Health and Society Flashcards

Question

What is it called when research is done into a condition more because it is rare and only found in a particular ethnic group, than because it is a significant burden on the population?

Answer 1

Ethnocentricity.

Answer 2

If tests are based on ethnicity, people may be stigmatised. Promoted the impression that ethnic minorities are sicker and are bringing disease into the country. There could be resentment against resources being directed towards ethnic minorities. If the screening programs are only run in regions with a high population of ethnic minority groups, is it fair for people living elsewhere who are still at risk to miss out?

Answer 3

More carriers will be found so the program will be more cost-effective.

Answer 4

It describes an approach where the focus is on factors that support human health and wellbeing rather than factors that cause disease (e.g bacteria).

Answer 5

Epidemiological transition.

Answer 6

Biological (genetics), social and economic (employment, education, housing), environmental (transport, pollution, water), lifestyle (diet...), access to health services, social class, country you live in.

Answer 7

Social and environmental interventions that enable people to increase control over, and improve, their health.

Answer 8

1) Healthy public policy - consider the consequences on health of all political policies. 2) Supportive environments - create environments that are easy to be healthy in (e.g cycle paths). 3) Community action e.g food banks. 4) Personal skills e.g cooking. 5) Reorienting health services - divert resources from tertiary care to primary care and primary prevention.

Answer 9

Facilitating voluntary actions conductive to health, providing advice and information to encourage people to improve health.

Answer 10

Legislation (from the Health Protection Agency) to control infectious disease outbreaks and improve public health (e.g smoking ban, seat belts).

Answer 11

Primary prevention prevents the onset of disease (e.g through immunisation, screening for risk factors, health promotion). Secondary prevention detects disease at an early onset, so treatment is more effective (e.g cancer screening). Tertiary prevention manages disease to alleviate symptoms and minimise the effects on life, but the disease progression is already established.

Answer 12

Health persuasion, legislative action, community development, personal counselling.

Answer 13

Authoritative intervention ("top down").

Answer 14

Collective focus.

Answer 15

Negotiated intervention ("bottom up").

Answer 16

Individual focus.

Answer 17

Media campaigns e.g "5 a day".

Answer 18

Smoking ban, seat belts, water fluoridation.

Answer 19

Food banks.

Answer 20

Opportunistic prevention during consultations.

Answer 21

Resources are limited, so diverting resources upstream seems unfair. Think about the opportunity cost.

Answer 22

There is an opportunity cost from diverting resources from tertiary care to primary prevention. It's difficult to get evidence of the effects of health promotion as the effects are more long-term, the outcomes are difficult to measure, and it is hard to control for different influences. There is a fine balance between individual freedom (autonomy) and social control.

Answer 23

There is limited time during a consultation. The patient may not be receptive. You must respect the patient and listen to their views. Preaching and paternalism must be avoided. It must be treated as part of a long term relationship.

Answer 24

Preventative measures which bring a lot of benefit to the population, provide very little benefit to the individual (e.g minimum pricing of alcohol).

Answer 25

Providing individual advice and support. Getting involved in organisations. Lobbying governments.

Answer 26

Differences in people's health linked to social inequalities.

Answer 27

Social gradient.

Answer 28

Measuring education, occupation status, housing tenure, looking at the Index of Multiple Deprivation (IMD).

Answer 29

Overall mortality has a social gradient, as the smaller killers have little impact on overall mortality.

Answer 30

TIME - even when there is an epidemiological transition and the major killer shifts, as it becomes more common a social gradient will emerge. PLACE - USA and UK have similar social gradients.

Answer 31

1) A statistical artefact (not real) 2) People's health drives social class (ill health pushes people into poverty) = health selection 3) There are differences in health behaviour - ill health is caused by lifestyle factors determined by social factors. 4) There are broader social inequalities in people's lives - social inequalities are material and structural

Answer 32

Structural inequalities are the position in the social structure into which people are born, and this is influenced by things like parent's occupations. Material inequalities are the everyday environments and living and working conditions people experience. Structural influences material conditions.

Answer 33

STRUCTURAL inequalities (a person's position in society from birth and throughout life) influence MATERIAL conditions and behavioural risk factors, which influences HEALTH, which in turn influences STRUCTURAL position again.

Answer 34

Childhood is an important period as you have rapid development and heightened sensitivity. Environmental differences can become hard-wired (epigenetics). Biological and psychosocial impact is greater in childhood.

Answer 35

Disabilities, premature birth, death. Poor nutrition. Difficulties of family change (e.g parental divorce, unemployment, illness, financial stress).

Answer 36

Leaving school early, without qualifications. | Smoking, drinking, being physically inactive.

Answer 37

Poor physical health (BMI, diastolic blood pressure). Increased mortality and morbidity. Financial stress from job insecurity etc.

Answer 38

How people tell you what's wrong with them, which depends on their interpretation (illness cognition).

Answer 39

Allopathic (western) medicine, lay medicine (ask friends, family, internet), complementary therapists (osteopaths, acupuncture). Together they lead to medical pluralism.

Answer 40

Defining an increasing number of life's problems as medical problems (e.g grief, sexuality, childbirth).

Answer 41

Transformation of human condition/capabilities into opportunities for pharmacological intervention.

Answer 42

Chaos - they feel they can't control their life already and this is just another thing they can't control so they don't even what a choice in it and just want you to make the choices. Restitution - they just want their life to get back to the way it was Quest - want to know what the cause is, and what they can change in their life to improve it. They seek complementary therapies and information from many different sources

Answer 43

``` Advantage = potentially reduces pressure on primary care services Disadvantage = can lead to a delay in diagnosis and treatment leading to worse outcomes, so could actually increase the pressure on primary care/A+E ```

Answer 44

A cumulative deposit of knowledge, experience, belief, values, attitudes, meanings, material objects, possessions, acquired by a group of people.

Answer 45

Learning from just the single knowledge base of your culture - as if learning a list of facts (simple learning).

Answer 46

Learning from lots of different sources alongside your own culture, picking up tips and snippets (complex learning). This is how patients transmit knowledge gathered from google and lay referral systems and put their own interpretation on it.

Answer 47

Using pharmacology and interventions to treat or suppress symptoms or disease.

Answer 48

Complementary therapy focusses on wellbeing, and has high contact time but is less invasive. There is a shorter wait for an appointment, and it costs less but is less effective. It is difficult to test the effectiveness, but it is regulated (General Chiropractic Council, General Osteopathic Council). Allopathic medicine is more focussed on the biomedical side of disease, it is more high tech and more scientific and evidence based. It is highly regulated.

Answer 49

They don't want to have to wait to see the consultant. They have experienced a poor doctor-patient relationship. They don't believe in the science, it may be against their religious views. They have had experience of iatrogenic medicine (illness caused by medical examination or treatment). They are desperate. They want something non-invasive.

Answer 50

Allevating symptoms (e.g back pain), not diagnosis.

Answer 51

The person's gender, culture, language, whether the patient sometimes distress (e.g saying they have a stomach ache, but the cause is depression).

Answer 52

Poor communication.

Answer 53

It improves the doctor-patient relationship. It increases the likelihood of the patient sticking to treatment. It is realistic.

Answer 54

Principles: 1) Explore the patient's main reason for the visit, their concerns, and need for information. 2) Seek an integrated understanding of the patient's world - their whole person, emotional needs, and life issues. 3) Find common ground with the patient on what the problem is, and mutually agree on management. Outcomes: 1) Enhances prevention and health promotion. 2) Enhances the continuing relationship between the patient and the doctor. 3) Is realistic.

Answer 55

Determining the nature of a disorder by considering a patient's signs and symptoms, results of lab tests, and medical imaging. It is not directly therapeutic.

Answer 56

Assessment of the future course and outcome of a patient's disease.

Answer 57

Results of rigorous clinical trials and observational studies that can influence clinical decision making.

Answer 58

Normative - what should you be doing according to social and professional norms? Descriptive - what are you doing? Prescriptive - how can we improve what we're doing?

Answer 59

Odds are the probability of the thing occurring over the probability it doesn't. The odds that an outcome will occur with an intervention, compared to the odds it will occur without an intervention.

Answer 60

The risk with an intervention over the risk without an intervention. If it is greater than one then the risk with the intervention is greater than the risk without the intervention. If it is less than one then the risk without the intervention is greater than the risk with the intervention.

Answer 61

