Revision EH - what need to know Flashcards
what is the medicare rebate for:
a) GP services
b) out-of-hospital services
c) in-hospital services
a) 100%
b) 85%
c) 75%
What is a schedule fee vs a reccommeneded fee?
SF= Fee for a given service set by the AUS government
RF= guide for doctors with suggested fees set by AMA
What does ‘the gap’ in medicare refer to?
difference between total cost of med treatment and schedule fee
What is the PBS safety Net and it’s purpose?
safety net threshold.
When reach a certain $ amount spent on medications will qualify.
protects those with chronic conditions from large medical costs
What does an odds ratio tell us?
The odds that one thing is related to another.
OR>1 = exposure MAY INCREASE risk of disease
OR<1 exposure may DECREASE risk of disease
What is relative risk and what does it mean?
estimation magnitude of association
RR>1 = risk of disease INCREASED as result of exposure
what is relative risk reduction and how is it interpreted?
Tells you by how much the treatment reduced the risk of bad outcomes relative to the control group
e.g
the incidence of disease in those exposed is 1% and the incidence of disease in those not exposed is 2%, then the RRR is 50% = , this is read as “your risk of disease is 50% greater than someone who is not exposed”
Absolute risk vs relative risk
absolute risk provides the direct probability of an event occurring, while relative risk compares the risk between two groups
interpretations of a P value
P<= 0.05 = less than 5% chance of difference due to chance.
P> 0.05 = probability that chance explains the difference is too high for null hypothesise to be rejected = not statistically significant
what is a confidence interval and how is it interpreted?
= Range in which reflects certain degree of assurance of where the true value lies.
interpretation
- can not include 1
if the interval contains the null value (e.g., 0 for a difference between two groups), it suggests that there is no statistically significant difference
What is population driven by?
fertility, mortality and migration
what is used to asses fertility?
CBR: live births per 1000
TFR: children woman likely to have in reproductive life
How is mortality measured?
CDR: deaths per 1000 of the population
Describe the current shift in Population in Australia (Indigenous Australians and Non-Indigenous Australians)
Non= contracting (TFR is below the replacement rate, living longer)
IA= expanding
Define infant mortality and child mortality rates
IMR= the number of children that die under one year of age in a given year, per 1,000 live births,
CMR= deaths of children aged 1-4 per 1000 live births.
What does the Demographic transition theory present?
Changing the composition of society
What does the Epidemiological transition theory present?
changing disease types and patterns
what is a replacement rate?
adjusted fertility rate required to maintain the population
what is the dependency ratio?
non-working: working age
potential socioeconomic burden on the working age by the young and elderly.
Health inequality vs inequity
Inequality = differences in health status
inequities: unjust, unfair or preventable
what are the upstream, midstream and downstream factors of health?
upstream = environmental factors, socioeconomic characteristics, broad features of society and knowledge, attitudes and beliefs
midstream= psychological factors, health services
downstream- biomedical
what are Social Determinants of Health?
Causes of the causes of ill-health
What is a Social Gradient? what is it caused by?
Graded relationship between SES n health in which poorest have worst health status.
caused by: natural selection, behavioural/cultural factors, structural factors and psychosocial capital
How can SDoH affect our health?
it affects:
- risk associated with developing disease
-the disease it self
-the capacity that people have to take action to prevent/treat
what are the ‘Solid Facts’ of the SDoH?
Stress
Social Gradient
Early
Social exclusion
work
unemployment
social support
addiction
food
transport
what is the impact of inequity and inequality on marginalised populations?
impacts: well-being/ stress levels, work opportunities, SES, resource access, health access and education access.
COMBINATION = profound impact
what is needed to help overcome inequity and inequality in marginalised populations?
multi-level response (systems, services and providers)
patient-centered care (offsets inequities)
What can be done on a system level to mitigate impacts on marginalised populations?
