Deck 15 Flashcards
What is the health belief model?
The health belief model is a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model suggests that people’s beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health-promoting behaviour. The following constructs are thought to vary between people and effect health uptake: Percieved safety: o Subjective assessment of health probkem and consequences of it o People who perceive the same problem to be more serious are more likely to seek treatment o Most people perceive flu to be relatively safe but a person who can’t afford to miss a few days off work may seek help Perceived susceptibility: o Subjective assessment of likelihood of developing a condition o Individuals w/ low perceived susceptibility are more likely to deny that they are at risk o More likely to be involved in high risk behaviour The above 2 combine to give perceived threat, this model states that those with higher perceived threat are more likely to engage in help seeking behaviour Perceived benefits: o An individual self assessment of the value of a procedure o E.g individuals who believe sun cream helps prevent skin cancer are more likely to sue it Perceived barriers: o An individual assessment of obstacles in the way of treatment or change o E.g. side effects / pain / emotions o E.g. not getting a flu shot because of perceived pain on injection Individual characteristics, including demographic, psychosocial, and structural variables, can affect perceptions (i.e., perceived seriousness, susceptibility, benefits, and barriers) of health-related behaviours. Demographic variables include age, sex, race, ethnicity, and education, among others. Psychosocial variables include personality, social class, and peer and reference group pressure, among others
What are guidelines?
Guidelines, as defined by the institute of Medicine, are: ‘systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances’
What are clinical guidelines?
From the clinicians perspective, clinical guidelines: Care to be more consistent To be more evidence based Close the gap between what clinicians do and what is supported by evidence Assist, not dictate Effect of Adherence to Practice Guidelines • Adherence to aspects of the guideline relating to diagnosis and first treatment was good • Adherence to aspects of the guideline relating to adjustment of treatment for patients who did not respond to treatment was poor • Greater adherence to practice guidelines significantly predicted fewer depressive symptoms Non adherence can be due to many reasons: Lack of knowledge of the guideline Conflicting guidelines for patients with multiple morbidities Rapidly developing area of medicine (out of date guidelines) Failure to understand or agree with responsibility for using the guideline Development of Guidelines • Development should be systematic • Use a formal and explicit process • Address relevant clinical questions • Use the best evidence to address each question
What is a systematic review?
Where possible, each clinical question answered in a guideline should be based on the results of a systematic review. A review that evaluates and interprets all available research evidence relevant to a particular question. - written by experts in a field - Work is described and summarised - May not be a reliable summary of the field. - May reflect the views of the author. - Unclear to the reader whether the review is objective or not - It addresses a specific question - Aims to be rigorous, comprehensive and explicit - Uses systematic models.
What are the processes of creating a systematic review?
o Well formulated question Population, Intervention, Comparator(s), Outcomes, Study Designs (PICOS) These comprise the inclusion criteria for the review (only studies that meet these criteria are included) o Comprehensive data search Aim is to collect all of the relevant studies Search all DBs, using appropriate search strategy o Unbiased selection and abstraction process Validity refers to the systematic methods used to minimise bias Clear inclusion data Good strategy for lit searching Selection of studies performed in duplicate by two reviewers Assessing quality of studies included (in duplicate) (randomised? Allocation concealed? Blinding?) Data extraction performed according to a template o Critical appraisal of data o Synthesis of data Descriptive Quantitative Heterogeneity (clinical diversity or statistical heterogeneity) Sensitivity analyses Publication bias o Objective interpretation of findings Is the review question correct Are the searches adequate Is the quality of included studies acceptable Is there a risk of publication and related bias
What are the levels of evidence?
Guidelines should be…
- based on a systematic review
- be developed by a knowledgable, multidisciplinary panel of experts and representative from key affected groups.
- Consider important patient subgroups and patient preferences.
- Be based on an explicit and transparent process that minimises distortion, biases and conflicts of interest.
- Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of reccomendations.
- be reconsidered and revised when important new evidence warrants modifications of reccomendations.
What are the domains for developing the quality of a guideline?
- Editorial independence
- Applicability
- Clarity of presentation
- Rigour of development
- Stakeholder involvement
- Scope and purpose.
What are the social challenges and consequences of being homosexual?
Challenges
Doctors feel sexuality should be discussed elsewhere
Lack confidence / fear enquiries will only lead to embarrassment
Difficulties around disclosure – 41-44% of gay men have not disclosed
Lack of gay men’s trust in GP (Scott 1998)
Confidentiality issues about how information is used e.g. reports to financial institutions or
employers
Fear of negative response from GP/Staff
Consequences
Missed opportunities for interventions around risk behaviours e.g. HIV/STIs
Gay men feel there is a ‘homosceptic’ environment (Cant 1999) & that gay sexuality is
distinct from experiences of health, illness & well-being
Lack of opportunities to discuss many health issues
Resulting in unequal access to quality health care
which can increase stress, limit social support, and negatively affect health
Affect MSM’s ability to establish and maintain long-term same-sex relationships that reduce
HIV & STD risk
Homophobia and stigma persist in the United States even though acceptance of same-sex relationships has been steadily increasing. For example, a Gallup poll conducted in May 2010 found that more than half (52%) of Americans believed that gay and lesbian relationships were acceptable. Forty-three percent of Americans believed that gay and lesbian relationships are not morally acceptable.