``` Advantages = descriptive, gives representation of population, describes the situation at present, can estimate prevalence, can choose sample size to fit question Disadvantages = difficult to establish causal relationship because it's not across a time period, can't estimate absolute risk, sometimes not representative of the population as a whole, doesn't answer the question "why". ```

Answer 62

``` Advantages = gives an alternative to experimental study which would be unethical if intervention was harmful, can sometimes be done historically if data was collected, can be used to estimate incidence. Disadvantages = other variables in the population can't be controlled so the causal relationship is not as certain, the study has a long duration to get results, the disease studied needs to be common. ```

Answer 63

``` Advantages = it is easy to allocate people to either group, it is faster than a cohort study, it can be used even for rare diseases, can be used to estimate odds ratio. Disadvantages = other variables can't be controlled, reliable past data is needed. ```

Answer 64

Hypothetico-deductive model, which means forming a hypothesis then seeking evidence to disprove it (starting with Cue Acquisition from the patient's history, then Hypothesis Formation, Cue Interpretation, Hypothesis Evaluation). Senior clinicians use Pattern Matching (having seen a similar patient before).

Answer 65

The ability to select and use medication to treat self recognised illnesses and symptoms. It is part of self care, which is important because it reduces demand on health services.

Answer 66

Pharmacy medicines - taken under supervision of pharmacist. General sales list medicines - purchased from a lockable premise. Herbal medicines. Vitamins, minerals, food supplements. Illicit drugs, alcohol.

Answer 67

``` From doctors in GP, hospital, private clinic, clinical trial. Pharmacy. Lockable shop e.g supermarket. Health food shop. Internet. Black market. ```

Answer 68

Medicines and Healthcare Products Regulatory Agency (MHRA).

Answer 69

POM - prescription only medicine. P medicine - can be bought without prescription but only in a pharmacy under the supervision of a pharmacist. GSL - general sales list medicine, sold in general retail outlets without pharmacist supervision.

Answer 70

POM (prescription only medication).

Answer 71

Unlikely to be a direct or indirect danger to human health Generally used correctly, not normally preconceived as injection Not contain substances whose activity or side effects require further investigation

Answer 72

Can reasonably be sold or supplied not under supervision of pharmacist Safe for self-selection

Answer 73

Only a smaller dose of the medication may be licences for over the counter not prescription. Or it may have a certain age limit below which you need a prescription to buy it.

Answer 74

Minor ailments schemes (supporting and encouraging responsible self care) Emergency contraception and sexual health Medicine use review (having a discussion with the patient and maintaining adherence to medication) New medicine service (answering patient questions about medication) Health education and promotion Ensuring patient safety

Answer 75

Prevent adverse drug interactions (e.g with St. John's wort) | Prevent abuse of OTC medication e.g co-codamol (which contains codeine and paracetamol)

Answer 76

Reluctant to take any pill Don't think twice about taking mild analgesics Want to let the pain run its course

Answer 77

Perceived effectiveness Familiarity with brand name Perceived safety

Answer 78

Quantitative - a numerical value that can be continuous or discontinuous Qualitative - people's perspectives

Answer 79

A choice between two categories

Answer 80

Interval - quantitative discrete or quantitative continuous Ordinal - qualitative where there are more than two categories and they have a logical order Nominal - qualitative where there are more than 2 categories but they have no logical order

Answer 81

Descriptive analysis - organise, summarise, and describe the data using graphs etc Correlational analysis - find relationships in the data Inferential analysis - use statistics and relationships to make generalisations about a population

Answer 82

The point that is 1 standard deviation from the mean.

Answer 83

68% within 1 standard deviation | 95% within 2 standard deviations

Answer 84

Normal = mean, median and mode at the midpoint | Positively skewed = mode median > mean

Answer 85

Make it a semi-log plot

Answer 86

``` Null hypothesis (H0) says that no significant difference between the groups exists. Alternative hypothesis (H1) says there is a significant difference between the populations. ```

Answer 87

P-value is the probability that the difference between the populations would be seen if the null hypothesis was true P

Answer 88

Type 1 error means rejecting the null hypothesis when you should have kept it. Type 2 error means keeping the null hypothesis when you should have rejected it (the probability of which is measured by Statistical Power).

Answer 89

Increase the sample size.

Answer 90

Statistical significance is shown by a p value

Answer 91

Descriptive (a survey, case report, case series - no control is used and you only look at a point in time) Analytical (seeks to answer question "why", uses a control and is over a period of time, can be experimental or observational)

Answer 92

Cross-sectional study Cohort study Case control study Randomised controlled trial

Answer 93

Ethical issues are raised if the intervention is harmful (no equipoise), because you can't knowingly allocate people a harmful intervention.

Answer 94

Systematic review of randomised controlled trial Randomised controlled trial Systematic review of observational studies Observational study Physiological study Unsystematic clinical observations

Answer 95

Systematic error = something wrong with the measuring instrument or it is wrongly used by experimentor Random error = error in experimental measures due to unknown cause of unpredictable changes on environment or measuring instrument

Answer 96

Not divulging patient information to others without the patient's consent.

Answer 97

It is a legal (human rights act) and professional (GMC) requirement. It establishes and maintains trust so the patient feels able to divulge all relevant information to the doctor. It ensures information is not obtained by people who would use the information to cause the patient harm. It respects patient autonomy, the patient has control over their personal information. Trustworthiness is part of being a virtuous doctor -acting with honesty and integrity You must never abuse the patient's trust in you or the public's trust in the profession.

Answer 98

Sharing information with people directly involved in the care of the patient Sharing information after obtaining the patient's informed consent

Answer 99

Inform the patient of what you are going to do.

