PCPH eMagazine Spring 2019

Spring 2019 DIET RISK IN PREGNANCY & TYPE 2 DIABETES ON THE RISE Dead End by Christopher Dombres

Spring 2019 Discussions continue about the United Kingdom’s future relationship with the European Union. Recent research from the department reported in this newsletter highlights the risk to the health of the public from our impending departure from the European Union. There will also be risks from ‘Brexit’ for our universities in areas such as teaching, research and staff recruitment. On a more positive note, we were very pleased with the department’s continuing research outputs, including articles in the New England Journal of Medicine. We were also very pleased with the continuing innovations and developments in our teaching programmes. Finally, we are very sad to be losing two longstanding members of staff, Christine Franey and John Rowntree. We wish them the best for the future. Professor Azeem Majeed Head of Department of Primary Care and Public Health Imperial College London We welcome feedback on the ARCHIVE PRIVACY NOTICE newsletter and are taking submissions for future issues. Email your news, events, achievements and stories to us. [email protected] PCPH eMagazine Team Subscribe Unsubscribe Javier Gallego Mehrosa Memood Copyright © 2019 Department of Primary Care & Public Health, Imperial College London

Improving patient safety in developing Photo by AMISOM Public Information countries In an article published in the journal JRSM Open, Mustafa El Monstri, Ricky Banarsee and Azeem Majeed discuss patient safety in developing countries. Through a review of the literature, lessons and interventions from developed countries have been taken into consideration to identify the themes needed for patient safety improvement. They provide an integrated approach based on best practice which can be used to guide the development of a national strategy for improving patient safety. Policy makers need to focus on developing a holistic and comprehensive approach to patient safety improvement that takes into account the themes discussed in this article.

Department News Child Health Unit: The First Thousand Days of Life The first thousand days of our life (from conception to age 2) is increasingly recognised as a key stage of the life course for policy and healthcare interventions. Dougal Hargreaves has been looking at ways to study this at international, national and local levels. Internationally, they published an article in the Lancet Child & Adolescent Health that studied the successful early years’ strategy in the Netherlands over the past 10 years, and looked at lessons for the UK and other countries. They are also in the early stage of setting up a 6 country study (Sweden, US, UK, Netherlands, Canada, Australia) to study healthcare policies, healthcare activity and outcomes during the first thousand days. At national level, they have been awarded a grant of £156,386 from the Nuffield Trust. The title of this project will be named 'Understanding the causes of poor child health and developmental outcomes in the UK' which will focus on local area analyses of the health and development of children under 5 years old’. The Health Select Committee also published their report into the first thousand days, which featured material from our submission and evidence session. Locally, our application to develop an early years’ dashboard which will link maternal and child records within the Whole Systems Integrated Care dataset has been approved. Development work on the dashboard is due to start in early Summer.

Digital Health Unit and members of Ministries of Health or WHO-related staff. The course objective is to support the acceleration of health systems strengthening for UHC and the adoption of a ‘health in all policies’ approach in order to leave no one behind. The PCPH Journal Club and Peer Support The course will provide an overview of key Network had its first meeting on 7 concepts, strategies and opportunities for February. The group held a very engaging effectively working with WHO Member first session with an interesting discussion states and non-state actors. about obesity and its risk factors whilst Beautiful Casablanca and Public Health in discussing the chosen paper. They look the Arab World forward to the next journal club which will be held in June. Watch out for posters In collaboration with Arab Public Health around the department for updates! Association, WHO CC is organising a conference in Casablanca, Morocco, on WHO CC for Public Health Training 4 - 6 April 2019 called ‘Opening the doors & Education: to Public Health in all policies’. The conference will bring excellent speakers Austria’s Carinthia University student and important characters in public health visit of the Arab World. More information In March 2019, WHO CC welcomed 38 students from Carinthia University of Applied Sciences in Austria. The students who are interested in health care management visit the WHO CC annually. ‘Accelerating Progress towards the UN’s Health-Related Sustainable Development Goals’ Course The WHO CC has been commissioned by WHO Geneva to deliver online interactive and face-to-face training on strengthening the United Nations SDGs related to health. The course is aimed at health professionals, non-health professionals

