Women's Health/ Triaging/ Palliative Care Flashcards
How does social class impact maternal mortality rate?
Poverty increases the mortality rate
How does socioeconomic status impact outcomes for babies?
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
What does Barker’s Hypothesis state?
Health prior to and when you are born will impact your health when you grow up
How do drugs and poverty relate in terms of pregnancy outcomes?
Drug use exacerbates the effects of poverty including:
Increased preterm delivery, low birth weight, cot deaths, poorer adult health
Is drug dependence in babies dependent on drug use?
No, it is related, but not indicative
Why is the Supreme Court’s 1973 ruling in Roe v. Wade so important in terms of women’s health?
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)
What are the different categories in the Manchester Triage Scale, and what do they represent?
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
What are different clinical observations that should be taken into account when assessing someone using the Manchester Triaging System?
- Heart Rate
- Blood Pressure
- Respiratory Rate
- Oxygen Saturation level
- Temperature
What is the definition of palliative care?
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
What are the four domains of care?
Physical
Psychological
Social
Spiritual
What is a general palliative care physician vs specialist?
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)
What are the two reasons for inpatient palliative care?
Control of unstable pain
End of life care (80% typically discharged)
What is the process of homelessness?
- Application- presents to council as homeless
- Assessment- questioned (are you homeless, intentionally homeless, do you have connection to the local authority you’re applying to?)
- Outcome- is there a legal obligation from council to help person?
What is destitution? What is an example of this?
Homeless, not enough money for basic needs
Example are destitute migrants who are refused asylum but not deported
What are reasons for fluctuations in homelessness levels?
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
What are common causes of homelessness?
Dispute within household/relationship breakdown
Being asked to leave
Only 5% intentionally homeless
How does homelessness relate to hospital admissions?
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
What population predominantly make up the homeless population?
White males, 1/3 aged 25-34
What are some of the multiple complex needs within the homeless population? And what does this mean for the approach for helping the homeless?
Mental Health Addiction Rough Sleeping (violence) Prison There are multiple and complex needs when "solving" homelessness, and more than one service is needed
What are severe and multiple disadvantaged homeless people?
Homelessness, Substance abuse, and Offending
1 in 3 will be involved in all 3.
What are multiple exclusion homelessness factors?
90% are unemployed
45% have no qualifications
80% are male
85% with 2+ severe and multiple disadvantaged factors have suffered Adverse Childhood Experiences
What are adverse childhood experiences?
Maltreatment Violence and coercion Adjustment (migration, asylum) Prejudice Household or family adversity Inhumane treatment Adult responsibilities Bereavement and survivorship
How many children have experiences at at least 2 adverse childhood experience?
50% of Scottish children
Why are Adverse Childhood Events important when assessing health?
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
Is homelessness a health inequality?
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
What are barriers to accessing healthcare for homeless people?
Organisational (administrative, transport, lack of flexibility)
Attitudinal (distrust, stigma)
Mental health/substance misuse (impaired decision making, chaotic life)
What health services are available to the homeless?
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)