Answer 100

Non-disclosure puts the wider community at risk e.g patient refuses to disclose that they are HIV+ to partner The patient is at risk of harm and lacks capacity (e.g child who is the victim of abuse) A court order demands the confidentiality breach It is not practical to seek patient consent

Answer 101

Use anonymised information if practical Get patient's informed consent Disclose the minimum amount of information necessary Keep up to date with and observe common legal requirements

Answer 102

Medical model - the person's disability is caused by their impairment, which needs to be treated and fixed. This can lead to exclusion from society Social model - the disabled person is only at a disadvantage because of the discriminatory way society is organised, and the barriers of assumption stereotype and prejudice A compromise can be found between the theories by embodiment - the spare spect for the individualism of each person's situation (biopsychosocial model)

Answer 103

Shows disability as an individual tragedy, rather than in a community context Doesn't account for social barriers causing difficulty for disabled people Shows disability as something that needs to be cured by doctors - paternalistic

Answer 104

``` Aspires to idyllic society where impairments cause individuals no problems - can't exist Doesn't recognise the complexity in disabled people's lives, developed on,y for white middle class men with spinal injuries Some people may see disability as a type of social oppression imposed on people with impairments, which restricts their activity and undermines their psychoemotional wellbeing ```

Answer 105

A disabled person is someone with a physical or mental impairment which had a substantial and long term negative effect of their ability to carry out normal daily activities.

Answer 106

Disability only applies to those who are externally defined as disabled, or self identify as disabled (not some deaf people).

Answer 107

The probability an event will occur within a specified time (not necessarily a bad thing).

Answer 108

Natural frequency e.g 1 in 84 Probability (decimal) Percentage

Answer 109

Absolute risk is the risk of you developing an illness over a certain period of time, relative risk compares the risk in different groups (e.g risk ratios and odds ratios).

Answer 110

Risk with intervention - risk without intervention

Answer 111

Odds ratio > 1 means the control is better than intervention Odds ratio = 1 means there is no difference Odds ratio

Answer 112

When outcomes are rare the odds ratio and risk ratio are identical. When outcomes are common the odds ratio is greater than the risk ratio.

Answer 113

``` If the risk is: Voluntary Controllable Familiar Non-catastrophic Fair (e.g higher risk for more benefit) ```

Answer 114

``` If the risk is: Uncontrollable Potentially catastrophic There is dread The benefit does not increase with the risk Unknown Unobservable Unfamiliar ```

Answer 115

It would undermine the altruism Erode sense of community Sanction profits in hospitals and clinics, and so subject medicine to market place rule Increase blood supply from poor, unskilled, unemployed, so increase infection risks

Answer 116

8-10 pints in a person, can survive losing 2-3 pints if given saline and iron tablets.

Answer 117

Publicly funded.

Answer 118

Blood is no different from any other tradeable product Financial incentives would increase the supply of blood You could offer direct payment, or exemption from payment for blood used in future

Answer 119

``` Kidney Liver Lung Cornea Heart Heart and lungs ```

Answer 120

Placed on dialysis - more expensive than transplant in the long term. Haemodialysis = £35,000 per patient per year Continuous ambulatory peritoneal dialysis (CAPD) = £17,500 per patient per year Transplant = £17,000 then £5,000 a year for immunosuppressive drugs Transplant is more cost effective and provides better quality of life to patient.

Answer 121

Give people who are on the donor list precedence to receive a transplant. Use an opt-out policy - relatives permission doesn't need to be given to obtain organs. Have transplant coordinators in hospitals to talk to patient's and quickly but sensitively obtain a decision on loved one's organs. Use financial incentives.

Answer 122

Can lead to corrupt doctors harvesting organs then selling them on to make profit. Chinese criminals who receive the death penalty have their organs harvested, but is this injustice? Can lead to desperate people selling organs and greatly harming their own health.

Answer 123

He says people have the right to do what they want with their own body, and doctors only stand in the way because they find commerce "ethically offensive".

Answer 124

The study of the distribution of the determinants of health-related states and events in populations, and the application of this to the control of health problems.

Answer 125

The number of new cases in a particular time period, as a proportion of the at-risk population. Technically a measure of rate. In a dynamic population the denominator will change so you need to use "person-time incidence rates"

Answer 126

The number of people with the disease at a particular time, as a proportion of the whole population.

Answer 127

A large proportion of the symptoms people experience (85%) don't result in a consultation with a health professional.

Answer 128

How people perceive, evaluate, and act upon their symptoms.

Answer 129

Age, gender, social class, race, culture.

Answer 130

The co-existence of deferentially designed and conceived medical traditions and systems (e.g allopathic Western medicine, homeopathy, acupuncture, herbalism).

Answer 131

Consulting other people about your symptoms before going to see the GP e.g relatives, friends, pharmacist, NHS Direct, Internet.

Answer 132

``` Interference with work or physical activity Interference with social relations Interpersonal crisis Putting a time limit on symptoms Sanctioning ```

Answer 133

Patients have as access much access to the evidence base of medicine as doctors.

Answer 134

They can check symptoms warrant medical attention Gives patients confidence to ask questions Patients can clarify doctor's advice Patients can access social support Allows patients self management and a feeling of being in control over illness Patients still rely on and trust doctors Shared decision making (i.e patient cantered care)

Answer 135

The provision and availability of health services The attitudes of staff (e.g receptionists and doctors) The inverse care law Geographical distance from services Difficulties with time and effort taken, loss of earnings, childcare Transport - costs and availability Past bad experiences with health care (iatrogenic) Long waiting times

Answer 136

Someone who, without payment, provides help and support to someone who could not manage without their help. (Informal care is unpaid and not carried out by professionals)

Answer 137

Life expectancy is increasing, but disability free life years is not increasing.

Answer 138

People losing money due to the expense of being a carer (e.g home adjustments, equipment, transport to appointments) and being unable to work.

Answer 139

It reduces bed blocking (patients are able to go home earlier), and it reduces the workload of institutional care.

Answer 140

1 in 10. The majority are women, and over 50.

Answer 141

They may be reluctant to speak out about their role if they think they or their younger siblings might be taken away from their parents care. They have less to gain because they will not get carers allowance if they are under 16 or a full time student.

Answer 142

Provide practical help (food shopping, cooking) Keep an eye on the patient and provide company Provide personal care (washing, dressing, toileting) Give medications Provide physical help (getting in and out of bed - can lead to musculoskeletal injuries without training on how to lift loads properly)

Answer 143

To make them aware of services and support they can access.

Answer 144

Co-resident carers, and elders carers who are likely to already have a health condition of their own.

Answer 145

``` National Carers Strategy 1999 Carer (Equal Opportunities) Act 2004 Equality Act 2010 Carers Strategy refresh November 2010 Carers Act/Children and Families Act 2014 ```

Answer 146

Carers have a right to an assessment of their own needs, even if the patient refuses one. Carers Special Grant provides funding for respite and short breaks for carers (can be difficult if the person they'd want to take a break with is the patient). Carers need to gain awareness of their entitlement to an Assessment and an Independent Advocate. The assessment considers the carer's wishes about employment, training, education, leisure, and the carer's wellbeing.

Answer 147

Caring for more than 35 hours a week Patient already receiving qualifying disability benefit Not under 16 or full time student Amount received is reduced if carer is also earning Other benefits that carers can receive = tax-credits, disability living allowance if they are disabled themselves, attendance allowance for severely disabled people over 65

Answer 148

Working age claimants who live in social housing and need help with their rent are allowed one bedroom per couple, one for two children under ten or two children of the same sex over ten. Any "spare" bedrooms will result in house benefit being cut. This is difficult if the patient has disturbed sleep so carer needs to sleep in separate room, or if a disabled child needs their own room, or if a room is needed to store equipment.

