This thesis looks at the subject of old age and retirement in the later years of the Scottish Enlightenment. These subjects are examined in relation to the final years of the physician and natural philosopher, Professor William Cullen (1710–1790). The Cullen Consultation Correspondence digital database (http://cullenproject.ac.uk/) is used to examine letters between the doctor and some of his elderly patients and a study of the botanical materia medica prescribed for this patient group is made. There follows an examination of Cullen’s personal retirement project, his improved farm and designed landscape at Ormiston Hill in West Lothian. The thesis examines the double meaning of the word ‘retirement’, both in its eighteenth-century sense as a retirement from active life, and its modern sense as the concern of old age. Even if Cullen’s notion of old age and retirement represented the concerns of an elite, it carried with it a broader social and moral responsibility. I show how Cullen and his peers sought to develop a programme of improvement which included how to live ‘a good life’.

Urinary tract infections (UTIs) are one of the most common healthcare associated infections (HCAIs) accounting for 17.2% of the total HCAI’s in England. Some of the underlying issues associated with UTIs include recurrent infections, catheter associated UTIs and antibiotic resistance. These issues are responsible for prolonged hospital admissions, increased costs and significant morbidity. Another possible issue relates to the ubiquitous protozoa, Acanthamoeba. Although it is known to cause infections in humans, the amoeba has been isolated from apparently healthy people. Furthermore, Acanthamoeba is known to have an endosymbiotic relationship with bacteria. Therefore, it is reasonable to hypothesise that Acanthamoeba may possibly play an important role in UTIs. Clinical isolates of E. coli, K. pneumoniae and P. mirabilis were used in the current study. All uropathogens exhibited the ability to form biofilms in a nutrient dependent manner and complete the biofilm cycle within 24h. They also displayed the ability to form intracellular bacterial communities in urothelial cells and induce significant cytotoxicity. Moreover, they were able to associate, invade and survive within Acanthamoeba castellanii (T4). Furthermore, 200 urine samples from patients suspected of UTIs were collected from Colchester University Hospital NHS Trust and analysed for the presence of Acanthamoeba. Nineteen samples were positive for Acanthamoeba spp. (unclassified) and two samples for A. castellanii supporting our hypothesis that the amoeba possibly plays a role in UTIs. This is the first study in the UK to have confirmed the presence of Acanthamoeba in urine. This study also investigated the antimicrobial efficacy of cetylpyridinium chloride (CPC). CPC coated latex catheters were able to prevent biofilm formation at very low concentrations. This finding provides promising evidence for the potential application of CPC impregnated catheters in preventing CAUTIs. In conclusion, the findings from this study can be used to develop targeted interventions aimed at the underlying issues associated with UTIs.

Universal health coverage (UHC) has been identified as a priority in the sustainable development goals (SDG3), but it is argued here that this is only possible if the health workforce is educated in, and values a public health approach at the primary health care (PHC) level. Encouraging community participation by developing a critical awareness of the social determinants of health and supporting communities to take action is needed. Community health workers (CHWs) have the potential to act as agents for social change to improve the health of rural communities if trained and supported appropriately. This study investigates the optimization of public health skills, knowledge and practices of health workers at the PHC level in rural Cambodia. It is anticipated that this study will afford new insights to inform stakeholders of the factors impacting on the development of public health workforce capacity. The research engaged twenty CHWs over two studies using a participatory action research approach. Over eight participatory workshops and a two-day training session CHWs identified (using photovoice), implemented and reflected on solutions to community health problems. In addition, ten semi-structured interviews were undertaken with key stakeholders from government and non-government organisations (NGOs) to gain an understanding of current methods used to develop the public health capacity of health workers in Cambodia. The public health skills gaps identified at provincial and community levels included planning, communication, community engagement techniques and using initiative to identify and implement solutions. These gaps are intrinsically linked to Cambodian social and political structures, and cultural values which promote a hierarchical working environment. In addition, aid dependency and a lack of ownership has created a new patronage which encourages further disempowerment and an apathetic approach to independently tackling community health issues. Fragmented public health training mainly directed by international agents and a lack of financial support to develop sustainable training, supervision and monitoring negatively impacts public health skill development. Health promotion and prevention training is provided to health facility workers, but there is a ‘know-do’ gap. They view their role as purely curative and removed from the community public health agenda, thus devaluing the application of new public health skills. The implementation of community participation policies in Cambodia is hindered by a reliance on external agencies and cultural norms of respect, obedience and fear of challenging the elite. The capacity for CHWs to act as agents of social change is unlikely given the current policy structure and implementing environment. The health workforce in Cambodia has the potential to contribute significantly to the goal of UHC, however factors affecting their desire and ability to implement a public health approach need addressing. Although many health systems are hierarchical in nature, the degree to which people can innovate, openly analyse processes and procedures and suggest solutions needs to be considered. Identifying ways of supporting CHWs to mobilise and enable communities to be empowered within the contextual environment is required, as is a better understanding of how to close the know-do gap in health facility workers.

