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Social Med > Social Med Exam > Flashcards

Social Med Exam Flashcards

1
Q

What is the historical development of Social Med?

A
  • Roots in the distant past (Babylon, Egypt, Ancient Greece, Rome) - Hippocrates’ teaching was close to Social medical ideas (he said that the doctor must know the conditions in which the patient lives. His basic thought was that the natural resistance of the human body should be supported in treatment)
  • In the beginning of the 16th century, a book was printed on the suppression of venereal diseases
  • In the 17th century, a register of births and deaths was introduced in England
  • In 1786, Johann Peter Frank gave the first definition for social med (he wrote about housing hygiene, nutrition, pregnancy, children’s health…the role of the state)
  • In the 18th century Frank : Medizinische polizei (the state is obliged to take care of health)
  • In 1848. Guerin: Social medicine represents a set of relations between medicine and society
  • In 1848. Virch’s: radical criticism of social conditions, which are responsible for health.
  • In 1848 in England the first law on public health
    In 1870 in the countries of Eastern Europe - Social hygiene
  • In 1915. in Berlin - a new medical discipline - Medical pathology (Grotjahn)
  • At the beginning of the 20th century, the first academic seats (Berlin, Nancy, Utrecht)
    Flourishing after World War II
  • In the 60s - Community Medicine- PUBLIC HEALTH
  • First dean of faculty Dr Milan Jovanovic Batut implemented public health ideas in Serbia and Montenegro
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2
Q

What are the definitions of Social Medicine?

A
  • Guerin 1948 - Social medicine is the sum of the relationship between medicine and society
  • Semaško - Social medicine is a science that deals with social pathology and the organization of health care for groups and the entire society
  • Frank - Social medicine is the responsibility of the community for the health of individuals through a system of social-medical measures
  • Andrija Štampar - Social medicine is a science that deals with examining the mutual influence of social relations and pathological phenomena in the people and finding measures of a social character to improve public health
  • Kesić - The object of action of social medicine is the people as a whole, vulnerable groups, populations and individuals as social units, exposed to the influences of social structure and events
  • Gerić - Social medicine is a medical discipline that deals with the problems of folk pathology and all other social and social phenomena, which are related to the health and illness of man as a social being, as well as a member of the immediate and wider community
  • Janjić - Social medicine is a philosophy of medicine
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3
Q

What are the subjects and content of the work of Social Medicine?

A

Study of the health status of the population
Study of factors of health status (biological, social, economic, cultural…)
Social diseases
Organization of health care
Health management
Economics in health (price of health and cost of illness)
Health legislation
Health education
International health cooperation
Measures of the health service in emergency occasions

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4
Q

What are the methodological procedures in clinical and social medicine

A

Find reason for seeking help (leading symptom)
History, status, provisional diagnosis
Additional tests (lab, scopies, etc)
Definitive diagnosis
Therapy plan

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5
Q

What are the methodological procedures in social medicine

A

Define the problem
Synthesis of information
Data collection
Analysis
Conclusion and proposal for measures

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6
Q

What is the definition of health

A

A state of complete physical, mental and social well-being, not merely the absence of disease and incapacity - WHO 1948
R. Dubos - The success or failure of an organism to respond adaptively to changes in the environment
Parson - The state of optimal capacity of the individual for the effective fulfillment of the roles and tasks for which he has been socialized

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7
Q

What is the modern concept of health?

A

It has medical, philosophical, psychological, social and economic dimensions
Lack of disease
Lack of dysfunction
Capacity for functioning
Equilibrium state at all levels
Positive concept
Necessity for carrying out daily life

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8
Q

What are the social determinants of health

A

Position/acceptance/rejection by society in society, happy childhood, personal peace and security (stress), social support
Job satisfaction/Employment opportunity and security
Permanent - genetics, gender and age
Lifestyle - nutrition, smoking, physical activity, sexual behaviour, alcohol, drugs
Socio-Economic - poverty, employment, education, social involvement and environment
Environment - housing, air quality, water quality, waste disposal
Food
Availability of services: transport, health care, social care

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9
Q

What are the main risk factors of health?

A

Sedentary lifestyle
Alcohol and drugs
Sexual activity
Behaviours that cause injury
Tobacco use
Poor eating habits
Lots more check pic

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10
Q

What is health for all?

A

Adding years to life - reducing premature mortality
Adding health to life - reducing illness
Adding life to years - promoting and improving health

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11
Q

What is health for all by 2000?

