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Archive for June, 2018

Dr Ann HoskinsThe protracted war in Yemen is among the world’s most devastating humanitarian disasters. The war has in many parts of the country destroyed the health and sanitation infra-structure, there is rampant inflation and increased levels of malnutrition especially in the poorer, more vulnerable sections of the population. These factors have enabled a resurgence of infectious diseases, an example being the cholera epidemic. With no peace in sight, the health of the population of Yemen, unfortunately, continues to deteriorate, as seen in the Yemen humanitarian dashboard OCHA (Jan – April 2018) published by the World Health Organization.

The Yemen SIGs main objectives are:

  1. To provide a forum for FPH members who are interested in the contribution that public health can make to improving the population of Yemen in a war and post-war situation
  2. To contribute new ideas and possible policy avenues to the health agenda of Yemen.
  3. To pilot and evaluate the use of social media to disseminate preventative messages to populations displaced by war and to areas where the health system has collapsed, starting with cholera
  4. To support the work of the Global Violence Prevention SIG in collating and developing a body of evidence-based knowledge on the important actions to take and develop to rebuild the health system during and post-conflict

Yemen Health Mobile Cholera Project (YHMCP)

One of the first projects we are undertaking is the Yemen Health Mobile Cholera Project. Cholera outbreak has affected more than a million people and left more than 2,500 dead.  The YHMCP aims to contribute to the prevention of cholera by using simple health messages sent via Whatsapp to people in the most affected urban areas in Yemen who have poor or no access to health services due to the war. The messages and the approaches will be evaluated to adapt them as necessary to help ensure the objectives of the project are achieved. The project is being led by the Yemen SIG in association with the Liverpool Friends of Yemen, Liverpool School of Tropical Medicine and the Faculty of Public Health.

The Yemen SIG will continue to meet on a quarterly basis and new members are welcome!

Written by Dr Ann Hoskins, Chair, Yemen SIG at FPH. You can contact Ann via email: drannhoskins@gmail.com.

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BRITAINCardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels usually associated with a build-up of fatty deposits inside the arteries and an increased risk of blood clots. It has led to over a quarter of deaths in the UK and affects around 7 million people. Risk factors include smoking, obesity, mental illness, physical inactivity, and long term factors like diabetes, high cholesterol and high blood pressure. These can all be addressed with the right care and support.

The National Institute for Health and Care Excellence (NICE) has produced a number of impact reports which show how the recommendations that NICE develop, are being used in health and social care services in the UK.

Data in the new NICE impact report on CVD prevention suggest NICE is having a positive impact in this area, but the report also shows that our recommendations need to be applied more consistently to provide better advice to prevent CVD and reduce the number of associated deaths.

For example, data from one report, shows that in 2016, the number of adults who smoked fell to 15.5% of the population. To encourage people to stop smoking, we recommend offering patients in hospitals, mental health and maternity services advice on quitting But it has been shown that of the 73% that had their smoking status recorded only 28% were asked if they would like to quit, which suggests key opportunities are being missed to further tackle smoking rates. Data also shows that more could be done to implement NICE’s recommendations in schools with 40% of pupils not receiving the right level of education on the risks of tobacco use, as advised by NICE.

The impact report also looks at some of the major causes of CVD including high blood pressure, high cholesterol and diabetes. Diagnosing and managing these conditions is important to preventing CVD events like heart attacks, where the blood flow to the heart muscle is suddenly blocked, and strokes, where the blood supply to part of the brain is cut off, which can cause brain damage and possibly death. NICE is working with other organisations to include our guidance in the CVD Prevention Pathway, which aims to give NHS Trusts the tools and resources to detect and treat these conditions in local services.

For high blood pressure, data shows that just 60% of people under 80 achieved the NICE recommended target blood pressure. Our guidance on high blood pressure highlights the importance of physical activity, in managing those with this condition. However, data shows only 9% of people with high blood pressure aged 16-74 had their physical activity assessed in the last 12 months. This indicates that we are not doing enough to encourage people to exercise more, and thus to reduce risk of CVD.

Our latest impact report shows the positive effect NICE is having on CVD prevention across the health and care system. But there is a familiar pattern of potential missed opportunities to improve patient care and save lives. We know only too well the challenges the system faces to deliver high quality care. When the evidence shows that using NICE guidance works, we need to make sure it is at the heart of local strategies to reduce premature deaths from CVD and preventable illness.

