Sem 4 Flashcards
5 Requirements for Gender Recognition Act 2004 to change your birth assigned gender.
- Must be at least 18
- Must have a diagnosis of gender dysfunction
- Must have lived as that gender for 2 years
- Declaration of marital status
- Declaration that you live as new gender till death
What would you legally do if an elderly person, requiring institutional care, resists admission?
5 justifications.
Consult National Assistance act 1948
allows compulsory removal from homes if:
- Not Mentally ill (but suffer from grave chronic disease)
- Old
- Infirm or physically incapacitated
- Living in insanitary conditions
- Not receiving care and attention
REMOVE IN PATIENT’S BEST INTEREST
4 components of getting informed consent.
- Understand info
- Retain info
- Weigh up decision
- Communicate their decision
What is the goal in decision making?
- Maximise beneficial health outcomes
2. Minimise undesirable effects from occurring
Components of high quality decision making
- Correct assessment of clinical situation by healthcare professional
- Correct information therapy to communicate situation
- Px aware of consequences of treatment & no treatment
- Relevant info is required
- Info in the form: understood, accurate and unbiased
- Numeric risks are communicated in complex info
- Px makes decision on accurate info and their values
Demonstrations of Professional Boundaries
- Doctors must not treat themselves/ family
- Confidentiality must be upheld
- Whistleblowing to ensure patient safety
- Must act with integrity
- Personal health must be upheld - GP registration
- Probity - must act with beneficence (not own views)
Primary, Secondary and Tertiary intervention
Primary- removal of cause of disease - reduces incidence
Secondary- screening for early stage disease - early intervention and treatment to improve prognosis
Tertiary - treatment of established/ late disease - manage consequences of disease
Why is it not always beneficial to perform screening tests?
May be costly, harmful or unethical to perform investigation to find out who is at risk of certain diseases.
Define DR (sensitivity)
Proportion of individuals affected by the disease that had a positive test result
a/ a+c
Define False positive rate (FPR; 1-specificity)
Proportion of people who are unaffected that tested positive on the screening test/
b/ b+d
Define OAPR
Odds of being affected given a positive result
a:b
Define TP, TN, FP, FN
TP - True positive = positive result + HAS disease
FP - False Positive = positive result + NO disease
TN - True negative = negative result + NO disease
FN - False negative = negative result + HAS disease
Positive Predictive Value (PPV)
No. of affected individuals with positive results/ total number of individuals with positive results
Requirements for worthwhile screening programme
- Disorder = well defined medically
- Prevalence = known and public health importance
- Natural history = possible to identify early disease from healthy
- Treatment = effective treatment is available
- Test = should be simple, safe, easily implemented and acceptable
- Performance of test= must be known
- Ethical = test procedures after positive result must be acceptable to both parties
- Access = all people who could benefit should have access
- Financial = cost effective
Why have death rates gone down (squaring the rectangle) in the UK?
- Decreased infant mortality
- Improvements in diet
- Improvements in sanitation
- Improvements in healthcare
- Increased standard of living
Define Ageing
Process of generalised impairment of function resulting in the loss of adaptive response to stress, and a growing risk of age related disease.
Strehler’s concepts of ageing
Deleterious - should be eventually harmful to the individual - i.e. blindness
Intrinsic - restricted to changes of endogenous origin
Progressive - all changes continue progressively through time
Universal - identifiable in all members of a species
Mutation accumulation and Antagonistic Pleiotropic gene
MA = gene not expressed until that species has reproduced and passed that gene on, cannot stop gene being passed on.
APgene = Gene has an early effect - kept - has an adverse effect later on = contributes to ageing.
Disposable Soma Theory of Ageing
- views organism as machine that transfers free energy for several options: food, foraging, maintaining, reproducing, defence.
- amount of energy given for each group is species dependent as they prioritise different factors.
Cellular level theories of ageing
Hayflick phenomenon = each cell undergoes a set no. of divisions. Younger cells undergo more divisions.
Cross link formation = fewer collagen cross links formed in older cells.
Heat Shock protein = HSP produced at times of cell stress. Fewer in elderly = harder to cope with stressful demands leading to ageing.
Genetic theories of ageing
GERONTOGENE, LONGEVITY ASSURANCE GENES = Gerontogenes contributes to ageing faster. LAGs make the individual live longer
TELOMERES = at end of chromosomes = responsible for cell division = shorten after each division = finite no. of divisions (TUMOURS can suppress this function.)
Genomic Stability Theories of ageing
Error catastrophe = errors leading to abnormal proteins important for cellular processes can accumulate and result in ageing
Free radicals = FRs from cellular reactions can damage DNA
Mitochondrial theory = mitochondrial damage from O2 radicals can lead to ageing.
Psychology of ageing
Bio-psycho-social approach = ageing brain determines any psychological changes occurring in ageing. Usually shown by a decline in intellect and ability to perform fast acting movements
Bernice Neugarten model = events in life require degree of adjustment, the more predictable the easier it is.
Socioemotional selectivity theory = knowing how long you have left shifts priorities from knowledge to life satisfaction
Theory of third age = period of time where one can live their life how they want and follow their own projects
Erikson’s theory = learning from experience = choices in psychosocial crisis’ in life determine our later life traits.
- in adulthood traits = being someone, having someone, helping someone and taking responsibility
Elder Abuse
- Criminal act to neglect elder who lacks capacity
- Abuse = violation of a humans personal/ civil rights
- Vulnerable person = 18+ who needs care for a disability/age/illness OR someone unable to care for themselves.
