Yr 3

Question 1

Sociology

Answer 1

study of development, structure and functioning of human society

Question 2

Sociology studies

Answer 2

• People’s interactions with those engaged in medical occupations, e.g. health-care professional relationships
• The way people make sense of illness, e.g. illness vs disease
• The behaviour & interactions of healthcare professionals in their work setting, e.g. professional values, interactions between healthcare professionals and other healthcare staff

Question 3

Characteristics of Professions as opposed to other occupations:

Answer 3

• Systemic theory
• Authority recognised by its clientele
• Broaded community sanction
• Codes of ethics
• Professional culture sustained by formal professional sanctions

Question 4

Role of patient in sick role

Answer 4

Exempted from daily responsibilities
Not responsible for being ill
Regarded as unable to get better without help of professional
Must seek help from healthcare professional
Under social obligation to get better as soon as possible to be able to take up social responsibilities again

Question 5

Role of dr in sick role

Answer 5

Be objective, do not judge patients morally
Not act out of self-interest/greed but in patients interests first
Must obey professional code of practice
Maintain the necessary knowledge and skills to treat patients
Has right to examine patient intimately
Prescribe medical Rx and has wide autonomy in medical practice

Question 6

Social Class

Answer 6

Group Description NRS equivalent
1 Higher professional & managerial workers A
2 Lower managerial and professional workers B
3 Intermediate occupations C1 and C2
4 Small employers and non-professional self employed C1 and C2
5 Lower supervisory and technical C1 and C2
6 Semi-routine occupations D
7 Routine occupations D
8 Long-term unemployed E

Question 7

What are socio-economic influences on our health?

Answer 7

Collective set of conditions in which people are born, grow up, live and work, including gender, ethnicity, housing, education, employment, financial security, health system, environment

Question 8

Socio-economic influences on health - gender

Answer 8

Men higher mortality

Woman higher morbidity and consult with GP more

Question 9

Socio-economic influences on health - ethnicity

Answer 9

Social, cultural, genetic factors
Low socio-economic groups in ethnic communities have higher morbidity than non-ethnic counterparts
Communication big factor
Stereotypes are concerning
Difference between ethnic groups

Question 10

Socio-economic influences on health - education

Answer 10

Higher level tends to be more healthy - better understanding of health, more effective engagement in healthcare services, e.g. screening

Question 11

Socio-economic influences on health - employment

Answer 11

Income and financial security
Social contacts, status in society, purpose in life
Unemployment assoc with morbidity and premature mortality

Question 12

Socio-economic influences on health - health system

Answer 12

Healthy must subsidise the sick
Burden of financing fairly shared by having better off subsidise the less well-off
Services designed to improve whole population health may widen health inequalities if uptake lowest in those who would have biggest benefit

Question 13

Socio-economic influences on health - transport & environment

Answer 13

Adverse effects on health due to car use, e.g. pollution, RTA
Active travel –> health benefits, e.g. better mental health, prevention of chronic dx
Combining public transport and active travel - people can achieve recommended daily activity levels

Question 14

Socio-economic influences on health - media and health

Answer 14

Shapes/stereotypes our views/expectations

Question 15

Define health inequality

Answer 15

Differences in health status/in distribution of health determinants in different population groups

Factors leading to health inequality incl. deprivation, age, gender, ethnicity

Question 16

Health inequalities in children

Answer 16

Deprived children have significantly worse health, more likely to have lower birth weight, poorer dental health, higher obesity, higher rates of teenage pregnancy

Question 17

What are the other vulnerable groups to health inequalities (apart from children?

Answer 17

Homeless - alcohol, drugs, difficult to sustain tenancy, susceptible to infections, poor oral health, may not be registered with GP

Learning disability - shorter life expectancy, barriers stopping people with LDs from getting good quality care

Refugees

Prisoners - drinking, smoking, feel less loved/close to others, drugs, live in poorer areas

LBGT - homophobia, higher rates of anxiety, depression

Question 18

What are the health care inequalities that refugees must face?