Universal coverage
Access to PHC
workforce innovation
financial subsidies/incentives
continuity of care
What can be done on a service level to mitigate impacts on marginalised populations?
Organisational influences (preventive care, use local workforce etc)
information systems
delivery system
health Lit and self-management support
community linkage
What can be done on a provider level to mitigate impacts on marginalised populations?
Patient centered
Culturally sensitive, aware of SoDoH, better communicators (Teach-Back)
Socialisation vs Acculturation
S= EVERYBODY goes through it (embeds culture and societal expectations)
A= when change culture, becomes evident when a change setting as what you have been taught NO LONGER MATCHES
What are the 5 stages of Migrant Acculturation?
Pre-contact
Contact
Conflict
Crisis
Adaption
what are the outcomes of accultruation?
Assimilation (don’t maintain old)
Integration (mix)
isolation (hold onto original)
marginalisation (forced to isolate)
what is langauge discordance?
when someone not knowing the language is expected not to comprehend, so you don’t take the time to try
Xenophobia
fear, hatred, and hostility to anybody from outside one’s own group
-What is ethnocentrism?
cooperation with members of one’s own group and noncooperation towards members of other groups based on our own cultural value
What are the three types of racism and their meanings?
I
Institutionalised = access to resources, services and healthcare opportunities different
Personally mediated = prejudice/ discrimination about ability, motive and intents (of others)
Acceptance (by stigmatized race) of negative messages about worth and ability.
what does the National Standard Indigenous Identification question ask?
are you of Aboriginal or Torres Strait Islander origin?
What are the historic factors that continue to impact health and wellbeing of ATSI population?
Loss of Land and Culture
Separation from families
Discrimination and racism
crowded living conditions
limited access to health care ]
cultural alienation
What is the life expectancy gap and what are its trends?
8 years
increases with remoteness
what is section 100 of the PBS?
helps improve access = providing for certain drugs to be available as pharmaceutical benefits, in addition to those available under normal PBS arrangements
The review included the following Section 100 programs:
Highly Specialised Drugs (HSD) Program
Aboriginal Health Services Remote Access (AHSRA) Program
what is the purpose of the CTG campaign?
National health and social policy initiative in Australia
improving the health and wellbeing (ATSI) people
close gap in: infant mortality, improve life expectancy and health outcomes, increase access to services….
What are effective approaches in Closing the Gap?
Action on upstream factors
access to patient-centred care
recognition of cultural factors (obligations, beliefs, kinship and connection to country
recognising strengths (community, approaches to sustainability and country)
How does the ACCHs improve access to health care?
allows for high-quality community controlled culturally appropriate health services
tailored to local needs
A hospital routinely automatically removes people from clinical lists after two Discharges Against Medical Advice.
Explain how this causes a health inequity.
- automatic = does not consider the reason WHY nor the individual
-certain groups may have barriers that prevent them from staying or attending that is not understood or addressed.
What are improvements in maternal death due to?
general health improvements, better health access (antenatal care)
what are the National Core maternity indicators?
Smoking in pregnancy
Antenatal care in first trimester
Episiotomy (tear from vagina)
APGAR score of less than 7
induction of labour
Casesaren section
What are the five functions of Antenatal care?
Pregnancy surveillance
education
preventative interventions
early complication recognition
management of pre-existing conditions
What is involved in pregnancy surveillance?
confirming dates
delivery planning
monitoring growth and wellbeing of baby
checking fetal position
dealing with common symptoms
what is involved in education (antenatal care)
Healthy lifestyle
Pregnancy
Delivery options
Parenting/ care of new baby
What are the preventative interventions undertaken in antenatal care?
maternal smoking and alcohol stopping
maternal diet
folic acid (pre-conception)
checking Hb and blood group of baby
What is considered in Early recognition and management of pregnancy-related problem
bleeding in pregnancy
gestational HTN
gestational diabetes
postnatal depression
What are examples of conditions managed in ‘management of pre-existing medical problems’ for antenatal care?