Answer 149

Work and Families Act 2006

Answer 150

Information and advice on services available and how to access them Information on the patient's health needs and treatment Social security benefits Practical and emotional support (e.g training, someone to listen to them) Respite care (e.g short breaks, time to go shopping and know patient is cared for)

Answer 151

Rural carers - transport and practical support Parents of disabled children - help accessing mainstream services Black and ethnic minority carers - culturally sensitive support, language support Young carers - emotional support Young minority carers - contact with social services, and interpretation for the care-receiver

Answer 152

Increasing demand due to longer life expectancy Smaller, more spread out families Changing role of women Raised pension age

Answer 153

A planned experiment involving patients, which determines the most appropriate treatment for future patients with a given medical condition

Answer 154

Phase 1 = healthy volunteers are used to find a safe dose range for the drug, and study the pharmacology, toxicology and side effects (use small groups as this is the first time the drug is given to humans) Phase 2 = initially investigate drug efficacy by giving to patients, screen out any inactive or toxic drugs, show the early outcomes and give a further idea of safety Phase 3 = randomised controlled trial to compare the drug to the current standard Phase 4 = continued monitoring for late adverse effects, long-term follow up

Answer 155

``` Case series (no control group so insufficient evidence to replace current standard) Historical control (potential for selection bias(prognostic index) and performance bias - way outcomes are measured may have changed) Before and after design (potential for regression to the mean leading to type 1 error) Concurrent (non-randomised) control (great potential for selection bias) Solve these problems by having a contemporaneous control group. ```

Answer 156

If a variable is extreme on its first measurement, it will tend to be closer to the mean on its second measurement.

Answer 157

It ensures a balance across comparative groups of known and unknown baseline factors that could affect the outcome.

Answer 158

It means it is not known whether one intervention is beta than another, and it is essential in a randomised controlled trial.

Answer 159

Stratify the baseline factor during the randomisation process.

Answer 160

To balance the cost and difficulty of administering the intervention, as different centres will vary in expertise.

Answer 161

Systematic distortion of the estimated effect of an intervention away from "truth" due to inadequacies in design, conduct or analysis of a trial.

Answer 162

Selection bias - systematic error in allocating the intervention groups so that comparative groups differ in certain baseline factors and with respect to prognosis, or the sample is not representative of the general population. Ascertainment bias - the person assessing the outcome has knowledge of the group allocation (e.g patient or investigator). Performance bias - other than the intervention, there are systematic differences in the care received by comparative patient groups.

Answer 163

They might think the study will be more likely to get published with better results, so put better prognosis patients in intervention group. Might think healthier patients will cope better with the side effects of the intervention so out more of them in that group. Might think sicker patients need the intervention more.

Answer 164

Get the randomisation list to be confidential and dealt with someone not involved in delivering or assessing intervention e.g Trials Unit (independent organisation who use computer programme for randomisation) Ensures allocation concealment (prevents selection bias)

Answer 165

Ascertainment bias.

Answer 166

Treatments being introduced and later turning out to have no effect, or harmful effects. E.g HRT increases risk of cardiovascular disease Pure oxygen given to premature babies and causing blindness Arrhythmia drugs given to patients after MI actually increasing mortality Folate supplements increasing MI risk Counselling women after difficult birth increasing depression

Answer 167

Any physical or behavioural attribute that is negatively valued, or leads someone to be regarded as unacceptable or inferior.

Answer 168

We need people who are "other" to make us feel normal.

Answer 169

"Bad" means you can be credited with free will, take your punishment, and repay your debt to society. A psychiatric record is more scarring and permanent than a criminal one.

Answer 170

Labelling (deciding which of the arbitrary differences between people matter and which don't) Stereotyping (assigning characteristics to the group instead of the individual) Othering (labels are used to separate yourself from the group, and individuals become fundamentally different and become their label) Stigmatising (the characteristics attributed to the other category are undesirable, you devalue people based on the undesirable attribute/behaviour) Discriminating (the undesirable characteristics given to that person by the label justify you acting differently towards the person)

Answer 171

Individual (e.g hate crime) Institutional (laws passed by government e.g ugly laws in US) Structural (seen as acceptable within society e.g chaining people with mental illness in Benin)

Answer 172

Mental illness is a social phenomenon which is just a consequence of labelling.

Answer 173

Discreditable - stigmatising condition can be hidden, person can present a front of normality Discrediting - stigmatising condition can't be hidden and is immediately apparent, person has mo control over the stigmatising process

Answer 174

Felt stigma - person feels ashamed/scared Enacted stigma - people respond to stigma, behave in discriminating way Courtesy stigma - stigma spreads from individual to people involved with them

Answer 175

Internalising - social views that they are a lower status are absorbed and impact on personal beliefs and behaviours Non-disclosure of discreditable stigma Passing - presenting a false front to appear normal and not acknowledge symptoms (felt stigma may still be experienced, leading to mental health issues) Covering - non-disclosure by avoiding situations and reducing visibility (solution is sought to stigma but not to condition) Withdrawal - symptom is socially acknowledged, and individual withdraws from socially expected interactions and relationships (high psychological cost which can lead to stress and depression) Resisting - individual doesn't accept label and contests stigma-related outcomes (groups resisting stigma can lead to positive change e.g legalised gay marriage)

Answer 176

Fear of stigma may be a barrier to seeking medical advice and acknowledging condition. Patients at have concerns about confidentiality, especially if there could be professional implications on them (e.g they are a doctor/pilot) A diagnosis is good in that it increases access to treatment, but can be challenging in that it labels the individual and places them in a category. In some cultures the stigma attached to a diagnosis (e.g HIV) leads to a lack of medical care. In some cultures there is a strong stigma associated with mental and sexual health. Doctors have a role in public health education, and can work to reduce stigma.

Answer 177

An imbalance between the demands made on us and our personal resources to deal with those demands. A challenge to the body's ability to maintain homeostasis.

Answer 178

It is not the Life Event itself that causes stress, but the interpretation and meaning given to it by the individual. The Life Event may seem positive but still cause distress. The process is Life Event -> Appraisal -> Stress

Answer 179

Primary appraisal - appraisal of the Life Event itself Secondary appraisal - appraisal of your personal coping abilities, including personal resources and external resources (mainly the immediate social network) Whether the stress response develops depends on the secondary appraisal.

Answer 180

Feeling on edge, depression, despair, anxiety, anhedonia, irritability, tearfulness, over-reacting.

Answer 181

Difficulty concentrating, ruminating, thoughts racing - difficulty switching off, self-critical, difficulty making decisions and problem solving.

Answer 182

Comfort eating/ loss of appetite Increased drinking/ smoking Withdrawing from exercise and social activity Disturbed sleep

Answer 183

Fight or flight Increased heart rate, breathing rate, blood pressure Increased muscle tension Increased sweating

Answer 184

Increases heart rate and palpitations misinterpreted as a heart attack Increased respiratory rate misinterpreted as a heart attack or asthma Unconsciously tensed muscles over a period of time causing pain and misinterpreted as arthritis Increased sweating misinterpreted as a fever as a result of infection/malignancy

Answer 185

Stress -> physiological response -> physical symptoms Physical symptoms -> misinterpretation Misinterpretation -> worry/anxiety Worry/anxiety -> physiological response

Answer 186

If the person has a tendency to worry, previous mental or physical illness, illness beliefs (e.g a family history of heart disease).

Answer 187

Physical symptoms that can not be explained by organic disease, and that cause distress and impair functioning.

Answer 188

Symptoms that arise from a problem in nervous system functioning, not caused by a structurally or pathologically defined disease.

Answer 189

A physical disease caused or made worse by mental factors such as stress/anxiety.

Answer 190

Mental illness that causes physical symptoms (e.g pain) that can't be traced back to any physical cause.

Answer 191

Primary care = 25% | Secondary care = 40-50%

Answer 192

Some MUS arise from misinterpretation of the normal physiological stress responses. Some MUS arise from minor pathologies that are exaggerated at times of stress.

Answer 193

It may be that physical symptoms led to child abuse stopping e.g abuser gets slipped disc/ child has to go into hospital for appendicitis, so the child learns to associate physical symptoms with being protected.

Answer 194

Maladaptive behavioural responses may negatively affect the existing illness e.g Poor compliance with medication Increased smoking/ alcohol intake Decreased exercise Poor diet Social withdrawal (Stress can also have a direct effect at a cellular level due to activation of the HPA axis and SAM system)

Answer 195

Increased risk of death in the six months following loss of a spouse, due to stress leading to high circulating levels of catecholamines, causing hypertension and increasing the risk of ischaemia.

Answer 196

The patient's own implicit common sense beliefs about their illness. These provide a framework around which the patient understands and copes with their illness.

Answer 197