Answer 18

Family integration, social adjustments, competing demands of distinct services, e.g. education, housing, mental health etc. may be overwhelming and limit resources, underdeveloped healthcare system in country of origin –> poorly controlled/undiagnosed medical conditions, unfamiliarity with preventative medicine/primary care, language barrier, urgent and complex medical problems that are unable to establish care and speciality referrals in timely manner, public health’s infectious disease screening results are not communicated to those providing on going medical care, exposure to violence, torture, interment, anti-immigrant segments, loss upon loss is the nature of the refugee life so depression, PTSD, anxiety in high prevalence and not always recognised

Question 19

What barriers stop people with LDs from getting good care?

Answer 19

Lack of accessible transport links
Not being identified with LD
Staff having little understanding about LD
Failure to recognise when a person with a LD is unwell
Failure to make correct diagnosis
Anxiety/lack of confidence for people with LD
Lack of joint working from different healthcare providers
Not enough involvement from carers
Inadequate follow up/aftercare

Question 20

What is the inverse care law?

Answer 20

Those who need the medical care the most are least likely to receive it and conversely, those with the least need of healthcare tend to use health services more and more effectively

Question 21

Equally Well Scottish Government 2008 Key Points

Answer 21

HI remains a big problem in Scotland
Poorest die early, have higher rates of dx, incl. mental health problems
Healthy LE needs to be increased across the board to achieve Scottish Government’s overallpurpose of sustainable economic growth
Tackling HI req. action from national and local government and other agencies, e.g. NHS, schools, third sector
Priority areas: children (esp, heart disease, mental health, alcohol, drugs, violence)
Radical cross-cutting action to address Scotland’s health gap to benefit its citizens, communities and country

Question 22

What factors reduce HIs?

Answer 22

Effective partnership across a range of sectors and organisations, e.g. to promote health, improve patient education about health
Evaluate and refine integration of health and social care
Government policies and legislation, e.g. smoking ban
Time to invest in more vulnerable patient groups
Improve access to health and social care services and professionals
Reduction in poverty
Social inclusion policies
Improved employment opportunities for all
Ensured equal access to education in all areas
Improved housing in deprived areas

Question 23

If third sector parties are effective at meeting local outcomes and priorities they should be…

Answer 23

Given the resources by their funders and commissioners to allow services to be maintained, developed and made more financially stable

Question 24

Wilson & Junger 1968 Criteria for Screening?

Answer 24

Is the disease an important public health problem?
Is the natural history of the disease adequately understood?
Will the test detect the condition at a pre-clinical stage?
Is a test available for the condition?
Is the test safe?
Is the test sensitive?
Is the test specific?
Is the test acceptable to the public and professionals involved?
Is the cost of the test feasible?
Does the overall cost benefit analysis make it worthwhile, i.e. no of tests req to save one life
Is the treatment of the condition being screened for of proven effectiveness?
Is the treatment of the disease being screened for safe?
Is the treatment of the disease being screened for acceptable to the public and professionals?
Are facilities available for treatment and diagnosis?

Question 25

Describe case control studies

Answer 25

Two groups of people are compared A group of individuals who have the disease of interest are identified (cases) and a group of individuals who don't have the disease (controls) Data is gathered on each individual to determine whether he or she has been exposed to the suspected aetiological factor(s) and whether or not a conclusion can be drawn that the suspected aetiological agent is a likely cause of the disease in question

Question 26

Describe cohort studies

Answer 26

Baseline data on exposure are collected from a group of people who do not have the disease under study The group is then followed through time until a sufficient number have developed the disease to allow analysis