- Types = physical, sexual, verbal (discriminatory) psychological, financial, neglect, institutional.
signs = bruising, change in character, unexplained injuries, social withdrawal.
Mental capacity act 2005 principles
Everyone has the right to make their own decisions and we must all respect that and allow them to maintain that right even if we disagree/ seems eccentric.
must act in persons best interest and be the least restrictive intervention.
2 stage test to determine decision making ability
- do they have an impairment of their mind?
- does it affect their decision making ability?
Safeguarding in work?
individuals who are deemed to be of a significant risk are placed on a vetting/barring list which will regulate their activity options.
i.e. paedophiles cannot work in schools.
Cognitive development- Piaget
- thinking is basic and becomes more advanced with age
- Sensorimotor- relationship between self and objects
- Pre-operational - thinks egocentric, can describe by single feature, conservation of numbers
- Concrete operational- conservation of mass and weight, can classify objects by many features, can think logically about events
- Formal operational- think logically about abstract ideas and can form hypotheses. Philosophical approach.
Morality (levels 1, 2 & 3)
all with thought of ‘should the man steal drugs to help his sick wife?’
1 = pre-conventional = s1 punishment and obedience orientation, s2 = reward orientation + acts in own interests.
2 = conventional = s3 good boy/girl theory = conforms for approval and not disappointing others. s4 authority orientation = upholds laws to avoid guilt of not doing duty
3 = post conventional = s5 social contract orientation - relatives values. s6 - ethical principle orientation- actions guided by own ethical principles.
Social development of attachment
Lorenz = imprinting = innate requirement to acquire specific info during time of critical care (geese follow mum)
Harlow = hard mum vs soft mum =monkey metal mum w/food worse than cloth mum w/o - need intimate care
Bowlby = affectionate bond formed by maternal reinforcement = need to provide secure base, be available and responsive, intervene, encourage exploration from base.
- individual needs care but not all needs met or won’t develop well (mummy boy). needs to find balance
Social construction of Gender
basis.
- biological sex = genitalia of individual
- Gender = social and cultural perceptions associated with sex differences, constructed as masculine and feminine. (MALE SO YOU’RE MASCULINE) = flawed
- gendering practices = clothing of child, treatment of child differs for genders; once verbal they identify as part of that gender group. Parenting roles = differ for mum or dad. Work roles differ by gender.
Social construction of gender - why is gendering done from birth with virtually everyone?
- major determinant of division of labour- alternative is basing jobs on peoples skills and talents
- gendered social practices are responsible for shaping men and women’s bodies. i.e. choice of sports.
- converts average differences into absolute differences
- social construction of masculine and feminine conceptions embodied in practices are fuelled by individuals. (girl doing sport too late, not as developed = seen as weaker_
- studies showed men having higher risk of CHD was due to gender not biology - lifestyle influences.
Psychosexual development
normal = occurs in first 3 months of foetal development
sex = gonads you have
gender identity = early awareness of belonging to one of the 2 human being categories
- shaped by actions of parents and environment (e.g. clothes and toys) by 2-3 are aware of their identity + can communicate it.
gender role = outward manifestations of their personality reflecting their gender identity (masculinity or femininity)
Atypical sexual development
Gender identity disorder = being feels more comfortable as the other gender (transgender)
Transvestite Fetish = likes dressing as other gender , no confusion of gender.
Genital abnormalities
- micropenis- doesn’t affect gender identity perception
- botched circumcision
- ambiguous genitalia
- eunuch transvestites + castrated males as male prostitutes (have no sexual drive)
Sexual orientation
Heterosexual = first sexual experience -males = 13 -females = 14 sex = 17
Homosexual
- boys = 20% in childhood show it, 3% in adulthood show
- girls = 10% of pre-adolescents show it, 2% of adults exhibit lesbianism
excessive masturbation is a sign of neglect or sexual abuse
Communication in people with disabilities:
Autism
Prelingual deafness
Visual impairment
Autism & Aspergers
- Apparent use of language for non communication
- Perseveration (repetition of own utterances)
- Reversal of pronouns
- Failures of theory of mind- unable to imagine what is in someone else’s mind
PL deafness- severe hearing problem for 2+ years
- Poor literacy
- Very partial, sporadic acquisition of surrounding vocab and grammar
- limited ability to gain info from lip reading
- poor articulation
visual
- some young blind show pronoun reversal
- vocab is limited by touch ability of object, person thats described. i.e. can only describe what they feel.
Communication in people with disabilities:
Cerebral palsy
Acquired hearing impairment
Cerebrovascular event
CP
- eye contact disruption. limits facial expression
- willingness to engage in comms = disrupted by resp defects
- pronunciation is affected
Acq hearing
- lip reading also difficult
Cerebrovascular event
- acquired dysphagia
- comprehension problems may mask as schizophrenia/ dementia
Communication in people with disabilities:
Acquired movement disorders
Dementia/ cognitive deterioration
AMD
- disrupted eye contact and limits on communication with facial expression
- pronunciation is affected moderately.
Dementia/ CD
- Adults with Down’s may lose ability to comprehend speech before other things
- General symptom of Alzheimer’s is anomia- trouble remembering words = distressing to patient at early stage
Diagnostic overshadowing and inability to convey symptoms often leaves it too late for treatment to improve quality of life.