``` Identity - label and symptoms of illness Timeline - perceived duration Consequences - expected outcome Causes - punishment? Cure/control - how to control it/ recover ```

Answer 198

Patients make an interpretation of their illness Patients select a coping strategy Patients appraise the coping strategy

Answer 199

Problem solving - controlling the problem and reconstructing it as manageable Emotion focused - managing emotions and maintaining an emotional equilibrium

Answer 200

``` Seeking information about the condition Seeking support Learning new procedures and behaviours Identifying new activities/ alternative rewards Developing a realistic action plan ```

Answer 201

Emotional discharge - talk about the problem and your feelings Making and maintaining supportive friendships Gaining emotional support e.g from religion Resigned acceptance - coming to terms with the inevitable

Answer 202

Sensitivity to all sorts of sounds.

Answer 203

Lowers your pain threshold.

Answer 204

Guilt, anhedonia, longing, yearning, anxiety, depression, shock + numbness.

Answer 205

Intrusive ruminations - preoccupation with thoughts of deceased, hallucinating presence of the deceased, denial, low self esteem, hopelessness.

Answer 206

Agitation, restlessness, fatigue, searching, crying spontaneously, social withdrawal.

Answer 207

Initial weight loss then possibly weight gain, sleep disturbances, energy loss, physical complaints similar to the deceased, suppressed immune system, hypertension, self neglect.

Answer 208

Nucleus accumbens.

Answer 209

Numbing Yearning and searching Disorganisation and despair A greater or lesser degree of organisation

Answer 210

Loss orientated - concentrating on the grief, risking becoming socially isolated if not given help to get into volunteering and things to keep busy Restoration orientated - get on with things, try and find ways to keep busy, emotional avoidance

Answer 211

Pathologised grief. Complicated grief has some similar symptoms to normal grief but has a much longer duration. Can manifest as anxious and depressive thoughts, painful memories, dreams and preoccupation with the deceased.

Answer 212

Pre-existing mental health problems, unfinished business with the deceased, guilt, remorse, financial difficulties, unemployment.

Answer 213

Religious - involves soul Moral - madness is a punishment for actions Scientific - medical and social models

Answer 214

Used in prisons so inmates can be constantly surveyed and never know if they're being watched or not so have to behave well. Demonstrates that knowledge is power.

Answer 215

Women are more likely to be diagnosed with neurosis (post-natal depression, anorexia nervosa, bulimia nervosa, anxiety, depression, PTSD, dementia and depression in old age). Men are more likely to be diagnosed with psychosis (antisocial personality disorder, sex offenders, substance misuse).

Answer 216

Women are more likely to be classified as suffering from depression. Women are more likely to seek help for emotional distress. Women are more likely to suffer from a mental disorder. Biological experiences of women are pathologised e.g childbirth, menstruation, menopause, medication

Answer 217

Constructions of masculinity leave men unwilling to express their emotions, which may lead to hiding anxieties and uncertainty. Men's bodies are supposed to represent strength and health. Men may be unwilling to use health services and require sanctioning especially from female partners.

Answer 218

``` Childhood poverty Social inequality Early exposure to urban environments Migration Belonging to an ethnic minority Early separation from parents Childhood sexual/physical/emotional abuse Bullying in school Debt Unhappy marriage Excessively demanding work environment Threat of unemployment ```

Answer 219

Difference in health outcomes between ethnic groups are caused by environment not genetics, and there are chronically high levels of stress experienced by minority groups. 1) minority status increases exposure to distal (external) stressors 2) as a by-product of distal stress, there is increased exposure to proximal stress 3) exposure to proximal and distal stress leads to adverse health outcomes e.g hypertension

Answer 220

Distal stressors = external stressors e.g experiences of rejection/prejudice/discrimination Prosoma like stressors = internal stressors e.g concealment of minority identity, vigilance, negative feelings

Answer 221

Recognise diversity through culturally competent care Recognise the role of context and social factors in the aetiology of mental health Acknowledge that mental health services and labelling can be seen as a form of social control (especially when it leads to imprisonment)

Answer 222

Be culturally competent and recognise the variety of presentations of mental distress Recognise that the reason people give for a consultation might not be their real reason for coming Ask all mental health patients about childhood trauma Provide support for the individual, the family, mental health workers themselves

Answer 223

A change in phenotype without a change in genotype. Physiological phenotypic trait variations that are caused by external or environmental factors that switch genes on and off, and affect how the cell reads the genes rather than changing the DNA sequence itself.

Answer 224

Fear of showing difference Shame Experience of prejudice Lack of insight - not realising you're ill

Answer 225

Trust in services - less willing to believe he will be understood Access to services - later in illness Respond of services - dealt with more restrictively

Answer 226

1) experience prejudice -> fear of showing difference -> become secretive -> experience shame -> not use opportunities -> become exclusive -> experience prejudice 2) communities don't trust mental health services -> only contact in crisis -> individual needs not known so treated insensitively -> feel badly treated by services -> communities don't trust mental health services 3) keep mental illness a secret -> go into crisis -> use services -> get label -> lose job -> poverty/exclusion -> keep mental illness a secret

Answer 227

``` Impairment = a loss or abnormality in psychological, anatomical, or physical structure or function Disability = a restriction in ability to perform an activity in a manner considered normal Handicap = a disadvantage for an individual that limits or prevents fulfilment of a role that is normal ```

Answer 228

Power of the medical profession to define who is fit for work Social Darwinism Industrial revolution (replacing low tech work) Revival of Christian morality (formation of philanthropic societies to help the disabled) Advances in technology (so something can be done)

Answer 229

``` Barthélemy index Functional Assessment Measure SF36 Nottingham Health Profile EQ5D Health Assessment Questionnaire (HAD) ```

