Women's Health/ Triaging/ Palliative Care

Question 1

How does social class impact maternal mortality rate?

Answer 1

Poverty increases the mortality rate

Question 2

How does socioeconomic status impact outcomes for babies?

Answer 2

Preterm (under 37 weeks) delivery increased 3x
Low birth weights (2.5kg>) increased by 3x
SGA (small for gestational age- represent inappropriate growth in uterus) increased by 5x
Increased perinatal mortality/morbidity
Increased SIDS (sudden infant death syndrome)
Increased consequent adult ill health
Reduced life expectancy

Question 3

What does Barker’s Hypothesis state?

Answer 3

Health prior to and when you are born will impact your health when you grow up

Question 4

How do drugs and poverty relate in terms of pregnancy outcomes?

Answer 4

Drug use exacerbates the effects of poverty including:

Increased preterm delivery, low birth weight, cot deaths, poorer adult health

Question 5

Is drug dependence in babies dependent on drug use?

Answer 5

No, it is related, but not indicative

Question 6

Why is the Supreme Court’s 1973 ruling in Roe v. Wade so important in terms of women’s health?

Answer 6

It has been accepted that statistically there is less risk to the health of a pregnant woman from undergoing a termination prior to week 13 of pregnancy than there is from giving birth.
As a result, terminations up to the end of week 12 are capable of being viewed as satisfying the first of the specified grounds for abortion in the Act (which is sometimes referred to as the ‘social’ ground for abortion)

Question 7

What are the different categories in the Manchester Triage Scale, and what do they represent?

Answer 7

Category 1: Immediate Resuscitation (red); Patients in need of immediate treatment for preservation of life
Category 2: Very urgent (orange); Patients with major illness or injury needing urgent attention, to be seen within 10-15 minutes of arrival.
Category 3: Urgent (yellow); Patients with serious problems but are stable enough to be seen within 60 minutes of arrival.
Category 4: Standard (green); Patients not in immediate danger or distress
Category 5: Non urgent (blue); In no danger, could be seen in another setting

Question 8

What are different clinical observations that should be taken into account when assessing someone using the Manchester Triaging System?

Answer 8

• Heart Rate
• Blood Pressure
• Respiratory Rate
• Oxygen Saturation level
• Temperature

Question 9

What is the definition of palliative care?

Answer 9

Approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, via prevention/relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

Question 10

What are the four domains of care?

Answer 10

Physical
Psychological
Social
Spiritual

Question 11

What is a general palliative care physician vs specialist?

Answer 11

General- team of professionals working together to ensure quality of life is as good as it can be despite deteriorating health. This may not include life-shortening illness
Specialist- Looking after people with life-threatening illness. Typically hospital or hospice (day service, clinic, community specialist, or inpatient)

Question 12

What are the two reasons for inpatient palliative care?

Answer 12

Control of unstable pain

End of life care (80% typically discharged)

Question 13

What is the process of homelessness?

Answer 13

1. Application- presents to council as homeless
2. Assessment- questioned (are you homeless, intentionally homeless, do you have connection to the local authority you’re applying to?)
3. Outcome- is there a legal obligation from council to help person?

Question 14

What is destitution? What is an example of this?

Answer 14

Homeless, not enough money for basic needs

Example are destitute migrants who are refused asylum but not deported

Question 15

What are reasons for fluctuations in homelessness levels?

Answer 15

Housing options
Scottish Empty Homes Partnership
Welfare cuts
Social housing availability not meeting demand
Rising Rent (without rising wages)
Levelling off of impact of housing policies

Question 16

What are common causes of homelessness?

Answer 16

Dispute within household/relationship breakdown
Being asked to leave
Only 5% intentionally homeless

Question 17

How does homelessness relate to hospital admissions?

Answer 17

Admittance to hospital with primary or secondary diagnosis of homelessness is rising (130% increase)
Average age of death for those homeless is 45 years in males, 43 years in female. - high majority of which are preventable

Question 18

What population predominantly make up the homeless population?

Answer 18

White males, 1/3 aged 25-34

Question 19

What are some of the multiple complex needs within the homeless population? And what does this mean for the approach for helping the homeless?

Answer 19

Mental Health
Addiction
Rough Sleeping (violence)
Prison
There are multiple and complex needs when "solving" homelessness, and more than one service is needed

Question 20

What are severe and multiple disadvantaged homeless people?

Answer 20

Homelessness, Substance abuse, and Offending

1 in 3 will be involved in all 3.

Question 21

What are multiple exclusion homelessness factors?

Answer 21

90% are unemployed
45% have no qualifications
80% are male
85% with 2+ severe and multiple disadvantaged factors have suffered Adverse Childhood Experiences

Question 22

What are adverse childhood experiences?

Answer 22

Maltreatment
Violence and coercion
Adjustment (migration, asylum)
Prejudice
Household or family adversity
Inhumane treatment
Adult responsibilities
Bereavement and survivorship

Question 23

How many children have experiences at at least 2 adverse childhood experience?

Answer 23

50% of Scottish children

Question 24

Why are Adverse Childhood Events important when assessing health?

Answer 24

If you have 4+ you are at increased risk of:
4x more likely to abuse alcohol
16x more to use hard drugs
6x more risk of never feeling optimistic
3x risk heart disease, resp disease, t2 diabetes
15x more to experience violence (committed, vs 14x experience in past year)
20x more to be in prison

Question 25

Is homelessness a health inequality?

Answer 25

Inverse care law - the availability of good medical care tends to vary inversely with the need for it in the population served
Services are potentially available, but aren’t necessarily being utilized
Homeless people compared to most deprived non-homeless are 2x more likely to attend emergency department

Question 26

What are barriers to accessing healthcare for homeless people?

Answer 26

Organisational (administrative, transport, lack of flexibility)
Attitudinal (distrust, stigma)
Mental health/substance misuse (impaired decision making, chaotic life)

Question 27

What health services are available to the homeless?

Answer 27

Homeless services- multidisciplinary in one building, interprofessional working, accessibility and flexibility, outreach, mobile clinics, utilising other professionals
Inclusion health/pathways
Link workers
Secondary care and prison services (transitional care)