Question 27

Sources of epidemiological data

Answer 27

``` Mortality data Hospital activity statistics GP morbidity/disease registers Health and household surveys/population consensus data Social security statistics NHS expenditure data ```

Question 28

Occupational history

Answer 28

Do you work with chemical irritants? How much exposure do you have to the hazardous chemicals? (intensity/duration) Do symptoms improve when you are not at work, e.g. on holiday/at the weekends? Is PPE used? Do you comply with PPE? Does the company enforce PPE use? Do other colleagues have similar symptoms? Do you have any hobbies/other activities/pets which may be a likely cause? Do you use anything you may be allergic to?

Question 29

Psychological/social issues facing offshore industry workers

Answer 29

Anxiety re travel Depression, e.g. due to loneliness/being away from family Stress due to shift pattern Pressure to maintain standard of living Difficulty adjusting back to family life when onshore Abuse of alcohol/drugs Anxiety re. job security

Question 30

Difficulties in consultations due to cultural differences

Answer 30

Language barriers Religious beliefs Third party may be present in the room, e.g. translator or family member Examination taboos Fear and distrust Racism Stereotyping Gender difference between the doctor and patient Differences in perceptions/expectations Ritualistic behaviours Lack of knowledge about some health issues/NHS

Question 31

Reasons for differing trends in age distribution from 1951 to 2031

Answer 31

Decrease in premature mortality/increase in LE Decrease in fertility rates/birth rates Migration Baby bloom after the war - increased sexual freedom and soldiers returned Contraception more widely available Improvements in housing and sanitation Health education programmes, e.g. healthy eating, smoking, exercise Improved safety and reduction of injury

Question 32

Issues presenting to healthcare due to shifting demographics

Answer 32

Increased need for geriatricians, or other allied healthcare professionals Increased demand for nursing homes, ward beds for the elderly Increasing prevalence of long-term conditions, e.g. DM, CVD, renal dx Need for specific health campaigns

Question 33

Social issues due to shifting demographics

Answer 33

Role of grandparents as carers of grandchildren likely to change Increasing dependence on families/carers who are also aging Demand for home carers/nursing home places likely to increase Increasing emphasis on activities for elderly within the community Housing demands likely to change as more elderly people live alone

Question 34

Effect of caring on the carer

Answer 34

Restriction of social activities/social isolation Less time for hobbies Adaptations to their house May gain satisfaction from her role May have to work less hours/quit job Financial implications if having to quit job/financially aid the person they are caring for Poor mental health - stress, anxiety, depression, emotional demands Lack of privacy for own family

Question 35

How can negative effects of being a carer be reduced?

Answer 35

Sitter services, e.g. cross roads Home carers to assist with person's personal care Elderly frozen food deliveries Day care centres Respite care Benefits, e.g. carers allowance Psychological support, e.g. carer's centres, counselling Disabled badge scheme Physio/OT assessment and support Medication review Additional help from other family members, friends, neighbours etc.

Question 36

Members of the multi-professional health team

Answer 36

District nurse/practice nurse - pressure areas, bloods, BP monitoring etc. Home carers - practical tasks, e.g. washing/dressing Pharmacist - dosset box, advice on medications Social worker - benefits, contact with agencies OT - adaptation of living environment to maintain independence, e.g. stair life Physio - maintain any remaining mobility, walking aids GMED/NHS24 - out of hours care if unexpected problems Nurse practitioner - initial assessment during house call if change in health Dietician - advice on diet Practice staff, e.g. receptionist - first point of contact/passing on concerns

Question 37

Tiredness in a child - causative factors apart from physical health

Answer 37

``` Excess screen time Poor diet Not exercising enough Exercising too much Not getting enough sleep, e.g. staying up playing video games too late Bullying Academic difficulties Social isolation Mental illness ```