A

WHO initiative with the slogan Health for All by the Year 2000 A.D. Health for all meant that every individual should have access to Primary Health Care and through it to all levels of a comprehensive health system

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12
Q

What is health for all in the 21st century?

A

The policy for “health for all in the 21st century”, adopted by the world community in May 1998, aims to realize the vision of health for all, which was a concept born at the World Health Assembly in 1977 and launched as a global movement at the Alma-Ata Conference in 1978
It sets out global priorities for the first two decades of the 21st century, and ten targets that aim to create the necessary conditions for people throughout the world to reach and maintain the highest attainable level of health.

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13
Q

What is international health cooperation?

A

Cooperation encompasses both global health and issues directly linked to health, including development, human rights, climate change, crisis management, and humanitarian assistance

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14
Q

What is the world health organisation?

A

WHO works worldwide to promote health, keep the world safe, and serve the vulnerable.
The goal is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and well-being

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15
Q

What is the red cross?

A

The Red Cross provides international aid to help people around the world in emergencies and support refugees and survivors of trafficking, and those facing chronic hunger
Its purpose is to protect life and health and to ensure respect for the human being

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16
Q

What is family health care?

A
  • Definition of family: the basic social category in which the largest number of people live the longest period of their lives, and in it they end their lives. (?)
  • A family can include – married/unmarried people with their children and other blood related members
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17
Q

What is family life dimension?

A

i. Family structure
1. Individual characteristics of family members
2. Cultural style (Ethnic, racial, religious)
3. Ideological stylrs (briefs, values, imitation)

ii. Family interaction:
1. Behaviour among members of the immediate and extended family
2. Level of cohesion (emotional balance between family members and their own autonomy
3. Adaptability (the power of the family members to change the family structure with a change to life cycle)
4. Communication

iii. Family functions
1. Biological (prolongation of the species, birth and raising of offspring)
2. Economic (employment. Income generation)
3. Physical (health protection, production and preparation of food and clothing, sustenance, providing security)

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18
Q

What are the indicators of family health?

A

i. Family size and structure
ii. Events during the life cycles – birth, deaths, marriages, divorces
iii. Types of functioning, activities, communications
iv. Risk indicators
v. Health indicators (anthropometry, results of systematic examinations)
vi. Disease indicators (incidence, prevalence, absenteeism, traumatism, absences from school)
vii. Family planning incidators (number of live births, number of still births, interval between births, abortions, materal age during pregnancy)
viii. Response models, directed towards health risk factors

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19
Q

What are the objectives in women’s health care?

A
  • Acquiring knowledge about healthy lifestyles and adopting positive forms of behavior in relation to parenthood,
  • Humanizing the relationship between giving birth to desired and healthy children
  • Acquainting pregnant women with the physiology of pregnancy, the importance of a hygienic and dietary regime, the importance of maintaining oral and dental health during pregnancy and psychophysical preparation for childbirth and maternity
  • Timely detection, elimination and treatment of risks in pregnancy, including especially genetic disorders
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20
Q

What are the measures in women health protection?

A
  • Childbirth planning
  • Protecting the health of pregnant women, women in labor and midwives,
  • Treatment of sterility,
  • Ensuring health care in connection with the prevention and early detection of malignant diseases, especially on the reproductive organs and the breast,
  • Solving the leading health problems of women in the generative and post-generational age by detecting health and social factors in women in childbearing age and the wider community,
  • Assessment of social needs and provision of women’s social protection
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21
Q

Define the elderly

A

people over the age of 65. Early old age – 65 to 74 years, middle old age 76 -84 years and deep old age – over 85 years

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22
Q

What are issues relating to the elderly population

A

i. Health issues
1. Increased risk of disease, risk of dependance on others, risk of disability, pressure on the health services and allocations for their health care

ii. Social needs
1. Reduction of social contacts, increased isolation and a growing need for ensuring social security

iii. Economic issues
1. Interruption if productive life, lack of material, possibilities for existence and the need for their provision.

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23
Q

What implementations are available for the elderly?

A
  • General practice and other segments of ambulatory-polyclinic care,
    Home care and treatment,
    Day hospitals,
    Inpatient and specialized geriatric institutions
  • Social protection  Geriatric care facilities, Home help services, Provision of material assistance and Provision of legal assistance
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24
Q

What is health education?

A

Health education is the translation of what we know about health into the desired form of individual and community behavior through the health process

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25
Q

What are the types of health education?

A

i. Spontaneous/unplanned
ii. Planned and systematic

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26
Q

What are the contents of health education and areas of its application?