HTN
Asthma
Diabetes
Heart Disease
Depression
What is done and looked for in Newborn screening?
physical exam (abnormalities) and heel prick test (genetic disorders)
e.g. PKU, hypothyroidism, CF and galactosemia
When is the formal postnatal follow up?
What is checked for mum (5) and bub (4)
6 weeks postpartum
mum
-physical recovery
-coping and mood
-breast-feeding
-parenting skills
-contraception need
bub
-growth and development
-feeding
-congentital abnormalities
-vaccines
what is the universal postnatal contact service?
midwife contacts mother within 10days of discharge
What is purpose of 3-4 year-old health check?
check child is developing properly both physically and mentally (before going to school)
vision
weight and height
dental problems
social development
gross and fine motor skills
What is the purpose of the Positive Parenting Program?
improve parent-child relationships,
promote positive behaviour
reduce stress and anxiety
improve child outcomes
what is the positive parenting program and is it’s intended audience?
What
evidence-based parenting program that gives parents strategies to help build strong relationships and manage their child’s behaviours
who
all parents of children aged 0-12
What are the key features of FASD and what are the difficulties in diagnosing it?
features:
- small eyes
- thin upper lip
- smooth philtrum
- neurodevelopment impairment
diagnosis
-stigma
-criticising parents
what is the leading cause of death for Young People?
Injuries (accidental or intentional)
What are the common issues that build the morbidity in young people?
Mental Disorders
-anxety, depression and EDs
Asthma
Injuries
What are some important health issues facing young people and what framework is used to address them?
Sexual health (pregnancy, domestic violence, consent, STIs)
Substance USe
HEADSS
what is involved in the HEADSS assesment?
H= Home
E= education/environment/ employment and eating/exercises
A= activities/ peer relationships
D= drug use, cigaretes, alcohol
S= sexuality and spirituality
S= Suicide and safety
what is the most common STI amongst young people?
Chlamydia
Chronological vs functional aging
C= years
F= ability to function physically and socially
What are the theories of programmed death?
hay-flick (cells limited to number of divisions)
endocrine (hormones control pace)
immunological (faults in immune = vulnerable)
What are the theories of non- programmed death?
free radical ( build-up of chemical by-products)
Wear and tear (accumulated damage)
what are the features of psychological aging?
increased neuroticism
Negative emotions decrease (positive remain)
Males and females become more similar in values
Memory better for past events but slower for new
Poorer fluid intelligence but declined in crystalized intelligence
crystallised vs fluid intelligence
Crystallised = established pathways
fluid = learning something new (forming new pathways)
Are the common health issues facing Older People normal and Okay?
No, just because they are common does not make them acceptable. must consider their impact.
what are the issues in regional/rural/remote access to residential care?
Small resident work force
Difficulties in attracting trained staff
Long distance to travel to provide care
Small populations make ‘for profit’ model less viable
Patients need to travel to receive care
‘lack of residential aged care in rural and remote locations
What are the documents involved in Advanced care planning?
Aged Care directives
Enduring Power of Attorney
what are the categories of disability?
(Many Normal People In Society)
mental health, neurological, intellectual, sensory and physical
often overlap
exits on a spectrum
what is the principle of normalisation?
people with a disability should enjoy the same rights, privileges, opportunities, and access
- normal rhythm to their day
- age-appropriate activities
- normal environmental conditions
- normal economic conditions
- respect
- normal sexual relationships
What is the NDIS, when was established?
2012 - commonwealth NDIS Act
2013- NDIS framework established
2017 - implemented
what
government-funded program that supports Australians with disabilities
What is included in the NDIS?
Person-centred plans
transport
home modification’s
job training
What is a NDIS person-centred plan
1- Develop a profile identifying support and housing needs
2- identifies standards of service to facilitate living in community
3- consideration of cultural background, location, age and history
4- involvement of informal supports
What does the NDIS NOT cover?