Answer 230

``` Functional Assessment Goal setting Advise and arrange adaptations for employment/hobbies Quality of Life Assessment Activities of Daily Living Assessment ```

Answer 231

Helps to target interventions at the group of people where problems are most prevalent Finds the patterns of need Find trends in mental health - how prevalence is changing over time Explore the causes and triggers of mental health, allowing you to provide earlier intervention

Answer 232

Great scale of exercise, mental health is common and varied Diagnosis can be subjective Prevalence of mental illness varies on different subgroups in the population

Answer 233

Describing the data by collecting, summarising, and describing it in terms of mean, standard deviation etc.

Answer 234

Use statistical tests and confidence intervals to make generalisations about a population.

Answer 235

Describing how good is our estimate of the true population mean. It is the standard deviation of the sampling distribution.

Answer 236

Standard deviation is a descriptive tool used when talking about distributions, to show how spread out the data is. Standard error is used in inferential statistics to show how accurate is the estimation of the population mean.

Answer 237

SE = SD/[square root]n n is the sample size, so the bigger the sample size, the smaller the standard error. Or SE = [square root]p(1-p)/n

Answer 238

Confidence interval = a range of values that probably contains the population mean or proportion. Confidence limits = values that state the boundaries of a confidence interval (upper and lower limits).

Answer 239

There is always the possibility the sample will be extreme and contain a lot of ether very small, or very large observations.

Answer 240

95% of the normal distribution will lie within 1.96 standard deviations of the true population mean. 90% confidence intervals are narrower, and the number used is 2.58. 99% confidence intervals are wider, and the number used is 1.65.

Answer 241

``` Statistically significant: P-value 0.05 Confidence interval includes null hypothesis value Risk ratio = 1 Risk difference = 0 ```

Answer 242

Number Needed to Treat - measures the impact of an intervention by estimating the number of patients that need to be treated for there to be a positive outcome for one person.

Answer 243

The continued repetition of a behaviour, despite adverse consequences.

Answer 244

Holding two contradictory beliefs/ideas at the same time (e.g liking and disliking the addictive behaviour).

Answer 245

1) Salience - the use of the substance takes on higher priority than other previously valued behaviours 2) Tolerance - e.g can drink bigger amount of alcohol without getting drunk 3) Withdrawal - physiological withdrawal symptoms of substance removed 4) Relief of withdrawal symptoms by further use - e.g "hair of the dog", "eye opener" 5) Compulsion - subjective need to use the substance so it becomes a habit 6) Narrowing of repertoire - other interests neglected, becomes a habit 7) Reinstatement after abstinence - brain is primed to be addicted

Answer 246

High dependence, low problems = methodone maintenance patient High dependence, high problems = addict High problems, low dependence = binge drinker getting into fights Low problems, low dependence = "social drinker"

Answer 247

Alcohol, drugs, gambling | Potentially Internet gaming

Answer 248

1) pleasure producing potency (intensity of dopamine release) e.g crack cocaine vs cacao leaves 2) rapid onset of action e.g cigarettes (directly into blood) vs nicotine patches (slow release throughout day) 3) short duration of action e.g 10 minute high from crack cocaine so there is a need to get it back 4) tolerance and withdrawal

Answer 249

Temperance movement in 19th century USA.

Answer 250

Some people have the "alcohol gene" and are inherently alcoholic.

Answer 251

There have been a collection of genes found that can predispose someone to alcoholism. There are many environmental factors e.g sons of alcoholic have a much higher risk of alcohol is, monozygotic twins are more likely to be alcoholic than dizygotic twins, people who have an inefficient isozyme of acetaldehyde dehydrogenase suffer the Flush reaction so are less likely to become dependent.

Answer 252

It creates a high steady rate of responding | It is resistant to extinction

Answer 253

Positive reinforcement (social/ dopamine buzz) starts the alcohol addiction, negative reinforcement (relief from withdrawal symptoms) maintains the alcohol addiction.

Answer 254

Rats will repeatedly administer heroin or cocaine until death, ignoring other activities like running in their wheel or eating or drinking.

Answer 255

Mesolimbic dopaminergic pathway - ventral tegmental area releases dopamine to nucleus accumbens and prefrontal cortex. All addictive drugs increase dopamine levels in the nucleus accumbens, and this is linked to the salience of the drug.

Answer 256

Personality factors e.g risk taking, thrill seeking, impulsive, mood dysregulation. Social factors e.g peer pressure as adolescents. Dependence on the drug, as the physiology has adapted to its continued presence over time so it is required for homeostasis. Unpleasant withdrawal symptoms maintaining the behaviour by negative reinforcement.

Answer 257

Overwhelming desire to take the drug and diminished ability to control drug seeking. Biochemical and physiological changes in the brain. Salience of drug and reduced pleasure from biological rewards. Taking drug so often it becomes an automated habit. Relapse triggered by drug cues (e.g walking past pub) even after years of abstinence. Over learning of drug cues. Disinhibition due to changes in prefrontal cortex.

Answer 258

Drug use and addiction are highly dependent on circumstance and environment (e.g availability, peers)

Answer 259

Severely distressed people and animals will relieve their distress pharmacologically if they can.

Answer 260

Minimum unit pricing - get rid of severely discounted alcohol in supermarkets Reduced availability

Answer 261

Long term memory encoding of substance taking behaviours | Reduced frontal inhibition of such behaviours

Answer 262

Follow up patients who have had the same exposure or treatment to see how they are doing.

Answer 263

Long-term High degree of self-management involved Uncertainty in diagnosis, prognosis, complications Consequences on identity, and on social relationships Consequences on employment Source of embarrassment and stigma Need for information, advice, and support Impacts on social life, employment, finance

Answer 264

Relief Access to the sick role (which leads to employment rights, and welfare benefits) Legitimises suffering, so not dismissed as a malingerer by friends and family Access to information and support groups

Answer 265

Facing a new set of uncertainties (in the prognosis etc) Facing stigma Fear of reaction of others Possible limitations on paid work Worries about being able to fulfil obligations e.g looking after children Reduced income, may have to claim benefits Worries about deterioration, or complications Worries about dealing with medication or equipment

Answer 266

Felt stigma is the fear of actual stigma, but enacted stigma means the person actually experiences stigma (and is excluded, sacked, teased etc)

Answer 267

``` Calibrate machine Prick finger Spread blood evenly over stix Insert stix into machine Read result ```

Answer 268

An assessment of the future course and outcomes of a patient's disease based on the knowledge of the course of the disease in other patients and the patients own prognostic factors (general health, age, sex...).

Answer 269

Characteristics of the patient that can be used to more accurately predict the outcome of their disease.

Answer 270

Demographic (age, gender...) Disease specific (e.g grade of tumour) Co-morbid (any co-existing disease conditions)

Answer 271

Risk factors predict someone's likelihood of developing a disease disease in the first place, prognostic factors are associated with different arts of outcomes in the presence of a disease.

Answer 272

What are the possible outcomes? (Qualitative aspect) How likely are the possible outcomes? (Quantitative aspect) Over what time period will the outcomes happen? (Temporal aspect)

Answer 273

Case-control study, cohort study. | You can't easily randomise people to different prognostic factors, and you don't have equipoise.

Answer 274

The experience of the patients are in the past compared to the patient in front of you who you're trying to give information to, so there may be performance bias. The cohort needs to be an inception cohort, so as few prognostic factors are decide by the start of the study as possible. There can be selection bias as people can't be randomised. It can take a long time. Must try not to cause selection bias by losing people during follow-up. Must follow-up for a long enough time to allow the outcome to happen. Blinding needed so people's expectations don't cause ascertainment bias. Historical cohort studies can have recall bias. Need to study disease/outcomes that are common.

Answer 275

The measurement of exposure can't be biased by knowledge of what the outcome is. Rare exposures can be looked at. Several different outcomes and prognostic factors can be looked at at the same time. Data is provided on the time course for development of an outcome. BUT need to take into account possibility of selection bias and confounding.

Answer 276

Need an appropriate control group (from the same population as the cases) There is great potential for recall bias if you rely of patient/family accounts (people who have the outcome may be more likely to think more deeply and disclose that they had the exposure, this can lead to a type 1 error) Potential for selection bias in selecting the controls and cases. The measurement of exposure to risk factors can be biased by knowledge of presence or absence of the outcome.

Answer 277