Question 38

Recommended exercise for teenagers/day

Answer 38

60 mins - moderate to vigorous

Question 39

Recommended sleep for teenagers/night

Answer 39

8-10h

Question 40

Breaking bad news - End of Life

Answer 40

``` Listen to patient and carer Set the scene Check whether they want someone present Find out what they understand already Find out how much they want to know Share the information using a common language/avoid jargon Review and summarise the information Allow for opportunities for questions Agree follow up and support ```

Question 41

What are different reactions to bad news and how might they manifest?

Answer 41

Bargaining - if I change something in my life, maybe it will get better Shock - news completely unexpected, patient tearful and anxious Anger - angry at themselves for health related behaviour or angry with healthcare professional for being unable to provide a cure Denial - patient does not believe it is true/will fail to acknowledge the reality of the situation Distress - patient unable to cope, shows acute anxiety and tearfulness Guilt - not being able to provide for family, guilt that earlier behaviours may have affected health, e.g. lack of exercise Fear/anxiety - fear of death/pain, worried about family left behind Relief - glad to finally know what is wrong so they can prepare for the future

Question 42

Proactive care resulting from ACP

Answer 42

Patient on GP palliative care register and discussed at team meetings Information on social and financial support given to patients and their carers and referral to relevant team members to facilitate provision of this Usual GP and district nurse visits and phone calls Assessment of symptoms and partnership with specialist to customise care to patient and carer needs Overall care assessed including respite, and psychosocial needs Preferred place of care noted and organised Care plan and medication issued for home End of life pathway used Dies in preferred place, family bereavement support Staff reflect - audit, gaps in care identified, learn, improve care

Question 43

Define sustainability

Answer 43

Able to continue over a period of time

Question 44

Factors contributing to a sustainable medical carer

Answer 44

Work life balance Autonomy Flexibility of role Job satisfaction Team working and development of the team Good relationship with colleagues Manageable workload Ability to develop knowledge and diversify interest, intellectual stimulation, maximal use of personal abilities/skills Outside interests, e.g. hobbies may promote resilience Potential for educational role Professional respect from colleagues and patients Reasonable occupational health provision Job security Financial security Stable terms and conditions

Question 45

What emotions may be aroused from unexpected death?

Answer 45

Profound shock No chance to say goodbye, take back hasty words Multiple deaths, legal involvement and press coverage may make things worse If child - may carry stigma of parental blame

Question 46

Define terminal care

Answer 46

Last stage of care when patients condition in deteriorating and death is close

Question 47

Define palliative care

Answer 47

Care that emphasises QoL (provided in GPs, specialist palliative care units/hospices)

Question 48

How do you know if a patient is ready for palliative care?

Answer 48

Supportive and palliative care indicator tools for those who have a life-limiting diagnosis, or a worsening of their chronic condition

Question 49

What does WHO say about palliative care?

Answer 49

Provides relief from pain and other distressing symptoms Affirms life and regards death as a normal process Intends neither to hasten/postpone death Integrates the psychological and spiritual aspects of patient care Offers a support system to help patients live as actively as possible until death Offers a support system to the family to cope during the patients illness and in their own bereavement Uses a team approach to address needs to patients/their families, incl. bereavement counselling if indicated

Question 50

Who is in the palliative care team?

Answer 50

Health and social care partnership team | MacMillian nurses, CLAN, Marie Curie nurses, religious/cultural groups

Question 51

Things contributing to a 'good death'

Answer 51

Pain free Open acknowledge of imminence of death Death at home surrounded by family and friends Aware death - resolve personal conflicts and unfinished business Death as personal growth Death according to personal preference and in a manner that resonates with the person's individuality The knowledge of not having to encounter FoPC

Question 52

Define voluntary euthanasia

Answer 52

Patients request to die

Question 53

Define physician associated suicide

Answer 53

Physician provides the means/advice for suicide

Question 54

Why do people request euthanasia?

Answer 54

Unrelieved symptoms/dread of further suffering/depression

Question 55

What should be your response to euthanasia?

Answer 55

``` Listen Acknowledge the issue Explore the reasons for the request Explore ways of giving more control to the patient Look for treatable problems Remember spiritual issues Admit powerless ```

Question 56

What is involved in realistic medicine?

Answer 56

Build a personalised approach to care Change our style to shared decision making Reduce unnecessary variation in practice and outcomes Reduce harm and waste, e.g. over diagnosis Manage risk better, e.g. safety netting Become improvers and innovators

Question 57

What questions are involved in the choosing wisely UK initiative?

Answer 57

Is this test or procedure really needed? What are the possible benefits and risks? What are the possible side effects? Are there simpler, safe or alternative treatment options? What would happen if I did nothing?

Question 58

Why is global sustainability important to healthcare?

