Non Communicable Diseases

Question 0

Write short notes on breast cancer

Answer 0

Clinical features 78% 5 year survival. Most common cancer in UK and most common in females
Time trends increasing incidence over time, mortality decreasing
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) higher in higher SES groups, women 50-69yrs, genetic association, white females
Causes and determinants smoking, alcohol, obesity, hrt use
Sources of data

Question 1

Cervical cancer

Answer 1

Clinical features
Time trends deaths reducing but highest in inner city areas
Place inner city areas
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) low SeS, sex workers, early first sex, no condom use, oral contraceptive long term, women only!
Causes and determinants hpv
Sources of data English cancer registry. Issues with previous inconsistent reporting of staging makes mortality trends difficult to interpret

Question 2

Colon cancer

Answer 2

Clinical features 57% 5 year survival
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data

Question 3

Lung cancer

Answer 3

Clinical features 5% 5 year survival
Time trends declining rates
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data cancer registries, gp sentinels, hes,death certs

Question 4

Skin cancer

Answer 4

Clinical features
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) commoner in higher social classes, more registered women but more deaths in men, outdoor workers, sunbed users, fair skin
Causes and determinants
Sources of data

Question 5

Diabetes

Answer 5

Clinical features
Time trends- increasing rates of type 2. Estimate around 630K people with diabetes are undiagnosed.
Place- linked to deprivation
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)- genetic tendency for type 1 and type 2 (family clusters). Type 1 young, type 2 older and in South Asian or Afro Caribbean.
Causes and determinants- type 2 links with deprivation, obesity
Sources of data- diabetes standard data set from care records, health survey for England

Question 6

Schizophrenia

Answer 6

Clinical features
Time trends declining
Place inner city areas
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) young males, family hx, Caribbean, low SeS
Causes and determinants drugs
Sources of data SMI registers, mental health minimum data set reports, data on use of mental health act, occasional mental health surveys conducted by health and social care information centre

Question 7

Dementia

Answer 7

Clinical features think vascular or Alzheimer’s
Time trends ageing pop therefore increasing
Place areas with lots of old people, eg Brighton
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) over 65, smoking, genetic Alzheimer’s, low SES for vascular (due to smoking)
Causes and determinants
Sources of data national de,entails and antipsychotic prescribing audit, qof registers, mental health minimum data set registers

Question 8

Suicide/deliberate self harm

Answer 8

Clinical features determined by coroners
Time trends decreasing since 1960s
Place inner city and deprived areas
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) older, male, low SES, isolation (sad persons scale),
Causes and determinants associated with mental illness, social isolation
Data sources coroners reports, death certs
Sources of data

Question 9

CHD

Answer 9

Clinical features- atherosclerosis, angina and MI. Treatable and preventable. Saving lives-our healthier nation targets for CHD
Time trends- decline since 1970s but still very high compared to global rates. Attributable to reducing risk factors.
Place- most common cause of death in the world, worst in developing countries due to lifestyle and urbanisation changes. Most common cause of death in UK.
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)- SES, North of England and in Scotland, South Asian, genetic link, age, male sex
Causes and determinants- atherosclerotic lesions, high cholesterol, smoking, low exercise. Whitehall study, British womens health study, WHO MONICA study
Sources of data- health survey for England, national cardiovascular intelligence network

Question 10

Stroke

Answer 10

Clinical features
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data

Question 11

AAA

Answer 11

Clinical features screening invites on 65th birthday
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) higher in white men aged over 75 , familial tendency
Causes and determinants tobacco atherosclerosis
Sources of data

Question 12

Asthma

Answer 12

Clinical features
Time trends- peak admissions in the summer
Place- UK highest rates in Europe , most common long term medical condition in children
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data- occupational health screening, syndromes surveillance survey

Question 13

COPD

Answer 13

Clinical features
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data

Question 14

Dental caries

Answer 14

Clinical features- tooth decay due to bacteria causing inflammation, tooth loss and infection
Time trends- rates generally improving over time for adults and children, uk doing well in European tables
Place- reduced levels north to South with exception of London
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)- low SES, high sugar diet, fluoridation, drugs that cause reduced saliva, poor cleaning habits,
Causes and determinants- bacterial growth not brushing properly!
Sources of data- adult dental health survey, dental health survey of children and young people, PHE dental public health intelligence programme

Question 15

Peptic ulcer disease

Answer 15

Clinical features- increased risk of cancer, dyspepsia, bleeds and perforation
Time trends- virtually unseen before 1800s, rates rising throughout 20th century
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) low SES, genetic susceptibility to h pylori
Causes and determinants- smoking, stress, h pylori, NSAIDs , alcohol
Sources of data- prescriptions of PPIs, surveys, deaths from perforation

Question 16

SIDS

Answer 16

Clinical features- 300 babies each year die of sids
Time trends- improving over time
Place-
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)- smoking during pregnancy, young mothers, low birth weight, bottle fed, prevalent in males, white British
Causes and determinants- smoking, bed sharing, high temperatures, sleep position
Sources of data- lullaby trust, nice developing guidelines, child deaths linked to birth certificates, confidential enquiry into maternal and child health,

Question 17

Down’s syndrome

Answer 17

Clinical features- learning disability and physical health problems (hearing,heart and thyroid) caused by trisomy 21
Time trends- diagnosis increasing but antenatally and having abortions so live births not increasing by as much
Place- increasing as maternal age increases e.g in developed countries
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle) although risk increases with age, most are born to younger mums as young women have more children- prevention paradox. Family hx also factor.
Causes and determinants- maternal age
Sources of data- national Down’s syndrome cytogenetic register
Combined, quadruple and integrated tests or amniocentesis/cvs. HCG, PAPPA,AFP, ue3,inhibin a, uss

Question 18

Falls

Answer 18

Clinical features
Time trends
Place
Person (age/sex/SeS/ethnicity/occupation/genes/lifestyle)
Causes and determinants
Sources of data