MEDIA MENTIONS With Brexit being only a few weeks away, its political and economic implications are largely discussed. However, Brexit could affect a wide range of sectors, including public health. A study, published by Paraskevi Seferidi and some of her colleagues in The Public Health Policy Evaluation Unit (PHPE), in the BMJ Open, investigated the impact of potential Brexit trade policy scenarios on prices and intake of fruits and vegetables and associated cardiovascular disease (CVD) mortality. All modelled Brexit scenarios were associated with higher prices of fruits and vegetables, especially of those highly dependent on imports. This could lower fruit and veg intake and contribute to increased CVD mortality. The model identified that a no deal Brexit could contribute to approximately 12,400 extra CVD deaths between 2021 and 2030. Trade can affect prices of food commodities, like fruit and vegetables, by changing import tariffs and costs occurring due to border checks. The model suggested that under a no deal Brexit, prices could rise by approximately 17% for bananas, 14% for citrus fruit, and 15% for tomatoes. With price being an important determinant of consumer behaviour, these prices hikes could reduce fruit and veg intake between 3% and 11%, depending on the modelled scenario. Low fruit and veg intake is a significant risk factor of CVD. Currently, only 27% of Britons aged 19-64 meet their 5-a-day recommendation. These findings are consistent with previous analyses suggesting that Brexit would increase prices of food and should urge policymakers to carefully consider public health during Brexit negotiations and planning. New Scientist The Independent Daily Mail Huffington Post The Times Evening Standard ITV News The Herald The Telegraph Daily Express Metro Pulse

Dover Banksy Mural - Photo by Ian Clark - Creative Commons

Malaysian Durian fruit by Austen El-Osta

Imperial SCARU Delegation Visit to Malaysia (18-22 February 2019) The concept & practice of self-care is attracting interest and attention around the world, because it also presents great opportunities for all other stakeholders in health. Governments, policymakers and academics around the world are all asking the same question: “How should we design and implement policies for self-care?”



The purpose of the Imperial SCARU delegation visit to Malaysia was to foster a culture of collaboration between Imperial College London School of Public Health and key stakeholders in Malaysia interested in the self-care, health & wellbeing space including: • The United Nations University Institute for International Global Heath (UNU-IIGH) • Monash University, Kuala Lumpur • The South East Asia Community Observatory (SEACO) in Segamat Region • The Social Wellbeing Research Centre (SWRC), University of Malaya • Ministry of Health Malaysia The visit was supported by the British High Commission in Malaysia. The delegation consisted of Drs David Webber (President, International Self Care Foundation) & Austen El- Osta (Acting Director, SCARU). Self-Care in Malaysia & around the world The primary objective of the visit to In this overall context the visit of Imperial Malaysia was to give Imperial SCARU the SCARU to Malaysia to discuss self-care, opportunity to work with key stakeholders and how it may be developed within the in Malaysia and consider as a group how country, was of particular interest. self-care policy and praxis may be Discussions explored policy development, developed and embedded in the country stakeholder interests and the for the benefit of patients and the public. opportunities for research. The SEACO observatory provides a large longitudinal Fundamentally, self-care as a concept and study population that can be examined in practice needs much further research through a self-care lens. New ideas for and development to realise its full examination also emerged – for example potential. One challenge is the simple fact to consider the interface between self- that there are so many different care and social protection mechanisms. interested ‘stakeholders’, each with Practical ways forward include important perspectives, but often using establishing a forum or network for differing terminologies and focusing on interested parties, and the development different aspects of self-care. Connecting of a country specific ‘self-care statement’ these ‘silos of excellence’ to a commonly- or narrative bringing together all shared mission of promoting ‘self-care for stakeholders. all’, and ‘self-care in all policy’ ethos is an important opportunity.

SCARU day visit to SEACO in the Segamat region, Malaysia The South East Asia Community Observatory (SEACO) is a health and demographic surveillance site operating in the rural district of Segamat (Johor Sate). The site tracks a population of about 40,000 people, with a focus on health & wellbeing. SEACO commenced operations in November 2011 & has since conducted a range of research studies in communicable and non-communicable diseases, including antimicrobial resistance, dengue, diabetes, eye health, atrial fibrillation, stroke, and dementia. The purpose of the SCARU delegation visit SEACO was to consider how the research platform could best be utilized to inform questions about self-care & chronic disease prevention and management in the context of middle- & low-income countries with a significant and growing chronic disease burden. Meeting at United Nations University International Institute for Global Health (UNU-IIGH) Professor Pascale Allotey, (UNU-IIGH Director) introduced the Imperial SCARU delegation to a wide audience, including Dr Feisul Idzwan Mustapha from the Ministry of Health Malaysia. A series of presentations & plenary discussions raised several important topics including: • Self-care research & development priorities • The role of the State, and the importance of rights and responsibilities of citizens (& patients) with respect to activation, the personalisation agenda & taking ownership of their own health & wellbeing • Important role of pharmacists in facilitating self-care • Self-care praxis in the context of low-middle income countries • The primacy of self-care in the context of immigration & those displaced individuals seeking refugee status (post-war/conflict zones) • Important role of schooling, education and training in instilling a culture of self-care in the population Self-Care Policy Prescriptions The ultimate goal of SCARU is to be able to offer a range of policy prescriptions for self-care, based on research findings in a range of country situations, and to be able to offer practical models for the management and development of self-care with a country’s institutions. Every country is unique, but learnings from Malaysia are potentially useful for other countries. In the past, the academic study of self-care has been rather neglected, as it lies outside the usual focus of health and social system studies. The Self-Care Academic Research Unit (SCARU) in the Department of Primary Care and Public Health is the first of its kind, and this presents a unique opportunity to drive the self-care agenda forwards.