Suicidal patients constituted a significant proportion of the annual admissions to nineteenth-century public lunatic asylums. They formed a distinct patient category that required treatment and management strategies that were capable of frustrating their suicidal propensity and alleviating their mental affliction. Yet despite being relatively large in number, the suicidal population of public asylums has received only nominal attention in the history of nineteenth-century psychiatry. This thesis examines the admission, discharge, treatment and management of suicidal lunatics over the course of the nineteenth century. It locates suicide and suicidal behaviour within the context of the asylum and uncovers the experiences of patients, their families and asylum staff. There is a distinct appreciation of the broader social and political context in which the asylum operated and how this affected suicide prevention and management. This thesis argues that suicidal behaviour, because of the danger associated with it, triggered admission to the asylum and, once admitted, dangerousness and risk continued to dictate the asylum’s handling of suicidal patients. Rather than cure and custody, it was protection and prevention versus control that dominated the asylum’s treatment of suicidal lunatics. Conclusions are drawn based on evidence from five asylum case studies and contemporary publications.

Childhood obesity is a recognised increasing public health problem in Iran, but no evidence for effective prevention strategies is available. The aim was to inform the development of an obesity prevention intervention for Iranian school children. A quantitative analysis was used to examine the pattern and associated factors with obesity and a qualitative study explored the beliefs of parents and school staff about the causes of childhood obesity and potential interventions. Overall 28.2% of the children were overweight or obese and there was a non-significant tendency for increased energy intake with higher weight status. Measures of body fat were highly positively correlated with blood pressure. There was generally accurate body size perception among children and no relationship between weight status and quality of life scores. Focus group participants identified a range of perceived obesity risk factors related to diet and physical activity at the micro and macro levels. In terms of interventions, the importance of macro level activities was highlighted. The study confirms that childhood obesity is an important health problem in Tehran and highlighted socio-economic variations in prevalence, which will inform the targeting of prevention interventions. Important contextual information was obtained to inform the development of a prevention intervention.

Nontyphoidal Salmonella (NTS) are a major cause of fatal bacteremia in Africa. We investigated the role of bactericidal antibody in complement-mediated killing of NTS. Immunised mice serum lacked such activity due to weak complement activity. Mouse anti-Salmonella antibodies were able to effect killing when given a source of human complement. Human serum bactericidal assays showed that the serum-susceptibility of an African clinical isolate varied based on growth conditions. In vitro kinetics of serum-killing, phagocytosis and antibody and complement deposition indicated that a proportion of Salmonellae are phagocytised before serum-killing occurs and this may explain how the protective effects of anti-Salmonella antibodies are undermined in IFN\(\gamma\) deficiency. We studied targets of bactericidal antibodies using an optimised serum-adsorption procedure and a range of different NTS strains and serovars as well as LPS mutants. Antibodies against the immuno-dominant O-antigen (OAg) were a major target of bactericidal antibodies against NTS in human serum. These data support development of an OAg based vaccine against NTS. Finally, using electron microscopy, we showed the physical effects of serum-killing on Salmonellae and also demonstrated that a major difference between inhibitory and bactericidal serum was the quantity of complement deposited on Salmonellae.