A
  • The content of health and educational work stems from the needs of the population of a certain locality.
  • The needs can be recognized by population, but also by experts.
  • The population may not recognize their need or consider it insignificant even if they recognizes it.
  • An expert can also recognize the need, but population remain uninterested.
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27
Q

What is health promotion?

A

Health promotion enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.

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28
Q

What are the key elements of health promotion by who?

A

i. Good governance for health
1. Companies must factor health implications into all the decisions they take, and prioritize policies that prevent people from becoming ill and protect them from injuries
2. By aligning tax policies on unhealthy or harmful products such as alcohol, tobacco, and food products which are high in salt, sugars and fat with measures to boost trade in other areas
3. Through legislation that supports healthy urbanization by creating walkable cities, reducing air and water pollution, enforcing the wearing of seat belts and helmets

ii. Health literacy
1. People need to acquire the knowledge, skills and information to make healthy choices.
2. They need to have opportunities to make those choices.
3. they need to be assured of an environment in which people can demand further policy actions to further improve their health

iii. Healthy cities
1. Cities have a key role to play in promoting good health. Strong leadership and commitment at the municipal level is essential to healthy urban planning and to build up preventive measures in communities and primary health care facilities. From healthy cities evolve healthy countries and, ultimately, a healthier world

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29
Q

What different approaches does health promotion take?

A

i. Communication
ii. Education
iii. Legal and fiscal measures
iv. Organizational changes
v. Community development
vi. Mass media
vii. Spontaneous local activities against health risks

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30
Q

What is health care planning

A

the process of defining health problems in the community, identifying unknown needs and seeking sources to meet those needs, establishing priority goals that are realistic and achievable, designing administrative actions to achieve goals

31
Q

What are the stages of health program planning

A
  • First phase: overview of health problems in the respective territory, which is carried out using data obtained from the assessment of the health status of the population and additional information on attitudes, habits, customs (collection through surveys).
  • Second phase: setting the “educational diagnosis”-goals and priorities.
  • Third stage: evaluation of options
  • Fourth phase: Programming in accordance with the specific problems of the defined territory (the method, personnel and resources are determined) - an example from our practice.
  • Fifth phase: Implementation of planning tasks and continuous monitoring
  • Sixth phase: Critical review of the path travelled.
32
Q

What are the basic principles of health care

A
  • Comprehensiveness
  • Continuity
  • Adequancy
  • Availability
  • Affordability
  • Preventive approach in work
  • Respect for priorities
  • Team work
  • Efficiency
  • Effectiveness
33
Q

What are the levels of healthcare?

A
  • Primary health care
    i. (ambulatory-polyclinic, outpatient) 80-85%
    First contact of patients and doctors
    Health sector and others in the community (schools, agriculture, industry, sports, church, authorities)
    Healthy lifestyle, healthy environment
  • Secondary health care
    i. Hospital 10 – 20%
  • Tertiary health care
    i. Highly specialized hospital 1-5%
34
Q

What are health activities are the primary level?

A
  • Training on the control and prevention of dominant health problems,
  • Improvement of proper nutrition provision of
    o healthy drinking water
    health protection of the mother and child
  • family planning
  • vaccinations
  • prevention of local endemic diseases
  • treatment of the most common diseases and injuries
  • improvement of mental illness health care
35
Q

What are primary health centres?

A
  • Includes the health sector and other sectors:
    Agriculture
    Education
  • Industry
    Housing, transportation… and coordinates their efforts
36
Q

What are health activities at the secondary level?

A
  • Activity above the level of the home of health
  • Cooperation with the home of health and the tertiary level of health care
37
Q

What are health activities at the tertiary level?

A
  • Tertiary level of care are highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals.
  • In-patient and specialist-consultative for certain categories or diseases
38
Q

What are the types of health insurance?

A
  • Bismark system
  • Beveridz system
  • Semashko system
  • Private insurance system short-term health plans, fixed indemnity plans, critical illness plans, accident supplements, dental and vision insurance, etc
39
Q

What are the objectives of measuring the health status of a population

A
  • Determining the basic characteristics of the health condition
  • Selection of priority health problems
  • Comparison of the health status of the population
  • Basis for making program tasks
  • Assessment of the scope and quality of work of the health service
  • Health policy evaluation
  • For the needs of scientific and research work
40
Q

What sources are used for measuring the health status?

A

o Census results
o Registers of vital events (reporting of births, death certificates…)
o Registers of certain diseases
o Routine health statistics data
o Results of epidemiological surveillance
o Health examinations
o Indicators of the Republic Fund for Health Insurance
o Results of scientific research work
o Economic and labor force statistics

41
Q

What are the divisions of health indicators?