Written by Professor Gillian Leng, Deputy Chief Executive and Director Health and Social Care, NICE

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Theeba Krishnamoorthy qualified as a doctor from the University of Cambridge and subsequently completed her NHS Foundation Medical Training in Portsmouth. Following this, she worked in Myanmar as an Improving Global Health NHS Fellow which ignited her passion for public health. She has since put a pause on medical training to do her PhD at the University of East London to truly explore her research interests in sexual and reproductive health education, use of innovation in health education and public health before she applies for further training. This is the first in a series of blogs by Theeba to document her public health journey and celebrate her achievements along the way.


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Sule Pagoda in Yangon, Myanmar

My time in Myanmar has finally brought me to this moment. In my traditional forest green Myanmar dress I stood on stage, under the banner titled ‘3rd Annual Myanmar Nephro-Urology Society Conference’. I put down my laptop to rest on the podium and looked ahead to face the row of leading nephrologists and urologists in South East Asia and Australia. The introvert in me wanted to freeze in fear, but a lot has happened this year. A lot has been learned and a lot has changed.

Inhale. And begin….

At the start of my 2nd foundation year, I found myself amongst other trainees deliberating about what step to take next. Though my foundation training has given me confidence and good exposure to various specialties, it sadly offered me minimal first hand experience in public health – the subject I loved most in medical school. At this point my path divided into two:

  1. continue further training in a specialty of my choice that I have had exposure in, or
  2. take time out and truly explore public health before applying for further training. It was a big decision as I have never taken a break from my education or training so it was a scary thought. Someone said fear brings opportunity so I decided to hop off the hamster wheel of medical training and take a pause. It was a risk for sure as I was afraid, but I had the courage to turn that anxiety into power and leapt at the opportunity to start on a journey of self-discovery and self-growth.

There was no doubt in my mind that I wanted to travel to the east to work. The timing could not have been better, because I soon received a call inviting me to attend an interview for the ‘Improving Global Health through Leadership Development’ programme. Fast forward a month, I received the good news and it wasn’t too long before May came round and I jetted off to Myanmar, in time to enjoy the last few days of Asian summer. I was placed to work at New Yangon General Hospital (NYGH) in Yangon as an Improving Global Health NHS Fellow, exploring methods to improve the quality of care of acute kidney injury, which is an increasing international health concern. By working with their medical team at NYGH, we launched the quality improvement project, ‘Beware AKI’. (To find out more about ‘Beware AKI’ click here.)

This was my first experience leading on a big project and I had no idea what to expect. The canvas was blank. And for the first time since my art GCSE, I had permission to think innovatively, creatively and experiment with ideas to solve problems. And intermittently enjoyed the process of sitting back, reflecting and developing my leadership techniques with the aid of the NHS Healthcare Leadership Model. One of the skills I developed during my time in Myanmar was my public speaking. Through frequent presentations, some good, some not so good, I mastered what worked well for me and how to connect with the audience to share my vision for the project. I enjoyed putting these newly developed skills to the test at my final presentation at the “3rd Annual Myanmar Nephro-Uro Society Conference”, ending my fellowship on a great personal and professional win. The journey does not end there for my public speaking. Since my return to the UK I have continued to invest in this skill and seize every opportunity to speak in public, as I feel it is important for a career in public health.

Written by Dr Theeba Krishnamoorthy.

 

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Thursday 21 June is the longest day of the year but it is important for another reason as it it’s also the date of Clean Air Day 2018. This special day, coordinated by Global Action Plan, is held each year to raise awareness about the harms of air pollution and to inform people of the simple things we can all do to tackle this silent killer on our streets.

The air we breathe is essential to life and air pollution affects us all – from before we are born until old age. Harmful pollutants including tiny particles and toxic gases cause a wide range of diseases which affect the heart, lungs, circulatory system, brain and other vital organs. In the UK, air pollution caused by the most harmful pollutants is estimated to cause approximately 40,000 early deaths each year. While air pollution is harmful to us all, people who are older, live in deprived areas, have pre-existing conditions or live near busy roads are at greater risk. This means that our poorest and most vulnerable communities are exposed to some of the worst outdoor and indoor air quality, worsening health inequalities.

Air pollution also has a major impact on ecosystems and biodiversity, it contributes to climate change and is damaging to our wider economy. A recent report estimated that pollution from cars and vans costs us £6 billion in health costs year – equivalent to £8000 for each car driven in central London. Whilst converting from diesel to petrol cars may be an option to reduce air pollution, it still increases carbon emissions. The best solution is therefore to travel by foot and by bicycle. If we as a society could swap just 1 in 4 of urban car journeys in urban areas for walking or cycling we could save £1.1 billion in health costs per year.

Therefore, why not use Clean Air Day to leave your car at home and try a different mode of transport – whether it’s walking, cycling, taking public transport, or test driving an electric vehicle. You can also play a role by getting involved in a wide range of events and activities around the country from nature walks to citizen science projects and much more. For more information about Clean Air Day 2018, to download free resources and get involved, visit the Clean Air Day website here.