One of the key responses to the HIV/AIDS crisis has been the provision of School- based HIV/AIDS education, to try and improve teenagers’ ability to make wise and sensible decisions regarding their behaviours. The interventions have been premised on links between education and behaviour, the underlying assumption being that teaching young people how to protect themselves from HIV can lead to a reduction in risk behaviour and hence a reduction in HIV incidence (UNAIDS, 1997). An important part of this process has been the development of an education sector policy on HIV and AIDS, aimed at implementing and effecting, among others, the policy goal of Prevention. This study, with the use of a systems theory as a theoretical framework, examines the policy, provision and practice of HIV/AIDS education in secondary schools in Kenya with the view to informing policy and providing options for re-designing and scaling up (if necessary) the HIV/AIDS program. A methodology combining literature review, semi- structured interviews and a school survey was adopted. The school survey covered students, teachers and Head teachers; while the semi structured interviews covered policy makers. Results revealed that there are discordances between national HIV/AIDS policy rhetoric and school realities. There is a general failure of schools to implement the type of detailed HIV/AIDS policy described despite the fact that the demand is high. Although there are merits that the study did not cover a wide enough population to warrant the generalizations it makes, the research findings and recommendations that do exist from previous investigations largely confirm rather than refute these results.

Adverse work environments, occupational sickness and accidents are common problems for many ‘Small and Medium Scale Enterprises’ (SMEs) in different parts of the world. Seeking better ways to improve health and safety in SMEs is a key target for national authorities and international agencies. This study aims to apply and evaluate the effectiveness of an occupational health training method called ‘Participatory Action Oriented Training’ (PAOT); claims have been made that PAOT is an effective technique for improving health and safety at SMEs in developing countries. An intervention study was performed with the assistance of 20 volunteer SMEs from five major industries in Can Tho City, Vietnam, between May 2007 and May 2008, to evaluate the effectiveness of the PAOT programme. The programme was applied in 10 factories and the traditional local health and safety methods were applied to the 10 ‘control’ factories. The research was conducted in two phases (pre-intervention and post-intervention) and consisted of matched cross-sectional studies using managers’ questionnaires (n=69), environmental measurements (personal dust (n=360), static dust (n=360), toxic gases (n=72), noise (n=540), lighting (n=900), air temperature (n=720), air humidity (n=720), air velocity (n=720)). Data were also collected quarterly follow-up visits to record the number of improvements that had been made, and to obtain monthly factory reports on productivity, workers’ income, accidents, sickness absence, health visits, and health costs. There were significant improvements among intervention factories after one year in terms of environment measurements, numbers of improvements, numbers of cases of sickness and accidents, health costs, productivity and workers’ incomes. The findings of the intervention study support the idea that a PAOT programme produces better outcomes in SMEs than a local traditional occupational health programme. The current study was limited, however, in a number of ways, and a fuller examination of PAOT will require a larger study with more environmental measurements taken over a much longer period of time, together with data on sickness absence and accidents that have been independently validated.

An analysis of Edwin Chadwick's contribution to public health. The first part examines explores public health agitation 1832-1848, specifically: the "Sanitary idea”, the Interments Report (1843), Health of Towns Commission (1843-1845), Sanitary profits and propaganda, the struggle with the Speculators, and the Public Health Act,1843. The second part investigates the impact of the General board of Health (1848-1854).

South Asian men living in the (UK) have higher rates of Type 2 Diabetes Mellitus (T2DM) compared with their white British counterparts. Diet, physical activity (PA) and sedentary time (ST) are important risk factors for the development of T2DM. The aim of this thesis was to use a mixed-method approach to assess diet, PA and ST, as well as to explore the factors influencing these behaviours in overweight and obese South Asian men living in the UK. Study 1 revealed there is currently insufficient evidence to recommend that any specific diet is superior in improving glycaemic control, but did display the crucial role weight loss plays in the management of T2DM. Study 2 indicated that 54% of overweight and obese UK South Asian men had a ‘healthy’ diet. Results from study 3 indicated that only 24.1% of the men met the minimum PA recommendations. Qualitative findings from study 2 and 3 revealed the unique sociocultural factors influencing diet and PA behaviours in South Asian men. The findings from this thesis can be used to advise the development of culturally tailored programmes and interventions to help reduce T2DM rates in this high-risk population.