Batu Caves near Kuala Lumpa, Malaysia by Bernard Spragg

THERE’S NO WAY TO SUGA Type 2 Diabetes in Children and Young Adults Newly published statistics show that nearly 7,000 children and adults aged under 25 in the UK have been diagnosed with type 2 diabetes. The onset of Type 2 Diabetes is strongly associated with lifestyle factors such as obesity, lack of exercise and high calorie (high sugar) diets. In recent decades, countries such as USA and UK have seen large increases in the number of people with type 2 diabetes. Most of these cases have been among older people but we are now also seeing an increasing number of cases of Type 2 Diabetes among younger people. Reversing the increase in Type 2 Diabetes is not easy. It requires action by individuals, and also by governments and societies. For individuals, it is important that people eat a healthy, balanced diet that is not too high in calories, and not high in refined carbohydrates and sugars. Dietary changes need to be combined with regular exercise to keep weight down to healthy levels, thereby reducing the risk of developing type 2 diabetes. A number of people with established type 2 diabetes have reversed their condition through measures such as dieting and exercise. This shows even if an individual has Type 2 Diabetes, they can resolve this through appropriate lifestyle measures. Measures taken by individuals need to be backed by measures targeting the entire population. This can include for example, ‘sugar taxes’ on high-calorie drinks to encourage individuals to consume them less and to encourage manufacturers to produce lower calorie version of these drinks. Calorie labelling of food can also help people make suitable choices about their diets. We also need measures to encourage physical activity, for example, making it easier and safer for people to cycle and walk rather than using cars. It’s important that regular exercise and healthy diets are introduced at a young age. Hence, nurseries, schools, colleges and universities also have an important role to play in addressing the causes of Type 2 Diabetes.

GAR-COAT IT

FROM TAUGHT TO TEACHER: TH By Dr Ben Stone, Primary Care Undergraduate

When was the last time you planned a journey? I visited a friend recently; with just an address I found the quickest route, adjusted for traffic and was acquainted with their garden gnomes before I heard a single beat of my ‘Driving tunes’ playlist. Now imagine planning a journey; you can visualise how the destination will look, but you’ll only know for sure once you arrive. The dark side of the moon. Everyone has heard the outdated adage of medical education: ‘see one, do one, teach one’. The gap between see and do is noticeably palpable, principally as you walk away from your first cannulation with a blood- stained shoe and still-shaking hand. Can the second gap be so large? It can’t require as much shoe polish. HE DARK SIDE OF THE MOON e Education

I joined the Department of Primary Care and as they are too kind to tell me they have work Public Health at Imperial College London in of their own. Soon, I constructed a glimmering early December 2018, the second rotation of evidence-based educational proposal, my Foundation Year 2. Days before, on a busy presenting it proudly to my supervisor. Of medical post-take round, I made a prescribing course, I’m sure I wouldn’t have overlooked error. I reflected: ‘what could I do to prevent the small matter of educational theory. this in future’? Following a slightly protracted e-portfolio entry: Eureka! In my new role, I It can be tempting to skim a stone across the will have the time, audience and resources to literary ocean of medical education, but develop a prescribing safety session for without full immersion my session lacked medical undergraduates. Inception, albeit structure and substance. Has your topic been with less DiCaprio. The destination is set, but taught before? How has your topic been why there? taught? Why is your selected teaching style appropriate? Asking these questions is one of Performing a literature search is familiar: big the hardest steps, but there are many studies, national guidelines and a few slightly excellent Imperial College courses designed to blurry pdf versions of old books. Maybe I hold your hand as you dip your toes. With spent some time updating the “Study tunes” their help, my stage was set, my proposal playlist. There was a lot of value in discussing complete. It was time to plan. my early findings with colleagues, especially The, hopefully not copyrighted, mnemonic of AILMENTS is the ABCDE of lesson planning: • Aim: the overarching goal of the session – what will I achieve? • Intended Learning Outcomes: often an afterthought, but the lifeblood of a session from aim to evaluation. My greatest appreciation of verbs since Year 3 literacy. • Learning needs analysis: fine tuning the contextual pitch, somewhere between astrophysics and sucking eggs. I performed a quick online survey ahead of time, much to the delight of my future audience. • Methods: the fruit of your literature search. What will I do? What will I use? You do realise you will have to write all those complex clinical cases now? • Evaluation: “how likely were you to give a 5 if the presenter was nice and you didn’t fall asleep?” I found that evaluation was integrated throughout a session, not just a feedback form at the end. • Next steps: this can range from 200-page guideline to a curriculum required e-learning module, but I found it interesting, hopefully they may do too. • Tests/assessments: Nothing demonstrates enlightenment like a pop quiz! I had to write these questions too. • Summary: what was that all about again? With some flesh on the bones, my lesson was coming to life. But like a fleshy skeleton or cake without icing, the final epidermal layer of planning pulls everything together. It does not take long to realise the logistics a printer? And so on. Whilst I was fortunate to involved. Do you have a room? Do you have a have the help of experienced colleagues and speaker? Did you want to show a willing volunteers, classic OSCE/PACES presentation? Have you got the link ready for practice with a trusty squadron of stuffed that video? I’m sure that video worked the animals could iron out a few creases. My last time I used it? Are there enough chairs? materials were ready. I felt prepared. Have you made enough print-outs? Have you made your print-outs? Do you have access to The dark side of the moon.

