Science of Epidemiology

Science of Epidemiology Edward Truelove EPIDEMIOLOGY Introduction This assignment will identify and explain what epidemiology is and describe how epidemiologists collect and analyse specific data. It will then identify a number of aspects of the science and then look a disease and see how epidemiologists data was used to influence health promotion. What is Epidemiology? Epidemiology is the ‘science concerned with the study of the factors determining and influencing the frequency and distribution of disease, injury, and other health-related events and their causes in a defined human population. Also, the sum of knowledge gained in such a study. There are two main types of Epidemiology. The first one is descriptive which describes the occurrence of the disease according to people, place and time and the second is analytic which determines the causation, risk factors for health, disease and association. Descriptive epidemiology describes and investigates the scale of the problem. This is the amount of people that have developed or caught the disease over a specified period. e.g. in 2004 there were 44,659 cases of newly diagnosed breast cancer in the UK. From this epidemiologists would look at the prevalence, the number of people that have the disease or condition at any particular time. e.g. the number of people who are regular smokers within a specified time period. The next factor is to look at how the condition is spread. This is done by analysing categories such as age, gender, socioeconomic class and ethnicity e.g. women from lower social classes are much more likely to smoke than women in higher social classes. Examples of questions asked to collect this data are as follows: What are the health problems? How many people are affected? Who is affected? Which communities are affected and why? What are the trends? Answers to these questions can indicate if primary prevention is possible and it can show the seriousness of the problem and how individuals and communities may be affected. Analytical epidemiology aims to answer the question, why did it happen? This is done by identifying and determining the causes and risk factors for health and disease. Comparisons have to be made between groups with or without the disease and between groups exposed and not exposed to a possible causal factor. Causation can show if there is a link from a certain disease to environmental influences, lifestyle or socioeconomic factors. To find the cause, epidemiologists can use inferential statistics to draw inferences about apopulationfrom arandom sample. From analysing the results and assessing the risks, a link between events and contributory factors can be draw and this can vary from negligible to high. Assessing the needs and analysing the data The first step in planning health promotion is to assess the needs and this consists of two elements. Firstly are the health service needs, which are determined from health data such as occurrence, frequency, mortality and morbidity. Secondly is the community determined needs covering issues that individuals and communities have brought to the attention of the local authority, politicians and letters etc. Sometimes these two elements overlap but it is important to identify which are priorities for communities. Health data is analysed according to who has been affected and this shows which communities are affected the most so that resources can be allocated. From this information about prevention begin. Prevention Primary prevention consists of trying to keep people healthy and free from disease such as immunization and encouragement of healthy lifestyles. Secondary prevention tries to identify the disease and persuade people to go for treatment at the earliest opportunity. Examples could be a cough that could lead to tuberculosis or a fever that could lead to influenza. In some conditions once the disease has developed it can often be too late, so one of the key roles of health promotion is to encourage screening i.e. breast cancer. Tertiary prevention involves actions if the disease has become very serious. This is to promote recovery and focus on rehabilitation to help speed the recovery. An example of primary prevention would be lung cancer as it is know what causes it, but it is not suitable for breast cancer as the causes are not yet known. Prevention can only take place if the causes can be established. Causes Epidemiologists need to establish causes and to look at many factors such as the environment, society and individuals. They also need to find out what causes the cause as there can be a whole chain of causal factors triggering a chain of events. These study designs are used for finding out possible causes, although they do not prove causal relationships as they just look at associations. There are two types of analytical study designs. The first is group one which are used for finding out possible causes. Ecological studies compare studies of a particular disease in different communities to try to ascertain the cause. Cross-sectional studies sample a section of society at one particular time