Foundations of Primary Care COPY

Question 1

What are the three aims of SIGN

Answer 1

• Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare
• Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live
• Improve healthcare across Scotland by focusing on patient-important outcomes

understand medical evidence

reduce variations in practice

improve healthcare

Question 2

Give examples of sources/types of epidemiological data.

Answer 2

michael gove HIDES CHARM

Health and household surveys

ISD Scotland statistics

Drug misuse databases

Expenditure data from NHS Social security statistics

Cancer statistics

Hospital activity statistics

Accident statistics

Reproductive health statistics

Mortality data

Question 3

Define a confounding factor

Answer 3

A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease.

Question 4

List three common confounding factors

Answer 4

• Age
• Sex
• Social class

Question 5

List Reasons not to do with healthcare why numbers of elderly population increasing

Answer 5

• Decrease in birth/fertility rates
• Improvements in housing
• Improvements in water supplies
• Improvements in sanitation/sewerage systems
• Improvements in nutrition
• Improved safety and reduction of injury
• Migration (some areas only)
• War/genocide (some areas only)

Question 6

social implications associated with Scotland’s increasing elderly population

Answer 6

• Increasing dependence on families and/or carers who are also ageing and perhaps still working themselves
• Demand for home carers likely to increase
• Demand for Care home/nursing home places likely to increase
• Increasing emphasis on social activities for the elderly within communities
• Role of elderly as grandparents and carers of grandchildren likely to change e.g. may have fewer/no grandchildren, may still be in employment themselves
• Housing demands are likely to change as more elderly people live alone e.g. increased demand for one-bedroom flats, sheltered housing
• Elderly people remaining in employment for longer may lead to an increase in unemployment rates in the young (this point could equally well be made as an economic implication)

Question 7

What are the different options for care when an elderly person becomes more ill?

Answer 7

• Living in own home with support from family • Living in own home with support from social services • Sheltered Housing • Residential Home • Nursing Home Care

Question 8

What is an anticipatory care plan

Answer 8

Advance and anticipatory care planning promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care.

Question 9

examples of legal issues which may be included in an Anticipatory Care Plan for any patient

Answer 9

• Welfare power of attorney • Financial power of attorney • Guardianship (POA = arranged with patient when has capacity, guardian is arranged through court when no POA made and person no longer has capacity).

Question 10

examples of medical issues which may be included in an Anticipatory Care Plan for any patient

Answer 10

• Potential problems • Home care package • Wishes re DNA CPR • Scottish Palliative Care Guidelines • Communication which has occurred with other professionals • Details of “just-in-case” medicines • Electronic care summary • Assessment of capacity/competence • Current aids and appliances (helps assess current functional level)

Question 11

examples of personal issues which may be included in an Anticipatory Care Plan for any patient

Answer 11

• Statement of wishes regarding treatment/advance directive • Next of kin • Consent to pass on information to relevant others • Preferences and priorities regarding treatment • Who else to consult/inform • Preferred place of death • Religious and cultural beliefs re death • Current level of support e.g. family/carers

Question 12

Why is disability increasing?

Answer 12

Increased age of population Rise in injuries from car accidents, falls and violence, chronic diseases

Question 13

What are descriptive studies and what are they used for?

Answer 13

Descriptive studies attempt to describe the amount and distribution of a disease in a given population This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies. Such studies are usually cheap, quick and give a valuable initial overview of a problem

Question 14

What are cross sectional studies?

Answer 14

(disease frequency, survey, prevalence study) In cross-sectional studies, observations are made at a single point in time

Question 15

What are case control studies?

Answer 15

two groups of people are compared: a group of individuals who have the disease of interest are identified (cases), a group of individuals who do not have the disease (controls).

Question 16

What are cohort studies?

Answer 16

In cohort studies, 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 17

What is meant by a trial? A randomised controlled trial?

Answer 17

Trials are experiments used to test ideas about aetiology or to evaluate interventions. The “randomised controlled trial” is the definitive method of assessing any new treatment in medicine.

Question 18

What is standardisation?

Answer 18

A set of techniques used to remove (or adjust for) the effects of differences in age or other confounding variables, when comparing two or more populations. An age-sex standardised rate represents what the unstandardised (crude) rate would have been in the study population if that population had the same proportion of males and females, and of people in different age groups, as the standard population. Rates can be standardised for any other relevant confounding factor (eg, social class). Comparisons of incidence or mortality rates in a population over time, or between two different populations, or between population subgroups, should always be based on standardised rates, never on crude rates.

