Block 4 Soc Pop Flashcards

1
Q

What are the key features and criticisms of the medical model of disability?

A

Features

  1. Disability : intrinsic to the individual
  2. Restrictions: attributed to physical or cognitive impairments
  3. Interventions/services: changing or curing the disabled person
  4. Medical/health care profession’s role: treatment and central

Criticisms
1. Individualises the issue of disability
2. Negative /disempowered image
3. ‘Personal tragedy’
4. Medicine defines and controls disabled people e.g.
Zachary/Lorber conflict

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2
Q

What are the key features of the social model of disability?

A
  1. Disability is extrinsic to individual - social, attitudinal and physical barriers prevent disabled people from participating in society to the same extent as other people
  2. Problem primarily caused by the way society is organised
  3. Public issue: needs socio-political responses
  4. Distinction between impairment and disability
    • Impairment = body, mental or intellectual limitation or condition
    • Disability = loss or limitation of opportunities to take part in
    society on equal basis
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3
Q

What are some advantages and disadvantages of the social model of disability?

A

Advantages

  1. Disability is not seen as an inevitable consequence of living with impairment
  2. Emphasises the need to remove physical, attitudinal and social barriers to full social participation
  3. Calls for social and political change rather individual adaptation

Disadvantages
1. Can fail to acknowledge the significance of impairments for individuals

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4
Q

Why did the International Classification of Functioning replace WHO’s International Classification of Impairments, Disabilities and Handicaps?

A

ICF aims to address some of the difficulties with the previous classification system:
o Addresses difference of emphasis implicit in the medical and social models of disability
o Establishes a common language for describing health and health-related states to improve communication between different users
o Provides an international coding system for classifying coding and functioning.

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5
Q

What is the interactional/integrated model of disability and how does this underpin the ICF and UNCRPD?

A

• ‘Interactional’ approach adopted by:
– WHO’s International Classification of Functioning (ICF)
– United Nations Convention on the Rights of Persons with
Disabilities (UNCRPD)
• Role of polices and services is to enable disabled people to lead
ordinary lives and to participate in society to the same extent as non- disabled people

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6
Q

Why is a human rights approach of disability considered appropriate?

A

Human rights approach (UNCRPD)
1. Establishes that disabled people are not ‘other’ i.e. have the same
rights and as others
2. Established a universal standard or benchmark which can be applied
3. If a disabled person’s experiences fall short of this universal standard,
it is understood as a human rights violation

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7
Q

What are the tools to promote human rights of disabled people?

A

Tools to promote rights and equality
1. International: UN Convention on Rights of Persons with Disabilities
(UNCRPD) and other human rights conventions E.g.
• Equality before the law without discrimination (article 5)
• Right to life, liberty and security of the person (articles 10 & 14)
• Equal recognition before the law and legal capacity (article 12)
• Freedom from torture (article 15)
• Freedom from exploitation, violence and abuse (article 16)

  1. National: e.g. UK Equalities Act (2010)
    • equal treatment in access to employment, private and public
    services, regardless of the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex, and sexual orientation
    • Definition of disability - A person is disabled if s/he has a physical or mental impairment and the impairment has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities
    • Health and social care services covered by the laws under the Equality Act 2010 including NHS providers, day centres/nursing homes, NHS commissioners
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8
Q

Why do disabled people live in more disadvantaged circumstances than non-disabled people?

A
  1. Employment
    – Significantly less likely to be in employment (46.3% compared to
    76.4% of non-disabled people of working age)
    – More likely to experience discrimination at work (19% compared
    to 15% of non-disabled people)
  2. More likely to experience poverty than other people:
    – Households with at least one disabled member:19% compared to 15%
  3. Education: 3 times as likely to have no qualifications than non-disabled people
  4. Over a quarter of disabled people say they do not frequently have choice and control over their daily lives
  5. Accessing goods and services: a third report difficulties
  6. More likely to experience poor health outcomes eg people with learning disabilities (see Phase 2)
  7. Accessing health services can be challenging
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9
Q

What language should you use in relation to disabled people?

A
  1. Avoid terms like ‘the disabled’ and describing people by their impairment/condition
  2. Use positive not negative language
    a. ‘Experiences’ rather than ‘suffers from’
    b. ‘Wheelchair user’ rather than ‘confined to a wheelchair’
  3. Avoid common phrases that have negative associations with impairments eg ‘blind drunk’, ‘deaf to pleas’, ‘mad as a hatter’
  4. Use words that respect disabled people as active individuals
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10
Q

what are the health disadvantages of not being in work?