to see if there are common characteristics between people. Case control studies compare a sample of people with a disease to a sample without and a conclusion can be drawn to see if characteristics are more likely to be found in people with the disease. Group two analytical studies are stronger design studies which are used to provide evidence for causal relationships. Cohort studies, also known as prospective or longitudinal studies are when a large sample of the population is followed over a long period of time to monitor their lifestyle and exposure to the risks. From this, the incidence of the disease can be followed to look for causal risks. Examples of this are following a sample of the population for fifty years to see if there is a link between smoking and lung cancer. Intervention study involves exposing a random selection of people to a health promotion trial to find out if the if intervention has health benefits and then to compare the results to a group of people who have not. Results can be analysed to establish if there are key variable such as income, age, distribution, etc. Relative or attributable risk provides a measure of the strength of a causal relationship. Decisions can be made from this as to how many lives c ould be saved if the causal factor was removed. Epidemiologists have also to work out which are confounding factors, ones that can appear to be associated with a disease but are not a causal. From all the information and studies undertaken there has to be a systematic review to identify which studies have strong conclusions. From the evidence, reasons can be worked out for showing the causes of health problems and disease and an action plan for health promotion can be set out. Epidemiology is an essential key discipline in health promotion and unless the specific factors that cause a health problem are identified, action cannot be taken to prevent it and promote health. Swine flu and Epidemiology What are the health problems? In the case of swine flu, dry cough, sore throat, headache and fatigue are the most common associated symptoms. Typically patients will have a fever over 38C. Most people recover in a week without any specific treatment. How many are affected In swine flu the number of cases in the UK rose quickly after the first established cases in Scotland. By May 312009, there were 252 confirmed cases in the UK.Seventy of these had been to Mexico or the US seven days prior to infection, and 178 reported that they had not been abroad. Who is affected? In the case of swine flu, in the first months of its outbreak in the UK, it mostly affected young people, and was most commonly spread through contact at schools. These findingsare based on an analysis ofthe first 252 cases of the disease diagnosed in the UK after news of the virus broke What are the trends? Of the 168 who contracted the infection it was established the likely place of viral transmission: 60% had been acquired in school; 25% from a household environment; 8% in the community; 1% (two cases) acquired in the workplace; Less than 1% (one case) in a healthcare environment; 5% acquired elsewhere. (nhs.uk) Which communities are affected and why? People of all genders and ages, including infants and the elderly were developing the disease equally. Due to a larger proportion of younger people travelling abroad and being in contact with younger people, the average age of the first 252 infected people was 20 years. Of the 178 first cases in the UK, 22% reported contact with someone who had developed the infection overseas (secondary infection) and 70% reported contact with a secondary case. 7% were not aware that they had contacted anyone (nhs.uk) Influence on health promotion The disease was first identified in Mexico in April 2009 and quickly spread round the globe. Initially the HNS had to make the public aware of the health problems through the media and do everything to contain the disease such as closing schools. After a while it was classed as a pandemic and moved from a containment status to treatment status. Generally the disease was fairly mild and was usually more serious in patients with other health problems. Part of the health promotion campaign was to offer antiviral medicines, Tamiflu or Relenza. Another step was to identify who and which communities are affected, and those people that are in high risk groups, as they are more likely to develop to complications. Vulnerable people are those who have lung disease, heart disease, kidney disease, liver disease, neurological disease and diabetes. Also at risk are people who have had drug treatment, pregnant women, people over 65 and children under five. A health promotion campaign through the Television and media was used to make these particular groups aware of the potential risks. Swine flu vaccination began in October 2009 The NHS issued information to the public to stop the disease spreading such as good respiratory and hand hygiene i.e. sneezing into a tissue and putting it a bin and to wash your hands and work surfaces at home regularly. Other public health information includes a National Pandemic