Written by Dr Suzanne Bartington, Clinical Research Fellow at University of Birmingham and Honorary Specialty Registrar in Public Health at FPH.

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save the date_2018_145What will you do for Clean Air Day 2018? 21 June is the opportunity for public health professionals to bring the issue of air pollution to the attention of our colleagues and patients.What will you do for Clean Air Day 2018? 21 June is the opportunity for public health professionals to bring the issue of air pollution to the attention of our colleagues and patients.

Air pollution is the largest environmental health risk in the country, ranking alongside cancer, heart disease and obesity in the scale of its health impacts.  Air pollution affects us all at work, at home and out and about.  It causes heart and lung diseases, affects children’s lung development and shortens the life of at least 29,000 people every year.  As the Chief Medical Officer acknowledged earlier this year, we must start to address air pollution as disease prevention.  The role of the public health professional in this is crucial.

Although the majority (68%) of people in a recent nationwide survey were aware that their day-to-day activities can have a direct impact on air quality in their local environment, comparatively few were doing anything to protect their health from air pollution, such as cycling/walking a route previously driven (21%) or buying milder, fragrance-free or naturally-scented cleaning products for the home (11%).

Public health professionals have an opportunity to address this knowledge-action gap on Clean Air Day, and beyond, by:

  • Providing information on what people can do to reduce air pollution and protect themselves from it;
  • Encouraging pollution-busting behaviour

The Clean Air Day campaign has free, ready-to-use resources such as leaflets, posters, newsletter templates and social media memes, to make it as easy as possible for every healthcare organisation and professional to get involved with Clean Air Day. Here are some of the things you can do:

1. Incorporate air pollution advice into care pathways – print out leaflets and give to patients

2. Tell your colleagues:

  • Work with your communications team to share messaging
  • Encourage colleagues/visitors/patients to cycle/walk/use public transport on 21 June.  Reward those who do with a free breakfast or some other form of recognition.
  • Hold an event about air pollution on 21 June e.g. a stall in reception, talk at lunchtime

3. Work with local partners – include air quality in Joint Strategic Needs Assessments and Health and Wellbeing Strategies

4. Share messages about what you’re doing – use the hashtag #cleanairday @CleanAirDayUK

5. Use the free healthcare toolkit –  contains leaflet, posters, messaging, sample newsletter text etc. www.cleanairday.org.uk/healthcaretoolkit  

Clean Air Day is a chance for the whole country to come together and improve air quality through collective action.  And as public health professionals, it’s your chance to seize this opportunity on June 21 2018 to start the conversation with patients about air pollution – and clean up the air in and around our organisations.  For more information and download graphics to support Clean Air Day on social media, go to www.cleanairday.org.uk.

Written by Larissa Lockwood, Head of Health at Global Action Plan, coordinators of Clean Air Day.

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Steve SeniorThe FPH has asked me to write a blog about preparing for the Part A exam. The trouble is, I’m very aware of how much luck was involved in how well I did with the Part A. I was lucky to have an unreasonably supportive family, a great bunch of people to study with, lots of support from the North West School of Public Health, and a great team in the office. And although my daughter was born in September (prime revision months – how very inconsiderate of her) she slept marvelously, and in any case I was allowed to sleep in a different room. You might call these the social determinants of Part A success.

There was a lot of luck involved on the day too. Questions came up on things that happened to be among my favourite topics, things that I could link directly to work I’ve done in my placement in Tameside Council’s public health team, or things that I just happened to have looked at my notes on that morning.

But ‘be lucky’ isn’t really very useful advice. So below are some things that seemed to work for me (a study of n = 1).