A

i. Population indicators
ii. Population health indicators
iii. Environmental indicators
iv. Health system performance indicators

42
Q

What are population indicators?

A

i. Number and structure
1.size of the population
2.biological structure of the population
a. gender distribution
b. age distribution
3. other population structures

ii. Demographic change
1.natural (births and deaths)
2. mechanical (migrations)

43
Q

What are the specific mortality indexes?

A

i. By age and gender Mt(ag) = D(ag) / P(ag)100000
ii. Proportional mortality Mt(c) = D(c) / D100 (for a specific cause)

44
Q

What are standardized mortality, infant mortality, lethality

A
  • Standardized mortality Mt(st) = D(i,a,g) / P(a,g) *100000
  • Infant mortality Mt(i) = D(i) / LB*1000
  • Under-five mortality rate Mt(<5) = D(<5) / LB*1000
  • Maternal mortality Mt(m) = U(p,chb) / LB*1000
  • Letality L = D/ I *100
45
Q

What is general and specific morbidity?

A
  • General morbidity Mb = I / P*1000
  • Specific morbidity Mb(a,g) = I(a,g) / P(sp) *1000
46
Q

What is the incidence and prevalence for morbidity structure?

A

i. Incidence I = N / P *100000 new events or cases
ii. Prevalence P = I / P *1000 new and pre-existing cases of a specific condition

47
Q

What are factors for fertility decline?

A

i. Education, especially of women.
ii. Decreasing infant and child mortality, reducing pressure for more children to ensure survivors.
iii. Economic development, improved standards of living, rising expectations and family income levels.
iv. Urbanization – family needs and resources change compared to rural society.
v. Birth control methods – safe, inexpensive, supply, accessibility, and knowledge.
vi. Government policy promoting fertility control as a health measure.
vii. Mass media can raise awareness of birth control, and aspiration to higher standards of living.
viii. Health system development and improved access to medical care.
ix. Changing economic status, social role, and self-image of women.
x. Changing social, religious, political and ideological values.

48
Q

What are factors for increasing longetivity?

A

i. Increasing family income, education level and standards of living.
ii. Improved nutrition including improved food supply, distribution, quality, and nutritional knowledge.
iii. Control of infectious diseases.
iv. Reduction in non-infectious disease mortality.
v. Adequacy of safe food and water, sewage and garbage disposal, adequate housing conditions.
vi. Disease prevention, reducing risk factors, promoting healthy lifestyle.
vii. Medical care services with improved access and quality.
viii. Health promotion and education activities of the society, community, and individual.
ix. Social security systems, child allowances, pensions, unemployment insurance, national health insurance.
x. Improved conditions of employment and recreation, economic and social well-being.

49
Q

What is QUALY?

A
  • QUALY – Quality adjusted life years
    i. QALYs are an adjustment or reduction of life expectancy reflecting chronic conditions, disability, or handicap, derived from survey, hospital discharge, or other data.
50
Q

What is DALY?

A
  • DALY – Disability adjusted life years
    i. The DALY is a summary measure of population health. DALYs are calculated as the present value of future years of disability-free life that are lost as a result of premature death or disability occurring in a particular year
51
Q

CVD as a social disease

A

o The Major Social Determinants of Cardiovascular Disease. Among the major social determinants of health are SES, race/ethnicity, sex, the environment (including social relationships, neighborhood physical and social environments, and work environment), and access to care
o Cardiovascular diseases account for: 40.8 million disability-adjusted life years (DALYs) each year. 36.4 million years of life lost (YLLs) due to premature deaths (89% of total CVD DALYs) 4.5 million years lived with disability (YLDs)
o Heart disease costs the United States about $219 billion each year

52
Q

Malignant diseases as social diseases

A

o Social determinants including level of education, occupation, income, sex, race, ethnicity, place of residence, and social support presence, among others — have been strongly linked to cancer prevalence
o Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million deaths and 105 million DALYs for both sexes combined, representing 44·4% of all cancer deaths and 42·0% of all DALYs.