``` Percentage of survival/outcome at a particular point in time (e.g 40% survive for 5 years) Median survival (the length of follow up by which 50% of participants will have died/experienced the outcome) Survival curves (shows the percentage of the original sample who have not yet died/experienced the outcome at each point in time) ```

Answer 278

You can prevent the disease by removing the cause (e.g lung cancer) An understanding of the natural history of the disease can improve treatment (e.g antibiotics to stop infection)

Answer 279

Falsifiability

Answer 280

1) Find an association (use statistical significance and clinical significance) 2) Consider what might cause the association ("chance, bias, confounding, cause" framework) 3) Use Bradford-Hill criteria

Answer 281

A systematic error in the collection or analysis of information

Answer 282

Both factors are not directly associated, but are linked by a third factor

Answer 283

``` Strength of association Temporal association Consistency Specificity Dose-response relationship Experimental evidence Analogy Theoretical plausibility Coherence ```

Answer 284

Sufficient (one cause leads to the disease) Not sufficient (many contributing causes) Necessary (cause must be present for disease to develop) Not necessary (cause doesn't necessarily have to be present for disease to develop)

Answer 285

The expansion of medicine into areas of human life previously understood in other ways.

Answer 286

They change throughout history.

Answer 287

Social, cutural, relational

Answer 288

True, e.g Freud saying women were asexual showed the sexism of that time

Answer 289

All aspects of social like and subjective experience that have any erotic significance.

Answer 290

Social categories of "femininity" and "masculinity" and their associated expectations, identities, conduct, and subjective experience.

Answer 291

Women and men were two versions of one essential sex, and women had the same genitalia as men just internal instead of external.

Answer 292

There are fundamental biological differences between men and women, and the two sexes are different in all parts of body and soul. This is when the female orgasm was lost. Women were thought of as asexual which justified the gender inequalities of the day.

Answer 293

They first started studying it scientifically, and first introduced sexuality (particularly women's) as a medical problem.

Answer 294

Upper and middle class women were predisposed to live quiet domestic lives centred around caring for their husbands and children. Advised by doctors to avoid education and live quietly and safely.

Answer 295

Emotional and mental isolation led to epidemic of depression. Fed notion of women as innately sick.

Answer 296

Changes in women's rights, increasing use of contraception, rallying against sexual repression.

Answer 297

They receive high profits from selling viagra, which Pfizer (a profit-driven company) discovered by accident.

Answer 298

Pressure to have sex more frequently, to have more penetrative sex, guilt about not wanting to have sex when pill has already been taken. Partner should be involved in discussions about prescribing viagra.

Answer 299

To increase profits by selling viagra to women.

Answer 300

1) Using male model as standard - does;t define female sexuality in women's own terms 2) Linear conceptualisation of sexuality and desire - assumes the only correct way to have sex is to progress linearly through the stages 3) Biological reductionism - sexuality is presented as innate, fixed and biologically determined, and the social, emotional and relational factors that contribute to and shape desire are ignored 4) De-politicises sexuality - locates it purely in the individual and ignores contributing political and socio-cultural factors. 5) Medicalises the primarily social experience of sexuality - interprets natural variations in sexuality according to medical model of disease

Answer 301

1) Sociocultural, political and economic factors 2) Partner and relationship issues 3) Psychological factors 4) Medical factors So a holistic approach to sexuality is needed

Answer 302

Awareness in GP practices that discrimination exists. | Determination to provide people with privacy and dignity (which can be hard to do on the wards).

Answer 303

They are more likely to smoke, drink alcohol, and use drugs, and more likely to carry this behaviour on past 30 when it usually begins to decrease. They have higher psychological morbidity. They are more likely to have STIs.

Answer 304

Further discrimination can be applied to an LGBT individual if they are disabled, BAME, older/younger.

Answer 305

More likely to live alone - social isolation. May not disclose to their GP as they lack trust or don't feel their confidentiality will be respected in the same way as someone heterosexual. They may delay screening or seeking treatment, so exacerbate acute and chronic conditions.

Answer 306

Missed opportunities for interventions around risk behaviours (so HIV/STIs not prevented or treated). May be a feeling that gay sexuality is distinct from experiences of health, illness, wellbeing. Lack of opportunities to discuss many health issues. Unequal access to quality health care.

Answer 307

Doctors who feel sexuality should be discussed elsewhere. Doctors who lack confidence or feel their inquiries will only lead to embarrassment. Not understanding that patients are usually happy to talk about sexual health if a doctor confidently initiates it, and they don't feel judged or uncomfortable.

Answer 308

GPs should be confident in taking a sexual history and carrying out a risk assessment. HIV test discussion (NOT called pre-test counselling due to stigma) Assessment and referral of men with STI symptoms. Hepatitis B vaccinations.

Answer 309

Having attraction to more than one gender (attraction regardless of gender)

Answer 310

Biphobia is different to homophobia. Bi people may feel they experience discrimination from all round - from heterosexual and from lesbian and gay communities. Bi and trans people challenge the binary way of thinking so may feel excluded from other support networks, feel that people are suspicious of them or that they don't belong. Leads to higher levels of distress and mental health problems than in equivalent heterosexual or lesbian and gay communities.

Answer 311

Those who challenge the binaries of sexuality.

Answer 312

Only just over a quarter had disclosed that they were homosexual to their GP, and there was a general feeling that this was not right. Men who had disclosed thought staff listened carefully to what they said, they were treated with courtesy and respect, staff seemed to know their job well, and had more confidence in their relationship with their GP than men who had not disclosed.

Answer 313

It influences quality of life, and an individual's capacity to maximise and maintain health (health promotion). It is clinically relevant, in relation to vulnerability to STIs etc.

Answer 314

Discrimination against homosexuals on the assumption that heterosexuality is the normal sexual orientation.

Answer 315

Separating sexuality from general health and wellbeing. Increasing assumptions that it is less acceptable to talk about sexuality in other environments. Being used as more of a primary healthcare service by LGBT people because they are worried about disclosure at their GP.

Answer 316

Increase all staff's capacity for meaningful communication. All surgeries develop and display equality policies, statements and guidelines, which explicitly include sexual orientation. Adhere to clear guidelines around confidentiality and patient's notes. Require all staff to act according to guidelines.

Answer 317

1) Advances in medical technology - can be expensive and not yield benefits worth the costs 2) Demographic trends - ageing population with more comorbidities so more cost to the health service, and relatively less of the working population to pay taxes to fund the NHS 3) Budgetary restrictions on the NHS - currently there is static real expenditure on the NHS but an increasing demand 4) Public expectations - people no longer expect to live with knee pain, expect a knee replacement

Answer 318

When someone is denied (or not offered) an intervention which everyone agrees would do them good and which they would like to have. NICE try and ration things at a national level so people in all areas receive the same and it is more fair.

