical health Stigma and fear of stigma obstructs presentation, diagnosis and care

Medicalisation: A process by which (previously) non-medical problems become defined and treated as medical conditions.

Can help validate symptoms (by labelling and proposing treatments)

Increase power and reach of

Ivan Illich - medicine can cause harm not only by stigmatising certain individuals but also through clinical, social and cultural

Professions:

Characteristics of a profession: Specialised training Shared knowledge Degree of autonomy State recognition and regulation Exclusion of others

Health System and Society

A health system reflects and reinforces values and structures of a society. Hierarchies by gender, social class, ethnic background . Technology (and biomedicine) has a

status than caring (and nursing)

The NHS Workforce:

1.4 million healthcare workers in UK

-33%

Support to clinical staff - 19% Infrastructure support - 19%

Therapists, Scientists, Technical - 14%

Doctors-

Ambulance Staff - 2%

30% growth over last 10 years

Rights to Health and Access to Healthcare:

Human rights to health are enshrined in national policy and a range of regional and international treaties

Founding Principle of the NHS: Providing healthcare based on need and not the ability to

Forced and irregular migrants fare

than UK residents on all measured of health and wellbeing

Refugees suffer from the triple trauma of: Leaving country of origin Experiences endured during migration Resettlement in another country

It is illegal for

to work in the UK

Migrants Access to Healthcare

Health tourism often conflated with migration in the media

UK is a net

of patients

Primary Care: All asylum seekers (including failed AS) have right to be fully registered with NHS GP Many undocumented immigrants do not register because of fears of

GPs have the discretion to refuse to register any patient but must not discriminate

Hospital Care:

People who are not 'ordinarily resident' in the UK,

charged for certain hospital treatments in the NHS (NHS Act 2006)

There are some contradictions between Doctor's Duty of Care/Hippocratic Oath

Patient Care in Context :

Changes in healthcare affect patients directly

Activism and social movements also affect patients: Improvements in patient experience and care More support and care inside the hospital More support and care outside the hospital Less taboo and stigma

Health movements and activism (e.g. breast cancer or HIV) includes: Patients and carers Health professionals Pharmaceutical companies and industries that manufacture health-related technologies

Epidemiological Transition: The changes in level and cause of

By decreasing the mortality of infectious and deficiency diseases you increase the relative role of non-communicable diseases such as cancers and CVD.

Affected by demographic, socioeconomic, technological, cultural, environmental and biological changes.

Some diseases disappear such as

, others appear (AIDS) and some re-emerge (TB).

There is a decrease in

cancer and a rise and fall of lung cancer.

Shift from stroke to heart disease

Cardiovascular Disease Epidemiology:

Mainly coronary heart disease and stroke

Accounted for

million deaths worldwide in 2010 - 29.5% of all deaths

More such deaths occurred in the developing world than the developed world

CHD and Stroke respectively rank first and second among cause-specific mortality worldwide.

Because of demographic (aging population) and epidemiological transitions, the burden of disease from non-communicable disease is likely to

Low incidence and mortality from CHD -

countries

High incidence and mortality from CHD - formerly socialist economies of Europe and the Middle East

Rates are

in men than in women

CHD and stroke mortality have been declining in many countries

Rise in CHD and stroke mortality in the formerly socialist economies of Europe and South Asia.

These epidemiological patterns indicate that

factors underlie much of the variation ins CVD risk worldwide.

3 main risk factors: High blood pressure, smoking and serum

Worldwide trends in overweight and obesity will increase the burden of non-communicable disease including metabolic disorders and diabetes.

Cancer Epidemiology:

Causes more than

of deaths in many countries

15.1% of deaths worldwide in 2010 - 8 million

Most commonly diagnosed cancers are lung, breast and

Most common cause of death: Lung, liver and

Cancer rates in migrants converge towards local cancer rates over time - role for modifiable risk factors

One third of cancers are likely to be preventable through a small number of lifestyle and environmental approaches

The largest preventable cause of cancer in the world is

Cancer can take 20 years to appear - so current cancer rates are affected by changes and exposures that took place in the past

Prevalence = the

of a disease in a

at a certain time

Hence it is often called point prevalence

Prevalence is a

Prevalence= number of cases in a population/ number of people in a population

Incidence = the number of

of a disease within a specific time interval

The measure of incidence can be interpreted as the probability, or risk, that an individual will develop the disease during a specific time period.