53
Q

Addictive disorders as social diseases

A

o Poverty, adverse childhood experiences, intergenerational trauma, and intergenerational substance use are all social determinants of health influenced by structural racism
o In 2019, drug use disorders were responsible for: 791.2 disability-adjusted life years (DALYs) per 100,000 population, higher in men (973.6 DALYs per 100,000 population) than in women

54
Q

Injuries as social diseases

A

o Injury rates result from the interaction of factors at the individual, family, and community levels. Individual factors include lack of resources, knowledge, beliefs, and behaviours related to safety, personal stressors, work environment, and exposure to hazards
o In 2013, 973 million people sustained injuries that warranted some type of healthcare and 4.8 million people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31%

55
Q

Mental health disorders as social diseases

A

o social determinants of mental health are racial discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underem- ployment, and job insecurity; poverty, income inequality, and neighborhood deprivation; poor access to sufficient healthy food; poor housing quality
o We estimate that 418 million disability-adjusted life years (DALYs) could be attributable to mental disorders in 2019 (16% of global DALYs). The economic value associated with this burden is estimated at about USD 5 trillion

56
Q

Infectious diseases as social diseases

A

o Location of residence, occupation, location of leisure activity, insecurity, living conditions, nutrition, mass population, density of transmitted vectors, and environmental factors
o We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs

57
Q

Health care of school children

A

o In developing countries: malnutrition, measles, diarrhoea, acute respiratory diseases, malaria and factors related to pregnancy and childbirth, sepsis, neonatal tetanus and AIDS
o In developed countries: obesity affects a high percentage of children in developed countries; it is estimated that every third obese child will be an obese adult, which will be associated with specific health risks (hypertension, diabetes).

58
Q

What are the 5Ds to reduce as objectives in healthcare?

A

o Death
o Disease
o Disability
o Discomfort
o Disatisfaction

59
Q

What is health education and what is the goal?

A

o Methods of work in health education - importance and division
o The goal of health education is to develop in individuals a sense of responsibility for their own health, the health of other people around us and for the preservation of the environment

60
Q

What are the communication methods in health education

A

o Four approaches to health communication: informative, educating, persuasive and prompting
o It can also be verbal communication, non-verbal communication (or body language), written communication, formal communication.

61
Q

What is the individual approach in health education

A

o This method involves person-to-person or faces to face communication which provides maximum opportunity for a two-way flow of ideas, knowledge, and information

62
Q

What is group work in health education

A

o The groups are many – mothers, school children, patients, industrial workers – to whom we can direct health teaching

63
Q

What is the organisational methods doe health education

A

o Analysis
o Identify problems and prioritise
o Setting objectives (SMART)
o Develop plan of work
o Implementation
o Evaluation

64
Q

What are health education tools

A

o Health talks
o Lecture
o Group discussion
o Buzz group
o Demonstration
o Role play
o Drama
o Traditional means of communication

65
Q

What is the economic importance of health?

A

o Better health fuelled global growth by enlarging the labour force and increasing productivity. In fact, economic historians estimate that improved health accounted for about one-third of the overall GDP-per-capita growth of developed economies in the past century

66
Q

How are healthcare systems financed?

A

o Financing through taxes
o Financed by national taxation, with a National Health Service in which providers of publicly financed services are owned publicly, and access to hospital specialists is typically by referral via a general practitioner

67
Q

What is health insurance?

A

o Health insurance is an agreement in which an insurance company agrees to pay for some or all of your medical expenses in exchange for a monthly premium payment.
o If you’re young, healthy, and lucky, the monthly premium may exceed the costs of your insurance.
o If you (or someone in your family) have a recurring condition that needs treatment or develop one, are injured in an accident, or develop a disease, you may well incur medical bills that you cannot possibly pay.

68
Q

What is compulsory health insurance?

A

o Health insurance under an obligatory public scheme, enforced by law. Payment for such insurance amounts to a tax. The obligation may be placed on employers to pay contributions on behalf of employees. Contributions may be income-related and progressive. Compulsory health insurance is usually administered by public bodies.

69
Q

What is health care?

A

An organized provision of medical care to individuals or a community.

70
Q

Who are healthcare workers?

A

A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers.

71
Q

What do health associate professionals do?

A

Health associate professionals perform technical and practical tasks to support the diagnosis and treatment of illness, disease, injuries and impairments in humans, and to support the implementation of health care, treatment and referral plans usually established by medical, nursing and other health professionals.

72
Q

What are the indicators of the natural population movements?

A

o Number of live births
o Number of deaths
o Natural population increase is a positive natural change, when the number of live births is larger than the number of deaths during the time period considered. Natural population decrease is the opposite, a negative natural change, when number of deaths exceeds the number of births.

73
Q

What are health status indicators?

A

o Health status indicators are a set of surveillance data that has been analysed in a way that permits assessment of the health status of the population so that public health priorities and actions can be appropriately identified.
o Indicators include:
1. Mortality, cause specific
2. Morbidity, diseases specific
3. Disability

Social Med (1 decks)

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