Idea! by Cristian Carrara - Creative Commons

Two simultaneous publications in the New England Journal of Medicine from ICCP. Photo: www.quotecatalog.com – Creative Commons

Research, published by Prof Ray, reports on findings from more than 2,200 patients and is the first to measure the safety and effectiveness of the new treatment against placebo in patients with increased risk of heart attack and stroke. The novel cholesterol-lowering treatment disease with no obvious adverse effects of could be added to patients’ existing drug blocking this pathway. The benefit was regimens as well as providing an option identical to that expected though blocking for people who are unable to tolerate the enzyme targeted by stains when statins due to side effects such as muscle individuals were matched for change in pain or bad interactions with other cholesterol. medications. Like statins, bempedoic acid works by blocking a key enzyme used by Professor Ray added: “One of the key the body to make cholesterol, in this case advantages of bempedoic acid is that it an enzyme called ATP-citrate lyase. After shouldn’t cause the muscle side effects three months of treatment researchers reported by some statins users, as it is found that bempedoic acid reduced taken up by the liver and needs to be patients’ LDL cholesterol levels from converted into its active form via an baseline by an average of 18.1% enzyme only found in the liver. Once compared to the placebo group. The converted to the active form, the drug treatment was also shown to be well- cannot leave the liver, so it can’t enter tolerated by patients, with some muscles and hence could be of increased incidence of gout. considerable advantage for some. It could be an option for patients who are unable In a second study, the team looked at data to tolerate statins at higher doses, or at from more than half a million people and all. Our genetic studies suggest that the used genetic markers to model the likely benefit on prevention of heart disease effects of the treatment (blocking the and strokes in ongoing trials should be action of the key enzyme ATP citrate) over identical to that achieved through a longer period and comparing the likely statins”. effects to the key enzyme blocked by statins. They found that the effects of The research was very widely reported in inhibiting the enzyme over longer time the media. scale reduced the risk of cardiovascular Imperial College News Article (Media links via article side bar)



10 years ago, the NIHR CLAHRC NWL PPEI (Patient and Public Engagement and Involvement) theme was launched and began a journey to end tokenism in PPEI. The theme has grown in strength by investing in people, collaboration and communication. Our learning with patients is embedded in the key principles of our ‘Successful Healthcare Improvement From Translating Evidence in complex systems’ (SHIFT-Evidence) framework. We support co-design and patient/public led initiatives. Visit our twitter link highlighting some of the key work driven by patients.

OUR STORIES THE RETIREMENT BY CHRISTINE FRANEY I will be retiring from Imperial College this year at the end of May. The news might be a surprise to some colleagues; at least Dr Filippos Filippidis, who shares my office, insists I'm too young to go! However, when discussing my retirement idea with Prof Azeem Majeed I was reminded I am one of the few longest serving members of the Department of Primary Care and Public Health. I've been thinking back to the origins of PCPH and find it hard to believe Room 310 in the Reynolds has been my base for the past 18 years. In 2001, I arrived at the 3rd floor with colleagues from The Centre for Research on Drugs and Health Behaviour. We were a team of 30 social scientists and support staff, part of the old Charing Cross and Westminster Medical School. We carried a portfolio of postgraduate courses in drug and alcohol studies designed for practitioners working in addiction services; I was responsible for developing