Flu website and telephone number for the public to call for any information. The public were asked to call their GP if they had flu like symptoms and particularly if they had a serious condition that weakens your immune system, if they are pregnant, have a sick child under one or if the condition suddenly gets worse. The Service assesses the symptoms and if required will provide authorisation to collect antiviral medicine. Carers also have been identified as at risk as they come into contact with the most vulnerable in the community and steps have been taken in the second phase of vaccination to protected them from the risk of infection Conclusion The science of epidemiology involves elements of biology, social sciences and ecology and it is therefore it is a bio-social-environmental science focusing on disease in populations. Epidemiology is a key discipline in Health Promotion as is analyses specific factors of a disease. From this data action can be taken to prevent the disease spreading and promote health i.e. smoking and lung cancer, asbestos and cancer, alcohol and liver disease. However, mistakes can be made as some diseases such as heart disease have many influential factors including diet, exercise, smoking, blood pressure and genetic history. Epidemiology is a population science and investigations of health problems in populations have been very important for public health. Its techniques in examining the disease patterns between populations have been widely applied and there is no consensus of the best means to measure health. As epidemiology is a study of populations it does not tailor health promotion needs for the individual and quite often complicated data and government health warnings such ‘eat five portions of fruit and vegetables a day can be largely ignored by a sceptical public, and therefore destructive activities still persist. This report has identified what epidemiology is and explained how epidemiologists assess the spread of illness and analyse data collected. It has also listed aspects of epidemiology and stated how they have an influence on health promotion. References Cancer Research (2009) [Online], Available at: http://info.cancerresearchuk.org/cancerstats/types/lung/incidence/index.htm 1 ( (Accessed 22 Nov 2009) Hubley, H. and Copeman, J. (2008) Practical Health Promotion, Polity Press: Cambridge. Naidoo, J. and Wills, J. (2009) Foundations for Health Promotion, 3rd Edn, Bailliere Tindall: London. Naidoo, J. and Wills, J. (2008) Public Health and Health Promotion, 2nd Edn, Bailliere Tindall: London. NHS (2009), [Online], Available at: http://www.nhs.uk/news/2009/07July/Pages/Swinefluearlyepidemiology.aspx 1 (Accessed 2 Dec 2009) NHS (2009), [Online], Available at: http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx?WT.srch=1 (Accessed 2 Dec 2009)

Preferences for Boys and Girls in South Korea, China, India and Nepal

Preferences for boys and girls in South Korea, China, India and Nepal The studies of gender bias in several developing countries in Asia have received wide attention over the past two decades. Demographers have noted worrying trends in sex ratio at birth in some of the most populous countries in Asia; South Korea, China, India and Nepal are the most markedly countries. One of the measures of agreement that has been recognized in this phenomenon among these four countries is the traditionally-and-culturally-rooted of son preference. Son preference has several features that illustrate the inclination of the male sex in contrast to the female sex resulting numerous differences in preferences of boys and girls in the societies of these four countries. The features of son preference are based on socio-cultural, socio-economic and institutional factors in South Korea, China, India and Nepal, and consequently, have formed an imbalance in the countries’ sex ratios mainly due to female infants mortality. South Korea was one of the first countries to represent the trend of son preference. This is mainly due to Confucian influence that is acutely embedded in the populace, whereby the eldest son of the most recent male ancestor must lead family rituals. The family â€Å"dies† if there were no sons being born (Westley & Choe 2007). Since pre-industrial South Korea, a person’s access to power, social status and economic opportunities depended heavily on their gender, lineage and their position within that lineage. Chung & Gupta (2007) described that a number of the lineages in South Korea had formed into larger super ordinates lineage or in other words can be referred to as â€Å"clan†, where some joint properties are held and utilized to support ancestor worship rituals and to help lineage members in need. Therefore, it was a primary duty to bear sons to ensure the continuity of a family’s lineage. On another note, son preference played a role in terms of a socio-economic view when the South Korean governments had subsequently reinforced the Confucian traditions in a series of authoritarian policies in order to maintain social and political stability. For example, the Family Law stipulated that family headship must be held by men in the line of the eldest son, inheritance should be through male line, women should be transferred to their husband’s family register upon marriage and children are belonged to the father’s lineage even in the case of divorce (Chung & Gupta 2007). {draw:frame} _Figure 1. 