  1. Don’t panic! It’s a tough exam with a fearsome reputation. I found studying for Part A really stressful. For a long time it seemed that I’d never get all this stuff into my head. It helped to keep things in perspective. For example, unlike University final exams, you can have several tries at Part A. And in the long term, no one is going to care what score you got.
  2. Start early. I found that the main challenge was the volume and breadth of material to get through. I started making notes around the beginning of September. This helps with getting through the material, and I also found it helped me feel more in control, which helped manage the stress.
  3. Get a study group. Taking turns to prepare and present sessions on topics is an effective way to learn. But the social support is probably more valuable still. Look after each other.
  4. Chunk it up. I made a big spreadsheet of the the curriculum with all the topics that I’d need to learn, colour coded by how confident I felt. This helped me to break the whole curriculum into manageable chunks, and focus my studies on the areas where I was least confident. Updating it as I went along gave me a sense of progress. Plus making the spreadsheet let me put off doing any actual studying for several hours.
  5. Test yourself. Testing yourself leads to better recall than staring at a text book or making notes. Better still, get someone else to test you. I am sorry to say that long car journeys became an opportunity for my wife to test me, and my four year old son probably knows more about Lewin’s theory of change management than is proper for someone his age.
  6. Do lots of past papers. I switched to mainly doing past papers about four weeks before the exam. I did each one in the time given in the exam, or a bit less. This helped me to focus my revision as the exam got closer, and helped get the timings right. The examiners’ comments are really important.
  7. If you can, link your answer to work you’ve done. This doesn’t need lots of detail, but a couple of sentences at the end of an answer showing that you’ve used that particular bit of knowledge in practice seems to go down well with the examiners.
  8. Don’t be scared to have an opinion. I was really quite rude about the Myers-Briggs Personality Type Inventory (or ‘astrology for business students’ as someone put it on Twitter), and I did fine on that question. If I were an examiner I think I’d quite appreciate someone saying something that isn’t straight from ‘Mastering Public Health’.
  9. Stockpile sleep before the exam. I found that I didn’t sleep the night before each day of the exam. Partly this was nerves. Partly it was poor choice of hotel. Partly it was someone, evidently having a great night out, singing ‘livin’ on a prayer’ outside my window at midnight.

I hope this advice is helpful. Either way, good luck!

Written by Steven Senior, a specialty registrar in public health based in Greater Manchester. He won the Michael O’Brien prize for the highest score in the January 2018 sitting of the Part A exam. You can follow him on Twitter.

 

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My name is Victoria and I am a public health registrar (ST3) in Yorkshire & the Humber. I am currently on an academic placement at the University of York, where I am doing qualitative research on palliative care needs and motor neurone disease, and also collaborating with the World Health Organisation on examining the cultural contexts of health.

This is a short blog for Phase 1 registrars with tips for preparing for the Part B exam. I sat Part B quite recently (December 2017) and was fortunate enough to pass first time – these are the things that I found useful during my preparation, so hopefully other registrars will find them helpful too!

Tip 1: Focus on communication skills, not knowledge

  • As the Faculty puts it – Part A is ‘know how’, and Part B is ‘show how’. Unlike Part A you don’t need to do months of learning from books beforehand; how you interact with the ‘actor’ is the most important part. Make sure you tune in to what’s important for them – even if you can’t directly address their questions make sure you acknowledge you understand what their concerns are.
  • Look at the question headings in the marking guide – make sure you know what the 5 key aspects of the marking criteria are (and note that they relate to communication skills, not external knowledge!)

Tip 2: Familiarise yourself with the OSPHE set up

  • The FPH website has useful guidance on exactly what happens on the day – make sure you read it in advance!
  • Mock exams are very useful – mine was arranged by our local Part B rep (another registrar) and had 6 stations, with a consultant and senior registrar at each. We got feedback at the end from the examiners about every station, and although I did mine 6 months before I actually sat the exam the feedback was very valuable.
  • The most important preparation I did was short practice sessions with colleagues, going through 1-2 scenarios each and getting feedback. I paired up with another registrar, who was working at health protection with me and also due to sit Part B, and arranged a session roughly once a week with a different consultant to go through a scenario each (using the FPH’s mock questions on the website). As well as being the candidate, it was also useful to role play the actor and examiner parts as this gave me more insight into what they were looking for! You also begin to appreciate how much you can say in 8 minutes (or 2-3 minutes if the question asks you to give a summary at the beginning), which helps pace the conversation better.

Tip 3: Practice writing notes in 8 minutes

  • 8 minutes is not long (particularly under exam pressure!) – the more used to the time constraint you are, the easier it is to concentrate on reading and making notes in the exam.
  • I had a structure for how to lay out my notes on a page so I remembered to write down important things like who I was talking to, key points to address etc.
    Although I mainly practiced using the mock questions available through the Faculty, you can practice on other things too e.g. reading a short journal article.

Tip 4: Practice tailoring your answer to a particular audience

  • Different people (e.g. finance director of a CCG, medical consultant, journalist) will have a different level of understanding about particular issues, and different priorities. You need to respond to their priorities as well as making sure you get your own key message across to them in a manner they can understand/relate to.

Overall, Part B is more similar to a standard day in the office than Part A, and so preparation should be less stressful. Many of these skills you will naturally practice every time you have a conversation – the extra work needed should just focus on fitting it into the specific 8-minute exam format!

Written by Victoria Turner, Specialty Registrar in Public Health and the winner of the 2018 McEwan Award for achieving the highest grade in the Part B exam. You can follow Victoria on Twitter.

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