- day-to-day living costs
- health-related costs (eg. medications)
- rehabilitative therapy
What are our health behaviours a combination of?
Conscious choice, learned behaviours and system factors
Classic vs operant conditioning
classic = neutral stimulus acquires ability to evoke natural stimulus
operant conditioning = behaviours modifed via consequences
(pos = increase acceptable behaviour for pos cons,
neg = increase acceptable behaviour to AVOID neg, Punishment = apply punishment as consequence)
What is cognition in terms of health behaviours?
recognition that behaviours are influenced by self-talk
what are the two key models relating to Health Behaviours?
What are their stages?
Health Belief Model
- susceptibility and severity
-barriers and benefits
-cues to action and confidence
Transtheoretical model
- pre-contemplation, contemplation, preparation, action and maintenance
What is illness perception?
Individuals own organised cognitive beliefs about their illness
What are the 5 components of illness perception?
Identity (label)
Consequences (cause and effect)
Cause
Timeline
Control
Eustress vs Distress
Eustress: leaves a sense of accomplishment or an achievement of goals
Distress: feeling out of control and that everything is out of control = hinders performance and overall wellbeing.
Episodic Stress
acute stress suffered over and over
What are the 4 stages of stress?
Acute phase – minutes, hrs or days
Reaction phase – 1-6 weeks shows all components of stress
Repair phase – 1-6 months stress reactions less intense develop coping mechanisms,
Reorientation phase more than 6 months– stress significantly reduced, grief reaction may be unresolved,
What are the 4 categories of Distress Warning Signs and Symtoms?
Cognitive
Emotional
Physical
Behavioural
what is the illness reaction a combination of?
nature/severity of illness
patient (capacity and beliefs)
situation
environment
What are the two coping startergies?
Adaptive or Functional
what are the four categories of stress managing strategies?
Cognitive focused
Emotional focused
task-focused
behaviour -focused
What is the difference between compliance and adherence
adherence - AGREED plan
compliance= paternalistic
What are strategies that can be used to improve medication adherence?
AIDES (assess, individual, document, educate and supervise)
patient-centred consult exploring why not
What are the two main schemes used to address gaps in medical adherence?
CTG scripts: reduces or removes the PBS co-payment for eligible Aboriginal and Torres Strait Islander people.
S100 meds
What is involved in Quality use of Medicine?
(Juding, Safely and Appropietly)
Judicious selection of treatment options: choice between medicine, non-medicine and no treatment
Safe and effective use: not misused, underused or overused
Appropriate choice of medicine when med is required.
What are the three interplaying parts to determinants of chronic disease?
FOAD
Psychosocial stress
Health Behaviours
What is meant by FOAD?
Maternal stressors during pregnacy –> epigenetic changes –> phenotypic change –> metabolic or structural change –> predisposed to chronic disease
What is an example of maternal influence on child?
smoking –> LBW –> smaller kidneys and less nephrons –> CKD
What is the role of oxytocin and cortisol in risk of CVD?
Oxytocin is a cardioprotective and stress reducing hormone that is released from our pituitary gland.
Social support encourages its release. Therefore in times of social exclusion Oxytocin will be decreased.
Cortisol is a stress hormone released when our body’s are in a state of stress. Stress from the psychosocial pathway encourages a cortisol acts surge. This cortisol surge increases risk of CVD
What is perinatal death and what is its LCOD?
within 28 days of birth
congimetal anomalies
preterm/LBW
What is infant death and what is its LCOD?
less than 1
perinatal/congenital
What is child death and what is its LCOD?
1- <15
accidents
What is youth death and what is its LCOD?
15-<25
suicide and accidents
What is maternal death and what is its LCOD?
within 42 days of end of pregnancy
direct = clot/haemorrhage
indirect = CVD
What is Adult death and what is its LCOD?
25+
CAD
dementia
stroke
What is older death and what is its LCOD?
> 65
as for adults
suicide also emerges