and delivering the courses. Imperial's of Imperial MPH graduates worldwide and a Faculty of Medicine had just been new online Global MPH will start in established and for a while two departments September. I'm proud to have played a role. co-existed on the 3rd floor: Social Science In 1980 when I started my career in research and Medicine, led by Prof Gerry Stimson and at the University of Surrey, it had not been Primary Health Care and General Practice my intention to teach. Indeed, I aimed to (from St Marys Hospital) led by Prof Brian avoid any involvement in education. Yet Jarman. over the years I have drawn inspiration from senior colleagues, too many to mention by I have very clear memories of our first day in name here, who by example demonstrated the Reynolds building. I was opening boxes that research-led teaching is important and in search of celebratory champagne we had personally rewarding. My current role as brought with us to toast the new Postgraduate Senior Tutor has been of value department. We couldn't locate the box we to me in diverse ways. I am fortunate to had clearly marked 'champagne'; it had have met so many bright, talented and probably disappeared en-route when the fascinating PhD and Masters Students in the removal boxes were transported from our School of Public Health. As Senior Tutor I am previous premises. Fortunately, we found a called upon to support students who kettle and toasted our new home on the 3rd encounter difficulties, some students have floor with mugs of tea instead. extreme personal hardship. It is especially rewarding to witness students overcome When Prof Azeem arrived in 2004 the two difficulties that seem to be insurmountable departments merged, and Primary Care and at the time and to go on to achieve success Public Health was established. Over the in their degrees and careers. intervening 15 years Department PCPH has expanded considerably; impressive new I will miss students and colleagues work and meeting areas were built and throughout the School of Public Health, old PCPH continues to flourish. I feel privileged and new. I am grateful to all my colleagues to have shared in the department's success in the School's Education Team. I have a and fortunate to have experienced the special thank-you for Jo Tite and Helen King journey from the beginning. in the School Office who have tirelessly and cheerfully supported me listening to my In 2006 the School of Public Health launched endless stories of house renovation disasters a new Master of Public Health (MPH) and mouse infestations. programme. Prof Azeem was Course Director and I was Course Organiser, so it I am frequently asked 'What will you made sense to locate the MPH in the 3rd do?' Well, I am looking forward to spending Floor seminar room. We had support at the more time with music projects I'm involved time from Prof Rifat Atun at the Business with. Also, I'd like to complete a couple of School, nevertheless the MPH was an projects I started a while ago including a ambitious project and all consuming. We postgraduate training in psychotherapy and started with an intake of just 13 the seemingly never-ending renovation of students. Today the MPH attracts hundreds my house. Recently a friend reminded me of competitive applications annually for the that when we were undergraduates in 1976 70 places available and the programme is the 'gap year' hadn't been invented hence delivered at St Mary’s campus by staff we studied and worked seamlessly across the School. There are now hundreds throughout. I've put 'gap year' on my list.

Illustration: U.S. Public Health Service: U.S. G.P.O., 1942

The Dalgarno Trust – Men’s Health Conference, February 2019 Over the last year, the Undergraduate Primary Care Education team has been working closely with The Dalgarno Trust; a community centre in one of the most deprived wards in the London Borough of Kensington and Chelsea. They are working to collaboratively design and implement a novel community placement for the Year 5 Health Promotion Specialty Choice Placement (SCP). During the first placement in October 2018, continued involvement, commitment and two students, Anudeep Bhattacharyya and sense of responsibility to the residents of Jannen Sathiendran carried out in-depth Dalgarno Ward following the completion of discussions with men attending the centre his SCP was highly valued by the Dalgarno about their health needs and perceptions. Trust. These discussions found that men were concerned and wanted to know more about Given the five-year gap between men and topics such as depression, suicide prevention, women’s life expectancy in the ward, the 12 sexual health, the importance of regular year difference in life expectancy between the exercise, and prostate and testicular cancer. most affluent ward in the borough versus the These topics informed the development of most deprived, and the self-identified the Men’s Health Conference that the centre reluctance of men to discuss personal health organised in February 2019. issues, this event was an important collaboration. The partnership was between The event itinerary included a talk from Dr academic, healthcare, community and Austen El-Osta regarding self-care in men and voluntary sectors, aiming to engage men in steps that can be taken towards achieving a these conversations in a safe and familiar longer healthy life expectancy along with environment, away from a formal healthcare information about the benefits of physical setting. It has also been an example of how activity and information about accessing local socially-accountable, collaboratively-designed resources. Additional representation at the medical education placements can contribute event included third sector groups to reciprocal learning through service. These disseminating information about prostate placements and approaches can have cancer and sexual health, and guidance from important benefits for the community and our the London Fire Brigade relating to household students as they develop professional values and health and safety. to support their future work as doctors who can more effectively meet the needs of the Anudeep designed and ran a student-led communities they will serve. health quiz for the community and his



Society of Academic Primary Care (SAPC) South East Regional Meeting A large number of the Primary Care department attended the SAPC South East Regional Meeting, held once again at the wonderful setting of Madingley Hall, Cambridge. The theme of this year’s conference, hosted by King’s College, was ‘Digital Features in Primary Care?’ Note the question mark.