0: Trends in sex ratio at birth and total fertility rate, South Korea, 1980-2003 (Westley & Choe 2007). _ In addition, ultrasound equipment was first mass-produced in the country in the mid-1980s. Therefore, the introduction in technologies to determine the sex of unborn fetuses combined with the widespread of abortion availability made it possible for couples that wanted a son to selectively abort female fetuses. In 1990, as seen in Figure 1. 0, the sex ratio indicated that nearly two boys were born at this birth order for every girl (Westley & Choe 2007) resulting in an increase of sex ratio at its highest peak in South Korea. Similarly as South Korea, son preference became visible in China since it is another Confucian-practiced country. The people held beliefs that a person’s empowerment relies on their lineage and the lineage is solely traced through the male. Therefore, failure to produce a son is considered tantamount to extinction of the family line (Almond et. al 2005). Furthermore, the influence of son preference has been historically and traditionally strong in the country where it can be reflected in this ancient Chinese song quoted; â€Å"When a son is born, Let him sleep on the bed, Clothe him with fine clothes, And give him jade to play†¦ When a daughter is born, Let her sleep on the ground, Wrap her in common wrappings, And give broken tiles to play†¦ â€Å"- Book of Songs (1000-700 B. C. ) (Baculinao 2004). {draw:frame} _Figure 2. 0: Sex ratio of population age 0-4 in China, 1953-2005 (Shuzhuo Li 2007)_ In rural areas of China and among the less educated societies, sons are basically preferred because they are needed to carry out farm work, offer financial support to aging parents, continue the family name and receive family inheritance, and also responsible for ancestor worships. Apart from that, as seen in Figure 3. 0, there has been a sharp rise in sex ratio of children age 0-4 since 1982. This is due to China’s government imposing the â€Å"one-child policy† as one of the forces to fast-track economic modernization. The policy’s main condition is that a family, reliant to their will, is allowed to have one child only. Subsequently, a son is more favoured among the societies due to putting Confucian values into practice (Muller n. d). The government had later on enforced the policy strictly over time where by the regulations included mandatory IUD insertion for all women who had one child and abortion for a woman who had an unauthorized pregnancy. Consequently, out of desperation for a boy, some parents may have killed newborn daughters or undergo an abortion (Graham et. al 1998) and thus, mothers suffer tremendous psychological pressure and health risks while undergoing sex-selected abortions, which affect both their physical and reproductive health (Shuzhuo Li 2007). {draw:frame} Figure 3. 0: Sex ratio of the child and overall population, India, 1951-2001 (Guilmoto 2007)_ In India, son preference is influenced by the strong religious Hindu belief in the country to a certain extent where by a family needs a son to perform last rites in order for salvation to be achieved. In other words, sons are considered as breadwinners as they will look after their parents and continue the family name. In addition, Almond et. al (2005) stated that only sons could light a man’s funeral pyre and perform the traditional ancestor cult. Moreover, some Indian societies practice a tradition whereby daughters have to be married off with a substation dowry and hence, daughters are more often considered as a financial burden resulting the killing of female newborn babies as the final solution to the dowry problem. What is more, it is enlarged and even becoming more accepted, particularly in the poorer areas of India (Almond et. al 2005). Since daughters will be married into another family, therefore only sons can guarantee for the care of the parents in old age, which then resulted a far more widespread practice of discrimination against daughters. Hence, in its most extreme manifestation, the influence of son preference in India can affect on how many girls survive into adulthood and even how girls are born (Westley & Choe 2007). As summarize in Figure 3. 0, from earlier years mortality conditions of female infants had increased from killing of the female infants and sex-discrimination regime started to experience a deep change during the 1970s, since pre-natal sex-determination tests became widely available and often led to selective abortion to female fetus (CHREHPA 2007). draw:frame} Figure 4. 0: Trends in sex ratio at birth under 1 year old in Nepal, 1952/54 – 2001 (CHREHPA 2007). Nepal has been classified as having considerable levels of son preference since the World Fertility Surveys first documented the phenomenon in the 1980s. As seen in Figure 4. 