Incidence measures

cases whereas prevalence measures

cases, new and old

Prevalence is dependent on the incidence (number of new cases) and the time that they remain cases for being they die or recover (duration of disease).

Individuals only leave the pool of prevalent cases if they

Mortality - the

of deaths attributed to a specific conditions in a given time period

Mortality= number of deaths from disease over a given time period/population at the

of the time period

Mortality rates are generally expressed as deaths per

individuals per

Morbidity - the number of cases of ill health, complications, side effects attributed to a particular condition over a particular time period

Units of Measurement:

Morbidity scores or predicted morbidity are assigned to ill patients with systems such as

Helps determine which kind of treatment or medicine should be given to the patient.

Useful for comparing different patients or disease progression while at hospital

Highest death rate in the world:

30.83 deaths per 1000 people per year

Leading causes of death: Heart Disease Cerebro-Vascular Disease Respiratory Infections, HIV/AIDS COPD

In third world countries - 58% of mortality reported is due to

or deficiencies

Epidemiology of Infectious Diseases:

More than 90% of deaths from infectious diseases are caused by Lower respiratory infections HIV/AIDS Diarrhoeal Diseases Tuberculosis Malaria Measles

They are the leading causes of death in

Africa

Age Standardised Death Rates: Measuring how many people die each year and why they have died is one of the most important means of assessing the effectiveness of a country's health system.

Globally,

million people die every year. 15% of these deaths occur in

Most of these preventable deaths in children occur in low-middle income countries

AIDS epidemic - successes and challenges of the response

For every person put on HIV treatment,

are newly infected with HIV.

Decline in HIV prevalence in pregnant women

HIV Prevention: Safer sex, Safer injection practices Condom use and

Bias = a systematic error in design, conduct or

of a study which produces a mistaken estimate of treatment effect.

Confounding = when a variable (or factor) is related to both the study variable and the outcome so the effect of the study variable on the outcome is distorted.

Hierarchy of Studies: 1-

and meta-analyses

2. Randomised Control Trials 3.

studies 4. Case-Control Studies 5. Cross-sectional Studies 6. Case Series 7.

What is a clinical trial?

A planned experiment in

Designed to measure the

of an intervention: A new drug A surgical procedure A vaccine Complementary therapy

Different from epidemiological studies because most epidemiological studies are

Features of a Clinical Trial:

Define your intervention, define your comparator- placebo, alternative treatment or standard of care

Define your inclusion and exclusion criteria

Control Group:

They have to be

for intervention but they receive the comparator

Why needed? Compare to intervention group and show difference is due to intervention

Randomisation:

Ensured balance and eliminates

Avoids bias in treatment allocation

Methods of Randomising:

randomisation - assign people to group A or group B randomly

- done by centre - can be divided by important patient characteristics e.g. male/female

- adaptive stratification - calculates imbalance and allocates to maintain balance

Minimising Measurement Bias:

Blinding - single, double, triple

Endpoint Selection: Objective/Subjective Accurate and Precise Consistent and Repeatable Primary/Secondary/Tertiary end points

Loss to Follow-up: Missing data Different between groups Intention-to-treat analysis

Phases of Clinical Trials:

Phase I: Test the

of a new treatment

Small number of, usually healthy, volunteers

Phase II: Test to see if the treatment is

A few hundred people usually

the condition

Phase III:

with old treatment

Look at how well the new treatment works (effectiveness) Continue to monitor side effects

Several thousand patients

Phase IV:

the marketing of the drug

Measure effect in various populations Look out for rare side effects

Evaluation of Drugs:

Efficacy - The

effect

Phase II

Effectiveness - The true overall effect - Does it work and is it worth it?