A
  1. poorer physical health - More likely to die sooner
  2. poorer mental health
  3. more medical care
  4. poorer social integration
  5. loss of self-confidence
  6. less monetary resources
  7. effect on next generation - child deaths from injury correlate with
    low employment status and worklessness of parents
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11
Q

What are the costs of sickness absence?

A
  • State: £15 billion – sickness benefits, healthcare costs, loss of tax
  • Employers: £9 billion – sick pay and other costs
  • Employees: £4 billion – lose earnings
  • Overall costs to economy: £100 billion
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12
Q

What is the changing demography of the workplace?

A
  1. State pension age adults is decreasing
  2. Working-age adults increasing
  3. Hence, all people working is up by 1.4 million between 2005/06 to
    2015/16
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13
Q

What is the definition of occupational health?

A

ILO/WHO definition:
- Promotion and maintenance of the highest degree of physical,
mental and social well-being of workers in all occupations;
- Prevention of work-related ill-health;
- Placing and maintenance of the worker in an occupational
environment adapted to his physiological and psychological
capabilities;
- “the adaptation of work to man and of each man to his job”

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14
Q

Define hazard, risk and risk assessment

A

Hazard
something that might cause harm

Risk
the likelihood of that harm actually occurring

Risk assessment
1. Identify hazard
2. Assess the risks - to health
3. Manage/control the risks
e.g. attending a rock concert;
potential hazard - noise,
one concert only – risk of harm from noise is low
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15
Q

What are the main categories of work-related ill-health

A

Previously

  1. Accidents
  2. Poisoning
  3. Muscoskeletal

Current

  1. Mental health – depression, anxiety
  2. Muscoskeletal – skin, respiratory, infection
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16
Q

Name the different types of healthcare exposures and give examples of each

A

Biological
Infectious agents from patients

Chemical

  1. Aldehydes
  2. Anaesthetic agents
  3. Antineoplastic drugs
  4. latex

Psychosocial

  1. Working Hours/Shift Systems
  2. Organisational Hierarchy
  3. Bullying
  4. Under-stimulation/Over-stimulation
  5. Commuting
  6. “Stress”
  7. Convicted of manslaughter
  8. Erased by the GMC
17
Q

What are the risks from a needle stick injury?

A

Hep B – 1 in 3
Hep C – 1 in 30
HIV – 1 in 300

18
Q

What are the causes of occupational neck and upper limb disorders?

A
  1. Shoulder pain
  2. Epicondylitis
  3. Tenosynovitis
  4. Non-specific diffuse forearm pain
  5. Carpal Tunnel Syndrome – e.g due to prolonged and extreme wrist
    flexion
19
Q

What are the causes of occupational asthma?

A
  1. Carpenters – wood dust
  2. Electronic soldering – rosin
  3. Bakers – flour and enzymes
  4. Isocyanates, paint sprayers, polyurethane foam, glues and laminates
20
Q

What are the causes of occupational back pain?

A
  1. Fear of re-injury
  2. High physical demand job
  3. Low expectation of return to work
  4. Low job satisfaction
  5. Low support
  6. Lack of adjustments
  7. Poor communication
21
Q

How do you take an occupational history?

A

Current job(s):
1. What is your job?
2. What do you do in your job?
i. What tasks do you do?
ii. What are you exposed to?
 Chemicals, vapours, gases, dusts, fumes, noise, vibration etc
3. How long have you been doing this job?
4. Have you been told that anything you use at work may make you ill?
5. Has anyone at work had the same symptoms
6. Do you have any other jobs?

Previous jobs:
7. Have you done any different kinds of work in the past? 8. What were you exposed to?

Other

  1. Domestic exposure to work agents
  2. Do you have hobbies e.g. DIY or gardening that may bring you into contact with chemicals
22
Q

What is a fit note?

A
  1. provide certification for statutory sick pay.
  2. play a key role in advising patients about (return to) work;
  3. help patients develop a return-to-work plan
  4. facilitate return to work through communication with patients and
    employers
23
Q

What factors may facilitate a return to work?

A
  1. Amended duties - activities to be avoided?
  2. Altered hours - changes to the times or duration of work
  3. A phased return to work - a gradual increase in work duties or hours
  4. Workplace adaptations - changing aspects of the workplace
24
Q

What is the role of occupational health services?