MADINGLEY 2019 We heard from Professor Chris discussion. One of our medical students, Salisbury, past chair of the RCGP, Saniya Mediratta, presented alongside two who raised some concerns about UCL students on the collaborative work they digital health, looking at some of have been doing on ‘The Hidden Curriculum’, the hype and the cons as well as a an ethnographic study describing the student few pros. Dr Shubs Upadhyay perspective on a career in General Practice. spoke to us about his experience with developing a podcast and Nadine Engineer, faculty development designing healthcare apps. Dr Zoe manager, presented her work around online Williams educated us on the world learning tools for GP undergraduate tutors. of health and wellbeing apps, Sonia Kumar spoke passionately about social encouraging us to both use these accountability and rethinking how we educate ourselves and promote them to our medical students on this topic. Georgina patients. Professor Martin Marshall Neve, academic clinical fellow, presented and addressed the conference on the demonstrated an artificial intelligence chatbot topic of re-thinking medicine, designed to support medical students. Edward discussing the role of social Maile, academic clinical fellow, delivered a prescribing and the community. presentation on the impact of mergers describing ten lessons learned from a merger Imperial had many abstracts accepted for at Oxford University. Viral Thakerar, course presentation this year – it was hard to keep lead, and Tom Durley, primary care executive track! Neepa Thacker, clinical teaching fellow, officer, delivered a workshop on creating a and Joanne Winning, Director for Medical digital learning resource from scratch – Humanities at Birkbeck Centre, presented ‘Doodles to Digital’ – which was well attended their work on humanities and medical and well received. education which stimulated a lot of exciting Overall the conference was an excellent two days with fascinating presentations from a range of institutions. We look forward to applying all that we learnt to our own student teaching and education research.

Dr Kumar (far left) with Undergraduate Medical Students presenting at Madingley

Fuir 2004 by Christopher Dombres

Emmanuella Ikem (pictured left), MPH graduate from the 2015/16 cohort and currently studying medicine at University of Bristol, published this week the results from her Master’s dissertation in the British Journal of Obstetrics and Gynaecology. The Master’s dissertation and subsequent paper examined dietary patterns and the risk of hypertensive disorders in pregnancy. Hypertensive disorders in pregnancy, including gestational hypertension and preeclampsia, can lead to adverse outcomes for both mother and child, such as haemorrhage, hepatic damage, renal dysfunction, and preterm delivery. The study was supervised by Dr Ekaterina Maslova (Teaching Fellow on the MPH. Pictured right) and Professor Thorhallur I. Halldorsson and was a collaboration between the School of Public Health, Imperial College London, School of Health Sciences, University of Iceland and the Centre for Fetal Programming, Statens Serum Institut, Copenhagen. The study used the Danish National Birth due to components of these diets having Cohort, a prospective, pre-birth cohort with converse effects on the systemic >100,000 pregnancies and >20 years of inflammation and endothelial dysfunction follow-up that examines associations between pathogenesis that occurs in these outcomes. early life exposures and maternal and offspring outcomes. The study found that The findings support previous studies that women consuming more amounts of the highlight the advantages of consuming a Western diet (characterised by high ‘healthy diet’ rich in vegetables, fruits, and consumption of potatoes (including French fish during pregnancy. They also pinpoint a fries), mixed meat, margarine and white conceivable avenue for reducing the risks of bread) and less of Seafood diet (characterised these conditions and for optimising pregnancy by high consumption of fish and vegetables) outcomes. The wide spread consumption of were more likely to develop gestational Western-type diets across various populations hypertension and preeclampsia. This may be makes these findings more likely to also be beneficial outside the Danish population.

Teams developing their ideas at the Imperial EIT Health Innovation Day



The European Institute of Innovation & Technology (EIT) Health Imperial College Innovation Day took place in November for the third year running. Imperial is the lead partner of this project which included 17 other host locations across Europe and engaged over 1,300 participants. Eighty-nine students arrived in South The competition was a huge success as 5 Kensington for a day of training in Imperial students were among the groups innovation and entrepreneurship. to secure the top 3 positions. The Gold Multidisciplinary teams competed to Place winners, who received a cash prize develop ideas on ‘healthcare facilities of of £140 each, consisted of 3 Imperial the future’ and presented pitches to a College Masters Students and 1 prestigious panel of judges, including undergraduate student; Momina Yawar exciting start-up founders born out of Khan (Mph Public Health), Matt Whittaker Imperial. and Yallu Su (MSc Health Data Analytics) and Anara Kukenova (BSc Biochemistry). Students spent the day going through design thinking training, pitch coaching The Gold Place Winners receiving their cash prizes and various rapid ideation tasks. Teams were allocated on the day and had no prior knowledge of the challenge. They worked on ideas to improve various aspects of healthcare facilities of the future, such as infrastructure, staff wellbeing and patient satisfaction. Five expert citizens attended the day to take part in a co-creation session with students as well as various healthcare professionals who agreed to receive phone interviews from students.