Question 19

What is the Standardised Mortality Ratio (SMR)?

Answer 19

This is a special kind of standardisation which you may encounter in your reading. It is a standardised death rate converted into a ratio for easy comparison. The figure for a standard reference population (eg, Scotland) is taken to be 100 and the standardised death rates for the comparison (study) populations (eg, Grampian) are expressed as a proportion of 100. A figure below one hundred means fewer than expected deaths, and above 100 means more. For example, an SMR of 120 means that 20% more deaths occurred than expected in the study population, allowing for differences in the age and sex structure of the standard and study populations and an SMR of 83 means 17% fewer deaths occurred.

Question 20

What is meant by case definition?

Answer 20

The purpose of case definition is to decide whether an individual has the condition of interest or not. It is important in because not all doctors or investigators mean the same thing when they use medical terms. Differences in incidence of disease over time or in different populations may be artefact, due to differences in case definition, rather than differences in true incidence.

Question 21

What is meant by Coding and classification?

Answer 21

This is related to the issue of case definition. When data are being collected routinely (eg, death certificates), it is normal to convert disease information to a set of codes, to assist in data storage and analysis. Rules are drawn up to dictate how clinical information is converted to a code. If these rules change, it sometimes appears that a disease has become more common, or less common, when in fact it has just been coded under a new heading

Question 22

Define bias?

Answer 22

Bias is any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth. There are very many types of bias which can creep into epidemiological studies. Four important types are described below.

Question 23

Define Selection bias?

Answer 23

Occurs when the study sample is not truly representative of the whole study population about which conclusions are to be drawn. For example, in a randomised controlled trial of a new drug, subjects should be allocated to the intervention (study) group and control group using a random method. If certain types of people (eg, older, more ill) were deliberately allocated to one of these groups then the results of the trial would reflect these differences, not just the effect of the drug.

Question 24

Define Information bias?

Answer 24

arises from systematic errors in measuring exposure or disease. For example, in a case control study, a researcher who was aware of whether the patient being interviewed was a ‘case’ or a ‘control’ might encourage cases more than controls to think hard about past exposures to the factors of interest. Any differences in exposure would then reflect the enthusiasm of the researcher as well as any true difference in exposure between the two groups.

Question 25

Define follow up bias?

Answer 25

arises when one group of subjects is followed up more assiduously than another to measure disease incidence or other relevant outcome. For example, in cohort studies, subjects sometimes move address or fail to reply to questionnaires sent out by the researchers. If greater attempts are made to trace these missing subjects from the group with greater initial exposure to a factor of interest than from the group with less exposure, the resulting relative risk would be based on a (relative) underestimate of the incidence in the less exposed group compared with the more exposed group.

Question 26

Define Systematic error?

Answer 26

A form of measurement bias where there is a tendency for measurements to always fall on one side of the true value. It may be because the instrument (eg, a blood pressure machine) is calibrated wrongly, or because of the way a person uses an instrument. This problem may occur with interviews, questionnaires etc, as well as with medical instruments.

Question 27

Define Cofounding factor?

Answer 27

A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease. In some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration.

Question 28

List two common cofounding factors

Answer 28

Age Sex

Question 29

List how cofounding factors are dealt with in trials

Answer 29

depending on the particular study design: • In trials, the process of randomisation (in effect the play of chance leads to similar proportions of subjects with particular confounding in the intervention and control groups). • Restriction of eligibility criteria to only certain kinds of study subjects . • Subjects in different groups can be matched for likely confounding factors. • Results can be stratified according to confounding factors. • Results can be adjusted (using multivariate analysis techniques) to take account of suspected confounding factors.

Question 30

Define multimorbidity

Answer 30

the co-existence of two or more long-term conditions in an individual (multi-morbidity often results in polypharmacy)

Question 31

Define criteria for causality?

Answer 31

Criteria establishing epidemiologic evidence of a causal relationship between a presumed cause and an observed effect

Question 32

What are the three main reasons for culturally competent healthcare?