Answer 58

``` Material inequality Population and consumption Resource depletion Climate change Loss in biodiversity Crisis in healthcare ```

Question 59

What actions can be taken to battle climate change?

Answer 59

Increase use of renewable energy sources Modify human behaviour Move back to more plant based diet Education about carbon literacy and numeracy Promote patient resilience Teach healthcare students that as well as human anatomy we are also part of a wider ecosystem

Question 60

How can we implement low carbon clinical care in the NHS?

Answer 60

Prioritise environmental health Sustitute harmful chemicals with safer alternatives Reduce and safely dispose of waste Use energy efficiently and switch to renewable energy Reduce water consumptions Improve travel strategies Purchase and serve sustainably grown food Safely manage and dispose of pharmaceuticals Adopt greener building design and construction Purchase safer more sustainable products

Question 61

What are the benefits of low carbon clinical care?

Answer 61

Better at preventing conditions Greater responsibility to patients in managing their health Be learner in service design and deliveries Use the lowest carbon technologies

Question 62

What did the new GP contract 1018 do?

Answer 62

Made changes in staffing/funding designed to promote sustainability of GP

Question 63

Define resilience

Answer 63

Quickly return to a previous good condition

Question 64

Define renewable energy source

Answer 64

Any natural resource that can be replenished with the passage of time

Question 65

What did the fit note replace?

Answer 65

The sick note

Question 66

What is the aim of the fit note and what does it involve?

Answer 66

Facilitate earlier discussion about returning to work Now includes terms of consideration for employers when signing a patient's return to work Must be done by doctor It is advice to patients as employees and is not binding on the employer and does not affect statutory sick pay Required if patient has been off for more than 7 consecutive days

Question 67

What do occupational health services do?

Answer 67

Help prevent work related ill health Advise on fitness for work, workplace safety, prevention of occupation injuries and disease Recommend appropriate adjustments for people to stay in work Improve the attdance and performance of the workforce Provide rehab to help people return to work Promote health in the workplace and healthy lifestyle Advise on medical health and ill health retirement Conduct research into work related health issues Ensure compliance with health and safety regulations incl. minimising and eliminating work place hazards

Question 68

Effect of unemployment on health

Answer 68

Higher mortality Poorer general health, long standing illness, limiting longstanding illness Poorer mental health, psychological distress, minor psychological/psychiatric morbidity Higher medical consultation, medication consumption and hospital admission rates

Question 69

What is re-employment assoc with?

Answer 69

Improved self-esteem, improved general and mental health and reduced psychological distress/minor psychiatric morbidity

Question 70

Define health promotion

Answer 70

Any activity designed to enhance health or prevent dx Includes: disease prevention, health education, health protection

Question 71

Define health education

Answer 71

An activity involving communication with individuals/groups aimed at changing knowledge/beliefs, attitudes and behaviours in a direct which is conducive to improvements in health

Question 72

Define health protection

Answer 72

Collective activities directed at factors which are beyond the control of the individual, tend to be regulations, policies, voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being

Question 73

What things affect health?

Answer 73

Genetics, environment, access, lifestyle

Question 74

What are the theories of health promotion?

Answer 74

Education Socio-economic Psychological

Question 75

Define empowerment

Answer 75

Generation of power in those individuals/groups who previously considered themselves to be unable to control situation or act on the basis of their choices Results in ability to resist social pressure, utilise effective coping strategies when faces with an unhealthy environment and a heightened consciousness of action

Question 76

What is the cycle of change

Answer 76

``` Pre-contemplation Contemplation Ready for action Action Maintenance/regression ```

Question 77

E.g.s of health promotion

Answer 77

Primary care: planned/opportunistic | Government: legislation, economic, education

Question 78

Define prevention

Answer 78

Measures taken to prevent onset of illness/injury | Reduces probability and/or severity of illness/injury

Question 79

Define secondary prevention

Answer 79

Detection of disease at an early (pre-clinical) stage in order to care, prevent or lessen symptomatology

Question 80

Define tertiary prevention

Answer 80

Measures to limit distress/disability caused by a disease