EIT Health Innovation Day students from across Europe at the Winners Event The winning idea was an app which used a topic for the Winners Event focused on ‘deliveroo’ style model to allow friends Student Mental Health, relatable and and family to track progress of their loved relevant to all participants. Students ones throughout surgery. The goal was to tackled language barriers, cultural and minimise the number of people entering academic differences and managed to the operating theatre to obtain updates embrace diverse approaches and work for anxious family members and therefore incredibly well in their multidisciplinary lower infection risk. The winners have European teams. One winner brought qualified for the Regional Finals of the along her 6-month-old daughter who Barclays Local Genius Challenge 2019 due broke the record for youngest to take place in April! participating innovator! Innovation Days will continue at Imperial in 2019 and Winners received vouchers and an endeavour to harness the enthusiasm and invitation to the Innovation Day Winners talent of all our keen young Event in December. The winning team entrepreneurs. from each of the 18 European Innovation Days attended this event at St Mary’s to If you are interested in getting involved, compete in a final round for mentorship please contact Dr Filippos Filippidis opportunities and invitations to European (Activity Lead) or Emily Saunders (Project entrepreneurship events. The challenge Manager).



Director of WHO Collaborating Centre for Public Health Education and Training, Prof Salman Rawaf was the principal author on the WHO publication ‘Primary health care: closing the gap between public health and primary care through integration’. Important contributions came from other WHO CC team members: Prof Azeem Majeed, Dr Elizabeth Dubois, Dr Mays Raheem, Dr David Rawaf and Dr Ahmed Razavi. Modern primary health care emerged how can we integrate public health into when gross health inequalities became a primary care and what are the possible global concern. Forty years ago, the models? There are various possible Declaration of Alma-Ata endorsed models of integration of public health primary health care as the means of into primary care. These could be attaining the World Health applied alone or in combination, but all Organization’s goal of Health for All. can potentially achieve health gains. With declining premature mortality, rising longevity, and an increase in This paper reviews the various healthy lifestyle, the fitness-for-purpose approaches reported in the literature of current health systems can be that have been taken to integrate public questioned. The current disease-focused health and primary care and summarizes model is out-of-date and proactive both the strengths and weaknesses of approaches to health through strong and each approach in order to advise policy- effective primary care are needed. makers of the different approaches available. We have used the WHO Such primary care should integrate most definition for health, the Starfield of the public health functions to address definition for primary care and Acheson population health needs at the individual (1988) for public health (based on and community levels. The question is, Winslow 1920). Read it

School of Public Health Athena SWAN Lecture Professor Tom Welton

In February, Professor Tom Welton, the Dean of Natural Sciences led a passionate discussion of how we can all improve our working culture by thinking about the best next thing we can do, within our \"own reach\". Professor Tom Welton, Dean of the Faculty of Natural Sciences at Imperial College London and the world’s first Professor of Sustainable Chemistry, began his academic career with a B.Sc. at the University of Sussex followed by a D.Phil., in the Chemistry and Spectroscopy of Ionic Liquids. After research positions at the University of Sussex and the University of Exeter he joined the Chemistry Department at Imperial College London in 1993 as a Lloyd’s of London Tercentenary Fellow. In 2002 he was awarded a Readership in Catalysis and undertook the role of Director of Undergraduate Studies in Chemistry. In 2004 he was promoted to Professor in Sustainable Chemistry. He was Head of the Chemistry Department from August 2007 to December 2014, during which time the Department achieved an Athena Swan Gold Award. He became Dean of the Faculty in January 2015. Tom uses solvents to improve chemical processes. He has worked with ionic liquids throughout his career, in order to develop sustainable solvent technologies. The central academic aim of his research is to understand the role that the immediate chemical environments in which reacting species find themselves influence the reaction process. He also aims to use this understanding to provide more effective chemical processes by the matching of the reaction with its optimum solvent environment. Tom is the author of over 100 papers, primarily on the structures and chemistry of ionic liquids and their solutes. He was the 2007 RSC Christopher Ingold Lecturer, the 2012 RSC Thomas Graham Lecturer, and the 2011 DFG Paul Walden Lecturer. He is an Honorary Member of the Chemical Society of Ethiopia. In June 2017 Tom was awarded an OBE for his services to diversity in education. Hear Tom’s lecture Find out more about how the Imperial College School of Public Health achieved its Athena SWAN Silver Award for supporting the careers of women in science.