0, there was an inclining trend in sex ratio at birth in 1970s to 1980s. Son preference in Nepal is a little different compared to the other countries concerning the discrimination against daughters are at a distinctive level. Daughters are very much loved in the family, as they are valued for their responsibility in religious festivals as well as for their emotional and household contribution to the family. Hindus in Nepal assign great value to marrying a virgin daughter. Girls marry early and universally in Nepal because of the religious merit bestowed on those who give them in marriage (Karki 1988). Nevertheless, having sons are very highly prized among the Nepalese societies compared to daughters (Leone et. al 2003). Sons are preferred due for old age security, and lineage where by the Hindu code of conduct in Nepal reinforced the transfer of family name through male offspring. Other than that, sons are more desired for their roles in religious rituals, agricultural labor and companionship. However, many Nepalese couples are willing to surpass their ideal family sized to satisfy their desire for sons (Hollander 1997). As a consequence, the son preference has affected the contraceptive behavior in Nepal to the extent that Nepalese rarely begin contraception until the desired numbers of sons are born. However, they began to articulate their realization that large families are contributing to shortage of cultivable land and to the deteriorating fuel wood and water supplies in the hills of Nepal (Karki 1988). Hence, methods of pre-natal sex determination came to view during the 1970s, and according to research from CHREHPA (2007), 10 out of 25 women that had been told the fetus was a girl resorted to sex-selective abortions an increase in Nepal’s maternal mortality rates and sex-ratio imbalance as seen in Figure 4. . As a whole, it can be seen that the rationale behind son preference in South Korea, China, India and Nepal are based on these six features; discriminatory inheritance laws, economic value of sons, continuity of family line, family security and strength, socio-cultural norms and customs and dowry system (Gupta et. al 1998). Enhancement of new medical technologies and sex-selective abortions had somehow supported the idea of son preference in these four countries a nd seem to be a method of having the desired son. Next, it is then perceptibly has created several impacts in socioeconomic and demographic manifestation where by it resulted in higher fertility transition, promotes inequality in social and human development, associated with excess female deaths and poor health of women, lowers quality of life for women, wastes a valuable human resource and perpetuates cycle of poverty and increases income inequality in these four countries (Gupta et. al 1998). Fortunately, the imbalance in sex ratio has spurred some official efforts to shift public opinion in these four countries. Approaches have been made to reduce the sex-ratio imbalances in these countries by making daughters more wanted. Governments and non-governmental organizations work through advocacy, sensitization and awareness-raising programs. In South Korea, after a series of extensive campaigns and programs, sex ratios were once greatly imbalanced, are now returning to normal after women gained status in society through employment opportunities, increased education, and parents with enough money to be financially secure without dependence on their sons (Guilmoto n. . ). South Korea now is the first Asian country to reverse back the trend of rising ratio of sex at birth. China on the other hand, participated by the country’s ambitious â€Å"Care For Girls† program. The program encompasses many dimensions of the sex-ratio predicament. It offers cash and other incentives to families with daughters, scholarships for girls, better housing or loans for targeted families and others. It als o includes several awareness-raising campaigns, as well as repressive measures against illegal abortions and infanticide. In India, a program called Tamil Nadu is created in 2004 that gave monetary rewards to couples that had one or two girls and agreed to be sterilized. The state also created a Cradle babies in which empty cradles were placed in government centers across the states for couples to abandon unwanted female child without killing them. Furthermore, in 2007, the New Delhi municipal government sponsored a program that provide every girl born in a government hospital with a gift deposit of 5000 rupees that accumulated interest and could be cashed once the girls reached the age of 18 (Lederer 2008). Nepal has banned sex-selective abortions in 2002 when it liberalized its own law on abortions. These laws were then strengthened later on in various ways, in order to make them more effective (Guilmoto n. d. ). Although the strategies for reducing son preference and getting back female’s rights are many, these are all rather considered as a short-run implication despite the positive and optimistic outcomes. According to an American demographer who has been closely following China's population program stated