Sample Size:

Prospective Power Calculation a =

Chance of obtaining a difference in the trial if there was

real difference between groups

Chance of false positive b = 0.1-0.2

Chance of obtaining no difference in the trial if there

a real difference between groups - Chance of false negative

Power = 1 - b

Reporting Results:

Control Event Rate (CER) = incidence in the

arm

Experimental Event Rate (EER) - incidence in the

arm

Absolute Risk Reduction (ARR) = CER -

Relative Risk Reduction (RRR) = ARR/CER

Number Needed to Treat (NNT) - number of patients that need to be treated for one to get benefit

Ethics and Consent:

Regulation aims to protect patients

All clinical trials have to be: Registered, Undergo independent scientific review, Approved by an independent Research Ethics Committee and Adhere to government and international guidelines

Independent data monitoring committee:

Researchers check progress during trial They unblind the results to see if there is any major difference in outcome

All participants in the trial must provide

and be free to withdraw at any time without affecting their care

Types of Epidemiological Study:

-to generate hypotheses: Individuals - case reports, case series, cross-sectional studies Populations - ecological studies

- to test hypotheses. Observational and Experimental

Observational - investigator merely observes and DOES NOT interfere or manipulate the exposure- Case Control Cohort

Experimental - investigator determines the exposure and who receives the intervention

Case Control Study = a

study in which individuals are selected on the basis of whether or not they have the outcome of interest. Exposure status is explored to establish whether the exposure is more common in those who have the outcome or the control. This type of study always results in

- for example, comparing the odds of being exposed in those who had the outcome with those who didn’t (the control)

It investigates the relationship between a risk factor and one or more outcomes Case (people who have the outcome) Control (people who don't have the outcome) Study

NOTE: PEOPLE IN CASE CONTROL STUDIES ALREADY HAVE THE DISEASE BEING INVESTIGATED

Cohort Study = a

study in which individuals are selected on the basis of

and are followed over a period of time to allow the frequency of occurrence of the outcome of interest in the exposed and non exposed groups to be compared. i.e. take a group of people, note whether they've been exposed or not, observe them over time and see who gets ill and who doesn't. This type of study typically produces a

NOTE: PEOPLE IN COHORT STUDIES DON'T HAVE THE DISEASE BEING INVESTIGATED

Procedure to carry out a Cohort Study:

Follow cohort over time and see how many people get the disease. Select people who are exposed and people who aren't. Compare risk of disease between the two.

Methods to Assess Exposure: Self-Reported Measured in clinic (e.g. BMI) Existing Records (e.g. medical/pharmacy records)

Measurement of Outcome:

Need to have a uniform method of detecting outcome among the exposed and non-exposed.

-With or without the disease of interest

-E.g. blood pressure Can use an arbitrary cut point

Retrospective Cohort Studies:

Uses data collected in the past to identify the population and exposure status

Determines at present the status (development) of disease

Takes

time as it takes relatively little time to: Assemble study population (and the exposed/non-exposed groups) from past data

Determine disease status at the present time (no future follow-up)

Measure of Association in a Cohort Study:

-The likelihood of developing the disease if you are exposed relative to those who are unexposed.

RR= incidence in exposed/ incidence in unexposed

Interpretation of Risk Ratios:

RR<1- Risk of outcome amongst exposed is

risk of outcome amongst the non exposed- Exposure causes a decrease in risk

RR=1 Risk of outcome amongst exposed and unexposed is the same- Exposure has no effect

RR>1 Risk of outcome amongst exposed is higher than risk of unexposed so exposure

risk of outcome

Case-Control Study:

Individuals with the disease (cases) are compared to individuals with the same general characteristics but without the disease (control)

Information to past exposure to possible

is obtained for cases and controls - exposure in the cases is compared with that in controls (retrospective studies)

Carrying out a Case-Control Study:

1. Select

with disease and controls without disease

2. Obtain information on

3.Compare proportion with exposure in cases versus controls

Definition of Cases:

It is preferable if the cases are

Objective and strict diagnostic criteria must be used

Defined eligibility criteria

Is it representative? Consider the undiagnosed, misdiagnosed, unavailable, dead

Definition of Controls :

Originate from the same study population as the cases

They

at risk of disease

Provide an estimate of the prevalence of exposure in that study population Defined eligibility criteria

Source of controls: Hospital/clinic Community/population

Hospital/Clinic Controls:

People recruited from the same hospital as the cases, but with diseases different from that being investigated

Advantages: Match with cases in

that bring people to certain hospitals/clinics

Convenient/Low Cost

Disadvantages: Medical conditions in control may be associated with the exposure being investigated

Population Controls:

People without the disease being investigated are recruited from the same

from which the cases arose. Usually chosen using random sampling.