The effects of homophobia, stigma and discrimination can be especially hard on adolescents and young adults. Young MSM and other sexual minorities are at increased risk of being bullied in school. They are also at risk of being rejected by their families and, as a result, are at increased risk of homelessness. A study published in 2009 compared gay, lesbian, and bisexual young adults who experienced strong rejection from their families with their peers who had more supportive families. The researchers found that those who experienced stronger rejection were:
8.4 times more likely to have tried to commit suicide
5.9 times more likely to report high levels of depression
3.4 times more likely to use illegal drugs
3.4 times more likely to have risky sex
What is normal sexual behaviour?
How Often? According to the National Opinion Research Center, people aged 18 to 29 have sex about 84 times
a year. In their 40s, most people drop off to 63 times a year, and by age 70 and up, it’s about 10 times.
Sexual Repertoire. The National Survey of Sexual Health and Behavior (NSSHB) revealed that Americans between the ages of 14 and 94 have quite a repertoire. It’s almost never about just one sex act. In fact, survey respondents reported more than 40 combinations of sex acts. Vaginal intercourse is the most common behavior, but oral sex and/or partnered masturbation are also popular.
Condom Use. According to NSSHB, vaginal intercourse is condom-protected 25 percent of the time in the U.S., and 33 percent of the time among single people in the U.S. They also found that black and Hispanic Americans have a higher rate of condom use than whites and other groups. The lowest rate of condom use is among people over age 40
Orgasm. Approximately 85 percent of men say their partner had an orgasm the last time they had sex. Only 64 percent of women say they had an orgasm.
For men, vaginal intercourse is the most common way to orgasm.
Women orgasm more often when oral sex or some other stimulation is included. According to Harvard Medical School, a norm for female sexual response is qualitative and difficult to measure
How many people identify as LGBT?
Orientation. Approximately seven percent of females and eight percent of males identify themselves as gay, lesbian, or bisexual, according to the NSSHB. However, the number of people who say they’ve had sexual relations with someone of the same gender is higher than that.
Explain the pattern of sexual understanding in children/teens/young adults.
Sexual Development in Children. From birth to five years of age, curious children explore their own bodies. By five years, most children ask questions about body parts and functions, gender differences, and where babies come from. From six to 10 years of age, children become modest about their bodies and more curious about adult sexuality. They begin talking about sex with their peers and engage in some form of masturbation. With the onset of puberty at 11 or 12 years, children become aware of sexual desires.
Teen Sex. Despite all the talk to the contrary, most teenagers are not having frequent sex. The NSSHB survey asked 17-year-old males if they’d had sex in the previous year. Forty percent said they had, but only 27 percent said they had in the previous three months. According to The Kinsey Institute, by the time we reach our late teens, about 75 percent of us have had intercourse at least once.
Older people. According to a study commissioned by AARP, people over age 45 say sexual activity is a very important part of their lives and has a direct impact on quality of life. About half of all study participants reported having sexual intercourse at least once a week. They also enjoy touching, caressing, and hugging. They like sex and say they would not be pleased to give it up.
Fetishes. Lots of people are reluctant to talk candidly about their sexual activities. That’s why real numbers are hard to come by. Suffice it to say that a fair number of us indulge in other sexual behaviors, including:
erotic fantasy and/or role playing
pornography
bondage, domination, and submission
anal sex
What is a systematic review?
A systematic review (also systematic literature review or structured literature review, SLR) is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high- quality randomized controlled trials are crucial to evidence-based medicine
Explain a forest plot.
Although forest plots can take several forms, they are commonly presented with two columns. The left-hand column lists the names of the studies (frequently randomized controlled trials or epidemiological studies), commonly in chronological order from the top downwards. The right-hand column is a plot of the measure of effect (e.g. an odds ratio) for each of these studies (often represented by a square) incorporating confidence intervals represented by horizontal lines. The graph may be plotted on a natural logarithmic scale when using odds ratios or other ratio-based effect measures, so that the confidence intervals are symmetrical about the means from each study and to ensure undue emphasis is not given to odds ratios greater than 1 when compared to those less than 1. The area of each square is proportional to the study’s weight in the meta-analysis. The overall meta-analysed measure of effect is often represented on the plot as a dashed vertical line. This meta-analysed measure of effect is commonly plotted as a diamond, the lateral points of which indicate confidence intervals for this estimate.
A vertical line representing no effect is also plotted. If the confidence intervals for individual studies overlap with this line, it demonstrates that at the given level of confidence their effect sizes do not differ from no effect for the individual study. The same applies for the meta- analysed measure of effect: if the points of the diamond overlap the line of no effect the overall meta-analysed result cannot be said to differ from no effect at the given level of confidence.
What is the GMC guidelines on dealing with children in medical practice?
You should involve young people and children as much as possible in discussions about their case, even if they are not able to make decisions.
A young person’s ability to make decisions depends more on their ability to understand and weigh up options, than on thier age.
There are three main legal areas that govern the legal rights of children and protect their interests.
- The children act 1989
- Family reform act 1969
Common Law: Gillick vs West Norfolk and Wisbech Area Health Authority