that, â€Å"The country may be coming o grips with problem as they country is still in dilemma – emotional and policy dilemma – because the solution to the problem will conflict with other parts of their population strategy to reduce birth rate or some of the measures could perhaps make the problem even worse. The country still has a lot of work to do. There’s no road map yet on how to achieve the goal of normal sex ratio† (Baculinao 2004). There fore, the future trends of the son preference are impossible to predict in the long run. Patriarchal systems are still underneath the attitudes among the societies in these countries. Regardless of how many levels of development in lasting efforts to address sex-selective abortion and female infanticide, it will fully require fundamental changes in cultural norms that promote son preference. References Almond, D, Edlund, L & Milligan K (2005) ‘Son preference and the persistence of culture’. Downloaded from http://www. nber. org/papers/w15391 as at 25 November 2009. Baculinao, E (2004) ‘China grapples with legacy of its ‘missing girls’, MSNBC. Downloaded from http://www. msnbc. msn. com/id/5953508 as at 20 November 2009. Chan, A & Yeoh, B. S. A (2002) ‘Gender, Family and Fertility in Asia: An Introdyuction’. Downloaded from http://www. unescap. org/esid/psis/population/journal/Articles/2002/V17N2A1. pdf . As at 25 November 2009. CHREHPA (2007) ‘ Sex Selection: Pervasiveness and Preparedness in Nepal’. Dowloaded from http://www. unfpa. org/gender/docs/studies/nepal. pdf as at 20 November 2009. Chung, W & Gupta, M. D. (2007)’Why is Son Preference Declining in South Korea? : The Role of Development and Public Policy and the Implications for China and India’, Policy Researh Working Paper, No. 373, The World Bank. Eberstadt, N (2004) ‘Power and Population in Asia: Demographics and the strategic balance’. Downloaded from http://www. aei. org/docLib/20040211_PowerandPopulationinAsia. pdf as at 25 November 2009. Edlund, L & Lee, C (2009) ‘Son pereference, sex selection and economic development: Theory and evidence from South Korea’. Downloaded from http://www. e con. columbia. edu/RePEc/pdf/DP0910-04. pdf as at 25 November 2009. Graham, M. J, Larsen, U (1998) ‘Son Preference in Anhui Province, China’, International Family Planning Perspectives, Vol. 24, No. 2.

The Secret Truth on How to Write a Essay about Yourself Exposed

The Secret Truth on How to Write a Essay about Yourself Exposed Life After How to Write a Essay about Yourself It is preferable to find professional writing assistance from the corresponding support. The most frequently encountered paper writing service that the vast majority of our clients require is essay writing. You could also get in touch with your writer to supply some additional recommendations or request information regarding the order's progress. There is equally as much info to avoid though. The Debate Over How to Write a Essay about Yourself You've got a limited word count. In order to comprehend how a personal essay appears like, you should go through few successful samples. Moreover, you wish to stay as true to yourself as possible. People today tend to opt for a variety of themes of who they are and attempt to describe all of them. 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It is possible to talk about your past, present and future in a thorough way. Oftentimes, there's absolutely no direct and sure method to at tain our objectives. 1 way of making certain that you're able to communicate clearly and to the point is via accurate and beneficial use of advanced vocabulary.

Personal Narrative Why Optometry - 948 Words

Why Optometry? It’s the question that has been asked ever since I gained in interest for this profession and it is still being asked to this day. I want to become an optometrist simply because I love what this profession has to offer. My desire to pursue optometry stems from my passion to help others and putting others before myself, and becoming an optometrist would allow me to continue to do so while improving the quality of life. After working at an optometry office, volunteering at a clinic, and shadowing multiple doctors, I can’t see myself doing anything else than being an optometrist. I first developed an interest towards optometry due to its intimate interaction between doctor and patient. As a child, there was nothing more I disliked than going to the doctor’s office especially if I thought my eyes were going to get poked and prodded at. But after my first visit to an optometrist, I didn’t mind the doctor getting close to my eyes. The doctor was not only friendly but was reassuring and explained things in a way that I can easily understand. What I thought would be a horrifying examination was made pleasant and tolerable. Although the exam was no longer than half an hour, the experience I had in the exam room sparked my initial interest in pursuing optometry as a professional career. My enthusiasm for optometry further developed as I volunteered at a local optometry office and shadowed under Dr. Michael Tran. Before this, I thought examinations were as simple as