Advantages: Estimate of prevalence of exposure is population-based rather than

-based

Disadvantages: Expensive Less motivation (lower response rates)

Measurement Error in Case-Control Studies:

bias -Patients with the disease may be more inclined to answer questions carefully - may have a distorted view of exposure

Interviewer Bias If the interviewer knows who has the disease, they may be more inclined to over-report exposures known to be associated with the disease of interest

Outcome Bias- Diagnostic bias

- the likelihood of having the exposure if you have the disease relative to the likelihood of having the exposure if you don't have the disease

Strengths of

study: Able to study multiple outcomes, can follow natural history of disease, disease incidence can be calculated and minimises bias in predicting exposure

Strengths of

study:

Well suited to study rare diseases ands diseases with a long latency, quick and less expensive

Weaknesses of

study:

Incidence rates can't be calculated, prone to selection bias and recall bias is an issue

Weaknesses of

study:

Expensive, time consuming and inefficient for studying rare diseases and loss to follow-up may introduce bias

Descriptive Studies:

Aim to describe the distribution of factors of disease in relation to: person, place and

Cross-Sectional Study:

Helps in decision-making regarding the allocation of resources.

Provide clues leading to hypotheses and analytical studies. Describes status of individuals with respect to absence or presence of both disease and exposure assessed at the same point in time

Cannot easily distinguish whether exposure

disease

Aims of a Survey:

Provide annual data about the nation's health

Estimate the proportion of the population with particular health conditions

Estimate the

of risk factors associated with these conditions

Assess the frequency with which

of risk factors occur

Examine differences between population sub-groups

Monitor targets in the health strategy

Core Topics of a Survey (included in Health Survey for England) :

General health and psycho-social indicators Smoking Alcohol Demographic and Socio-economic indicators Questions about use of health services and prescribed medicines Measurement of height, weight and blood pressure

Routine Data:

Data that are routinely collected and recorded in an ongoing systematic way, often for administrative or statutory purpose and without any specific research question in mind at the time of collection.

Advantages of Routine Data:

Relatively cheap Already collected and available Standardised collection procedures Relatively comprehensive (population coverage - large numbers) Wide range of recorded items Available for past years Experience in use an interpretation

Disadvantaged of Routine Data May not answer the question (not enough detail) Incomplete ascertainment (not every case captured) Variable quality Validity may be variable Disease labelling may vary over time or by area Coding changes could create artefactual increases or decreases in rates Need careful interpretation

Types of Routine Data

Health outcome e.g.

Exposure and health determinant data e.g.

Disease prevention data e.g.

Demographic data

Geographical data

Health service provision

Standardised Mortality Ratio:

Crude rates can mislead so: Adjust for

Represents the

of the number of observed deaths (or cases of disease) (O) in a particular population to the number that would be expected (E), if that population had the same mortality or morbidity experience as the standard population, corrected for differences in age structure.

SMR= O/E

Most Common Cancers Diagnosed in the UK (Male and Female): Breast, Lung, Large Bowel, Prostate and

Single studies are often unable to conclusively answer a research question:

Poor study design or small numbers - low power - false-negative results

Study will often only look at one subset of the potential study population

-review all available evidence

Structure of a Systematic Review :

Step 1:

a review- Specify the question to be addressed Usually framed around PICOS:

Step 2:

the review- Identification of Research Clearly defined search criteria Search published medical literature Search other sources

Missing studies-

Selection of Research, Study Quality Assessment and

which is the use of statistical techniques in a systematic review to integrate the results of included studies.

Step 3: Reporting and dissemination-

Study details tabulated in a meaningful way Should include details of PICOS

Issues in Systematic Reviews and Meta-Analyses:

Publication

Inconsistency of results Low study quality note: Null or non-significant findings are less likely to be reported/published than statistically significant findings This BIAS may distort meta-analyses and systematic reviews

Publication bias in Meta-analyses can be explored using

This is where each study is a plot and it position is determined by the study result - odds ratio- and the study precision

If the analysis is unbiased the results will look like an upside down funnel

Heterogeneity - Inconsistency of results:

Studies that are trying to answer the same questions may still differ with respect to the

Even when this is the same, heterogeneity may still exist because of clinical differences, methodological differences or unknown study characteristics

Advantages of Meta-analyses:

Generate a pooled overall risk estimate, Produce a more reliable and precise estimate of effect, Explore differences (heterogeneity) between published studies, Identify whether

bias is occuring

Health Promotion:

Wanless Report - focus on prevention and the wider determinants of health - cost-effectiveness of actions to improve health and reduce inequalities

Review - had 6 policy objectives:

Give every child the best start in life

Enable all children, young people and adults to maximise their capabilities and have control over their lives

Create fair employment and good work for all

Ensure a healthy standard of living for all

Create and develop healthy places and communities

Strengthen the role and impact of ill health prevention

Trends to know:

Health decreases with

class

Smoking is more prevalent among

Smoking generally decreases with age though in some socioeconomic classes there is a peak around

years old

Alcohol consumption

with socioeconomic class

Obesity increases as deprivation

Neglected Tropical Disease - Drugs to Know :

Praziquantel -

Albendazole - Helminths + LF Mebendazole - Helminths

- Onchocerciasis + LF

Zithromax - Blinding trachoma

Kingdoms of Infections:

- dengue fever, rabies

–leishmaniasis, human African trypanosomiasis, chagas disease

- leprosy, buruli ulcer, trachoma, endemic treponematoses

– schistosomiasis, ascariasis, hookworm infection, trichuriasis, lymphatic filariasis, onchocerciasis, dracunculiasis, cysticercosis, echinococcosis

– mycetoma, paracoccidiomycosis

– scabies, myiasis, tungiasis

Animal/Insect vectors of NTDs: Schistosomiasis - Snails Onchocerciasis - Blackfly Lymphatic Filariasis - Mosquito

Soil Transmitted Helminths: Ascariasis Trichuriasis Hookworm

3 key policy documents regarding Health Promotion:

Ottawa charter,

declaration and

charter

Tannahill Model - simple practical framework which advocates 3 health promotion approaches: Prevention, Health Education and

Current public health initiatives:

Smoking Cessation Alcohol Harm Reduction Strategy Tackling Obesity - Change for Life Sexual Health - National Chlamydia Screening Programme Tackling Teenage Pregnancy Vaccination Programmes

Bradford Hill Criteria for

- Strength - a small association does not mean that there is no causal relationship

Consistency

Specificity - the more specific the association between a factor and an effect, the bigger the probability of a causal relationship

Temporality- exposure has to happen

the event

Dose-Response Relationship - greater exposure should generally lead to greater incidence

Plausibility

Coherence - between epidemiological and laboratory findings

Experiment

Analogy - the effect of similar factors may be considered

Sofia Cleans Sometimes To Disinfect Petr's Constant Excess Afterload

Some key terms when critically appraising literature

- considers whether the effect of a treatment has a multiplicative effect on the subject's hazard rate (e.g. taking a statin may halve our immediate probability of having a MI)

Hazard Ratio - the effect of an explanatory variable on the risk of an event

Leading Causes of Death due to infectious diseases: Lower Respiratory Tract Infections HIV/AIDS Diarrhoeal Diseases Tuberculosis Malaria Measles

Liam had diarrhoea that made mad

Three most commonly diagnosed cancers (BLC):

Three cancers responsible for the most deaths: (Less Likely to Survive)

Leading causes of death worldwide:

Ischaemic Heart Disease Stroke COPD Lower Respiratory Tract Infections Lung Cancer HIV/AIDS Diarrhoea Road Injury Diabetes Tuberculosis

Chances in Cancer Mortality:

Stomach cancer mortality is

Cervical cancer moratlity:incidence ratio hasn't changed much

Breast cancer mortality:incidence ratio has decreased Cervical cancer mortality has decreased

Mass Screening Programmes in the UK :

Cervical Cancer - every

years for women aged

every 5 years to women 50-64

Breast Cancer - every 3 years for women aged

women aged 70 and over can self-refer

Bowel Cancer - every

years for men and women aged 60-74

Abdominal Aortic Aneurysm - offered to men in their

th year

Diabetic Eye Screening - offered to people with type 1 or type 2 diabetes over the age of 12

Statistical associations may be due to 4 main factors (CBCC):

chance, bias, cause and

Methods of controlling the effect of confounding:

Design Stage:

Restriction and

Analysis Stage: Stratification (risks are calculated separately for each category of confounding variable), Standardisation and