Answer 32

1) eliminating misunderstandings in diagnosis or treatment planning 2) improve patient adherence with treatment 3) eliminate healthcare disparities

Question 33

What are the components of the mental state exam? MSE - structured way of observing and describing a patients current state of mind

Answer 33

ASEPTIC - R Appearance - Age, sex, dress, unkempt? signs of self harm? and B- behaviour - alert? fidgeting? eye contact? inappropriate conduct? Speech Emotion (mood and affect - blunted, flat, labile) low, elated, anxious Perception - hallucinations Thought/ Thinking - Content (abnormal beliefs/delusions, obsessions) and Process - speed and fluency Insight and judgement - Do they think they have a problem? What do they think caused it? Do they want help? Cognition - orientation, attention and concentration

Question 34

What is psychopathology? What is descriptive pathology? Define phenomenology? (phenomenon)

Answer 34

Psychopathology is concerned with abnormal experience, cognition and behaviour Descriptive pathology - describes and categorise the abnormal experience as described by the patient Phenomenology - in psychiatry refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patients experience feels like

Question 35

What is the hypothetico- deductive process?

Answer 35

1) Make 4 or 5 diagnostic hypotheses 2) rare but not immediately concerning diagnosis excluded at this stage 3) strengthen case for diagnosis through brief history and examination 4) extend the search thereafter if no diagnosis identified 5) not about common diagnosis, rather about likely diagnosis

Question 36

List two coping mechanisms used to cope with stress and describe

Answer 36

1) Problem focused e.g. enlist friends and family help 2) emotion focused e.g. seek counselling/stress management (positive) alcohol or drug misuse (negative)

Question 37

What are the individual variables in risk perception?

Answer 37

Previous experience attitudes towards risk values beliefs socioeconomic factors personality demographic factors

Question 38

What are the three principles that govern the perception of risk?

Answer 38

Feeling in control Size of the possible harm Familiarity with the risk

Question 39

List four ethical principles and their meanings

Answer 39

Respect for autonomy; promote right to self determination, confidentiality, informed consent, promote capacity. Can we promote autonomy? Justice ; fairness/equity, individual vs population (non discrimination, equal treatment for equal need, rationing) Beneficence; To do good, what are the benefits of giving treatment? Non maleficence; avoidance of harm (to do no harm) what are the \*harms\* of giving treatment?

Question 40

What are the 4 options of decision making? When are they used?

Answer 40

1) degree of certainty 2) speed of change Pattern recognition (both 1+2 high) if speed of clinical change is high and complexity or ambiguity is high (ie A and E/ ITU) Algorithms Speed of clinical change is high, complexity or ambiguity is low = childbirth Pathways Speed of clinical change is low and complexity is low. e.g. elective hernia surgery Scenario/option planning Speed of clinical change is low but complexity is high e.g. GP caring for patient at home with co-morbidity

Question 41

Blaxter (1995) identified factors which influence lay beliefs around health (list 4)

Answer 41

Age - if older - see health as functioning, young people see health as fitness social class /difficult economic and social circumstances - more likely to think in terms of being able to work/care for others ie. functional Gender - women of higher social class or educational equlifications have a more multidimentional view of health. women include social aspects of health, find concept of health more interesting. Culture- e.g. Afro-Caribbean patients hypertension regarded as normal and less likely to take medication

Question 42

List actions a government might take to promote health in the population as a whole (5 actions)

Answer 42

legislation/policies on smoking/alcohol (minimum age to buy products, licencing laws, taxation) improvements in housing provision of health education health and safety laws traffic/transport legislation/policies

Question 43

List 5 reasons why people may feel they are in good health

Answer 43

1) no diagnosed long term conditions 2) not on medication 3) able to work/socialise 4) able to have children (fertile) 5) on a 'healthy diet' 6) 'exercise regularly'

Question 44

Define: Hazard and Risk Risk factor Protective factor Susceptibility

Answer 44

Hazard: something with potential to cause harm Risk: the likelihood of harm occurring Risk factor: something that increases the risk of harm Protective factor: something that decreases the risk of harm Susceptibility: influences the likelihood that something will cause harm

Question 45

List some examples in disparities in disease outcomes between people who are different races (3) Disease prevalence? (3)

Answer 45

- Lung cancer death rates are higher in black men than white men - Ethnic minority women with breast cancer have a poorer survival rate than white women (even with similar access to care) - Racial disparities in uptake of joint replacement for knee osteoarthritis not explained by prevalence -Diabetes 5 x higher amoung pakistani and bangladeshi women than in general population - all male minority groups (except chinese) have higher rates of heart attacks - black Caribbean men have higher rates of stroke

Question 46

List 5 duties of a doctor registered with the GMC

Answer 46

make the care of your patient your first concern treat every patient politely and considerately respect a patients privacy and dignity give patients information in a way they can understand recognise the limits of your professional competence be honest and trustworthy avoid abusing your position as a doctor.