A
  1. Providing independent and impartial advice to both the employer and the employee
  2. Investigating and diagnosing those who are sick or injured due to their work
  3. Assisting the return of the sick and injured to work at the earliest opportunity
  4. Matching people with jobs appropriate to their health, fitness and susceptibility status
25
Q

What is the role of a Health and Safety Executive?

A
  1. Shaping and reviewing regulations
  2. Producing research and statistics
  3. Enforcing the law
26
Q

What is involved in the Access to Work Scheme (DWP) (for workers with a disability or health condition)

A
  1. special aids and equipment
  2. adaptations to equipment
  3. travel to work
  4. travel in work
  5. Mental Health Support Service
27
Q

What is the Improving Lives 2017 (white paper)?

A
  1. Disability employment gap
    a. Support for disabled in work and out of work
  2. 1 in 3 working age have a long-term health condition which puts their participation in work at risk.
    a. Give them timely and appropriate health and employment support
  3. Join up
    a. The welfare system
    b. The workplace
    c. Healthcare
  4. Support for those who need it – whatever their health condition
28
Q

What are the key functions of a systematic review?

A
  1. Synthesise the evidence
  2. Understand heterogeneity in treatment effect
  3. Set the research and practice agenda
29
Q

Why are systematic reviews useful/important?

A
  1. To help identify which forms of healthcare work, which do not, and which are even harmful
  2. Results from similar randomized trials are brought together (synthesized)
  3. This combination of trials needs to be done in a reliable way (systematically)
  4. A systematic review uses a predefined, explicit methodology
  5. The methods include steps to minimize bias in all parts of the process
30
Q

Define systematic review

A

A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review.

31
Q

Define meta-analysis

A
  • If the results of the individual studies are combined to produce an overall statistic, this is usually called a meta-analysis
  • Requires statistical packages to conduct the analysis (STATA, RevMan)
  • However, it will be subject to any biases that arise from the study
    selection process, and may produce a mathematically precise, but clinically misleading, result
32
Q

What is the hierarchy of evidence?

A
systematic reviews
Randomised control trials
Cohort studies
Case-control studies
Case series, case reports
Editorials, expert opinion
33
Q

What are the key stages in a systematic review?

A
  1. defining the question
    - PICO (population, intervention, comparator, outcomes, study design)
  2. the use of a Protocol
     Search strategy: sources, terms, limits
     Inclusion/exclusion criteria: linked to research question & aims
     Data extraction: linked to research question & aims
     Risk of bias assessment: suitable tool; inform analysis &
    interpretation
     Analysis/synthesis plan: quantitative, qualitative, both
     Presentation and interpretation (GRADE)
  3. defining the search for studies – where to search e.g. MEDLINE, search terms, search techniques e.g. free text searching
  4. study selection (and display it on a PRISMA flowchart)
     identification  screening
     eligibility
     included studies
  5. Quality assessment of the included studies –
     Suitable tool; inform analysis & interpretation  GRADE
  6. synthesis of the results
     Narrative analysis: walk us through the trials, note similarities
    and differences, narrate the evidence for outcomes
     Meta-analysis: pool the study effects together, look for
    heterogeneity, interpret what the studies collectively are telling
    us
  7. test for heterogeneity – I2 used - The percentage of variation
    between studies in this meta-analysis is due to differences between studies and not just sampling error
34
Q

Give some examples of where you could search for systematic reviews

A

Medline, Psychinfo

35
Q

What does PICO stand for?

A

Population
Intervention
Comparison
Outcome

36
Q

Describe what each thing in a Forest plot means

A

The y-axis is usually an alphabetical list of the studies

The x-axis is usually the Odds Ratio (OR), typically as a logarithmic scale

The vertical line represents an OR of 1 ie. “no effect”

The position of the square is a point estimate of the odds ratio (OR).

The size of the square represents the weight of the study according to the weighing rules of the meta-analysis, likely representing the sample size and statistical power.

The diamond represents the combined results of the trial. The results have statistical significance if the combined results do not cross the vertical “line of no effect”

37
Q

How do you read a funnel plot?

A

Plots the effect size against the sample size of the study.

To study a funnel plot, look at its lower left corner, that’s where negative or null studies are located.

Note that if the corner is not empty, this does not mean you can rule out publication bias.

38
Q

Where can there be bias in systematic reviews?

A
  1. Publication bias
  2. Duplicate (multiple) publication bias
  3. Language bias
  4. Outcome reporting bias
  5. Citation bias