Answer 319

There must be an evidence base for the effectiveness of the intervention (homeopathy is not rationed). If the patient turns down the intervention out of choice, that is not rationing.

Answer 320

Healthcare was rationed by price

Answer 321

1) Central government decides the funding for the NHS then divides it between the 4 nations 2) NHS England allocates the NHS budget to CCGs on the basis of population weighted by "need". CCGs fund hospitals, NHS England funds primary care 3) Doctors and other healthcare professionals act as primary rationing agents and ration patient's access to care (by making decisions on referring, admitting, and treating)

Answer 322

It excludes the poorest and discourages the rest from using healthcare, so leads to a reduction in population health.

Answer 323

Need means there is an effective and acceptable treatment or cure. Demand means the individual considers he has a need and wishes to receive care. Utilisation occurs when an individual actually receives care. So, need isn't always expressed as demand, demand isn't always followed by utilisation, and there can be demand and utilisation without any underlying real need.

Answer 324

Evidence for relative treatment effects on health related quality of life from randomised controlled trials and systematic reviews. Evidence of cost, to economically evaluate the cost per QALY.

Answer 325

1) Technology appraisals - look at the new intervention and decide whether or not the CCG should fund it (this decision is MANDATORY) 2) Clinical guidelines - advise recommended treatments for a whole disease area (these are ADVISORY so CCGs can choose to fund things differently)

Answer 326

Rationing by need is defined by cost per QALY, which assumes a QALY is of equal value to all citizens.

Answer 327

1) Treat equals equally and with dignity 2) Meet people's needs for healthcare as efficiently as possible and impose the least sacrifice on others 3) Minimise inequalities in the lifetime health of the population

Answer 328

Long-lasting Insidious, poorly defined onset so hard to diagnose Uncertainty in prognosis, diagnosis, complications Can't be cured but can be controlled High levels of self-care management, and becoming an "expert patient" Biological and social factors interact Impact on identity, relationships, work, finance Cause embarrassment and stigma Cause pain Lead to social isolation Have very high financial costs (so a large percentage of annual healthcare expenditure is targeted at a disproportionally small group of the population)

Answer 329

People with a lower income Older people Economically-inactive people (so can't receive benefits) People living in Wales

Answer 330

1) Can't cure people (which exposes the limits and weaknesses of medical science), but have to work with them on a long journey 2) The existential issues around diagnosis means the patient is having to reconstruct who they are and their future 3) The pain the patient feels can't be avoided or eradicated by modern medicine, and has to be endured 4) Many illnesses in old age can only be treated palliatively

Answer 331

It can be many years before diagnosis of a LTC is made, so harder to gain access to the sick role. People with a LTC may be seen as responsible for their illness. The course of a LTC is less predictable and much more likely to be deterioration than actually getting better. The diagnosis is very important, as it provides an explanation and legitimises symptoms that may have been experienced for many years.

Answer 332

1) Legitimises suffering, patient is not dismissed as a malingerer 2) Confirms the symptoms are not "all in your head" 3) Leads to acceptance by family and friends 4) Provides a label and access to treatment 5) Provides a gateway to welfare benefits, sick leave, support groups and information

Answer 333

Brings new uncertainties about the effects on the rest of your life: Social - finance, employment, relationships Clinical - relapse and remission, uncertainty in prognosis and the rate of deterioration Diagnostic uncertainty - whether the doctor has got it right

Answer 334

Destabilisation and questioning of identity after the onset of a long term condition. The patient questions their past and future, and the life they thought they were going to have.

Answer 335

Disruption of taken-for-granted assumptions and behaviours Disruption to biography (identity, re-examine future plans) Response to disruption (mobilise resources)

Answer 336

Narrative Reconstruction (which may not be all negative as it may prompt someone to think they are too stressed and take a break from work to spend time with their family)

Answer 337

1) Meaning as a consequence - the extent symptoms disrupt everyday life, and the way you deal with every issues 2) Meaning as a significance - looking at how other people will see you, and dealing with a sense of negativity and stigma and the disvalues bodily changes

Answer 338

1) Everyday work - deciding who completes what roles (e.g shopping, cooking, financial work) 2) Biographical work - starting again and changing aspirations after a biographical disruption, assessing the future in the light of ones physical and mental resources 3) Illness work - seeking information, membership of support groups, treatment and medication regimens

Answer 339

Biographical continuity

Answer 340

It is adult centred, and assumes the life had aspirations and a planned trajectory

Answer 341

Normal crisis

Answer 342

The illness is part of biographical flow. This applies to people who experience many disruptive episodes in their lives due to poverty, poor housing, ageing. They see the illness as biographical continuity or biographical reinforcement.

Answer 343

The HIV crisis being seen as part of their political struggle and identity by gay men.

Answer 344

Seeing the diagnosis as positive in a "whatever-doesn't-kill-you-makes-you-stronger" attitude.

Answer 345

1) See drugs as best avoided 2) Think drugs are unnatural and unsafe, associated with side effects and hidden risks 3) May adversely perceive drugs due to past negative experience 4) May see drugs as a signifier of ill health, so unwilling to take drugs in front of people for fear of being labelled as ill and facing stigma

Answer 346

It has a lot to do with the doctor-patient relationship: Positive experiences with doctors Trust in doctor's advice The patient being shown the medication is working through being given their bp readings etc The patient feels better, gains peace of mind There is no practical alternative to the drugs There is an absence of symptoms and this guides medicine use

Answer 347

Perceived efficacy - if they don't think the drugs are working Perceived side effects Experiment to see if they can manage without drugs Drugs reinforce and remind them about their illness identity They have a fear of dependence on drugs Practical reasons around social events e.g increasing medication before a party, exam...

Answer 348

1) Strict diet - stuck to regimen, as believed diet to be important to avoid complications and have longer life 2) Moderate diet - mostly adhered to prescribed diet, balanced indulgences with extra exercise 3) Flexible diet - often eat restricted foods and may feel guilty over lack of self control, monitor blood glucose so feel they can afford to be risky 4) No diet - not come to terms with diabetes, still angry so eat things in opposition, experience self-loathing and miserably obsessed with food

Answer 349

Girls incorporated the disease into their identity, it was accepted by their friends, they felt able to take medication at school, it resulted in positive attention. Boys kept their illness quiet and did not want it incorporated into their identity, they did not want to take insulin injections at school so took less injections during the day which led to poorer health outcomes over time.

Answer 350

Teenagers won't want to stand out at different so are reluctant to use visible medication. This can result in a struggle for autonomy which can lead to poor health outcomes if non-compliance is hidden from their parents. Parents need to find a balance between being responsible carers and granting autonomy and independence.

Answer 351

General Practitioner

Answer 352

Practice nurse

Answer 353

Psychiatric social worker

Answer 354

Specialist diabetes nurse

Answer 355

Community pharmacist