As part of our Educational Community of Practice (eCoP) activities, Primary Care Undergraduate Education have been running a series of initiatives for wellbeing in the department. These have been short sessions of 30 minutes to an hour, taking place on a Wednesday morning before work. Typically, Wednesday is a particularly busy day of the week for most members of the team. The aim of the sessions is to provide everyone with an opportunity to do something slightly different to the usual pattern of the working day and to begin work more mindfully. So far, we have delivered a variety of activities, which all members of the wider team are invited to participate in. These have included a walk through historic Brompton Cemetery and sharing breakfast together. Most recently Dr Maham Stanyon has been sharing her knitting expertise with us. With a group ranging in ability from complete novices to seasoned professionals, it has proved to be a great way to begin the day!

One of our longest- serving security guards retired in January. John Rowntree worked with Imperial College at the Charing Cross campus for 11 years. In that time, he became friends with and a great support to many colleagues, particularly those who, like him, are Chelsea supporters! He is married and has grandchildren. He lives in West London and still comes into town to support Chelsea FC and to keep in touch with some of his former colleagues. John was really surprised and ‘chuffed’ at his send off and sends his heartfelt thanks for the M&S voucher which he has used to buy a mirror and clock. John, all at PCPH wish you a long and happy retirement!



C IM CONSTUHLR Working with industry, government or other external parties is a great way to test the impact of your expertise, discover real world challenges and ensure your research remains relevant. Consultancy gives you the chance to network and forge new opportunities for research and funding. Plus, real-world examples and lessons can be taken back to the classroom, improving your student’s experience and satisfaction.

CREATE ILRMTOAPUNAGCCHYT Introducing Uscher Devkota – the Department of Surgery and Cancer’s dedicated Consultant Engagement Manager from Imperial Consultants (ICON). Do you have any queries? • What is consultancy and how can I be a part of it? • What should I charge a client? • Will there be any IP issues that I should be aware of? • Can I waive my consultancy fee for future research works? Feel free to email Uscher your questions.

Five minutes with… Michael Goetzinger What is your role within the department and how long have you been here? I am a Primary Care Education Administrator and I have been here for almost three months now. What does your role involve? I support the department in organising courses, placements etc. for years 1, 2 and 5. What do you enjoy most about your role? Contact with colleagues, students and external stakeholders; a wide variety of tasks and never a dull moment. Why PCPH? The thing that first struck me at the interview was the friendly but competent environment and the positive approach to working here and achieving excellent outcomes with a smile on the face. What were you doing prior to this/what is your background? I graduated in Sociology and spent a few years at home looking after my now 6-year-old son, Adam. Tell us something we may not know about you. Being born in Vienna (Austria), I have lived there, also Italy for several years and now here in London for almost two decades. A role in an Austrian street fashion magazine (yes, they really do exist) brought me here. Tell us about your outside interests? Music, reading, history, politics, traveling. You’re marooned on a desert island – which 3 people (real or fictional, dead or alive), 3 tunes and luxury item would you choose to be marooned with? My son, Adam, my best friend since childhood, Thomas (from Vienna) and Saul Bellow. My three tunes would be Erik Satie ‘Gymnopedie’, Herbie Hancock ‘Maiden Voyage’ and Ohio Players ‘Pleasure’. What are your goals for the next few years? Having interesting experiences, progressing in my career and enjoying life.

The Strudlhofstiege is an outdoor staircase of architectural and literary significance in Vienna, Austria. Located in the Alsergrund district, it is named after a former art school run by the painter Peter Strudel.

SEMINAR CITY Highlights of the latest talks and seminars held at PCPH Fostering policy innovation to address the double burden of malnutrition - Dr Anne Marie Thow Dr Anne Marie Thow is Senior Lecturer in Health Policy at the University of Sydney. Her research uses theories of public policymaking to explore facilitators and barriers to best practice public health nutrition policy globally, with a focus on the interface between economic policy and nutrition. Policies in economic sectors such as examines strategies to foster and scale up agriculture, commerce and trade are major policy innovation through policy learning – influences on food systems and are thus particularly through reverse innovation and critical considerations in developing a drawing lessons from a policy change in comprehensive response to the double diverse contexts. burden of malnutrition. This presentation Watch this presentation There are many more fascinating seminars ready for you to view on the PCPH Website (Check out the ‘Past Seminar Recordings’ section)