Question 47

What factors make GPs appropriate HCPs to sort out a problem for a patient? List types of questions

Answer 47

Awareness of current and past medical history Awareness of social circumstances A GP has a knowledge of a broad range of illnesses and health conditions Trusted HCP ho is likely to be known by the patient/family for some time/lifelong GP local to patients home 1) direct (specific) 2) closed (yes/no) 3) leading 4) reflected (doctor asks patient to think of the answer)

Question 48

List five questions for practising Realistic medicine

Answer 48

Is this test, treatment or procedure really needed? What are the potential benefits and risks? What are the possible side effects? Are there simpler, safer or alternative treatment options? What would happen if I did nothing? Needed? risk/benefits? side effects? alternative treatments? do nothing?

Question 49

Define terminal care

Answer 49

The last phase of care When the patient is deteriorating And is near death

Question 50

List 6 points to consider when breaking bad news

Answer 50

Setting - Listen to patient and the carers Set the scene Check whether patient wants to speak alone or with a relative Perception - Find out what the patient already understands Invitation - Find out how much the patient wants to know Knowledge - Share the information with a common language/avoid jargon review and summarise the information Empathising -allow opportunities for questions Strategy and summary - agree follow up and support

Question 51

List 5 actions that are taken because of anticipatory care plans

Answer 51

Preferred place of death noted and organised patient put on palliative care register and discussed at MDT meeting Information on social and financial support given to patients and families - appropriate referrals completed Assessment of symptoms and partnerships with specialist palliative care team to customise care to patient needs Dies in preferred place, family bereavement and support GP and district nurse phone calls and visits

Question 52

Define sustainability

Answer 52

The ability to be able to continue over a period of time

Question 53

List 4 positive factors that might contribute to a sustainable career in medicine

Answer 53

Autonomy work life balance manageable work load flexibility of role good job security good financial security

Question 54

Give 2 reasons why there are differences between two population pyramids one from 1800s and one from 2031

Answer 54

increased life expectancy decrease in birth rates migration greater availability in contraception improved housing conditions

Question 55

Give three ways the change in population pyramids will affect healthcare services give three social issues that could arise due to these population changes

Answer 55

Heath increased number of Geriatricians Increased numbers of people with long term conditions such as diabetes Promotion campaigns aimed at the elderly Social increasing dependence on families/carers demand for home carers/nursing home places likely to increase housing demands change as more elderly people living on their own increasing emphasis on social activities for elderly within communities

Question 56

Give a description of a case controlled study

Answer 56

two groups of people are compared a group of people who have the disease of interest are identified (cases) and a group that do not (controls) Data is then gathered to see if each individual has been exposed to the suspected aetiological factors Then whether a conclusion can be drawn as to whether that factor caused the disease

Question 57

Give a description of a cohort study

Answer 57

a group of people are selected who do not have the disease yet They are then followed through time until a sufficient number of the cohort have developed the disease to allow analysis

Question 58

List 6 possible sources of epidemiological data which provide information on IHD

Answer 58

Mortality data hospital activity statistics General practice disease registers NHS expenditure data Household surveys social security statistics

Question 59

List five psychological issues that may be affecting a patient who works offshore and is from russia

Answer 59

drug/alcohol abuse being away from home (if not from scotland) and anxiety towards travelling anxiety from job insecurity pressure to maintain standard of living shift work stress

Question 60

List ten potential difficulties during a consultation as a result of cultural differences

Answer 60

lack of knowledge about health issues fear and distrust racism bias and ethnocentrism stereotyping language barriers presence of third party translator in room differences in perceptions and expectations examination taboos religious beliefs

Question 61

List 5 ways a role as a carer may affect a patient

Answer 61

poor mental health due to stress/anxiety may have to give up work/ work part time financial implications lack of privacy for patient and family (if live with person caring for) less time for hobbies adaptations to patients home e.g. stair lift

Question 62

suggest 5 ways that issues with being a carer can be alleviated

Answer 62

sitter services (crossroads) home carers to assist with personal care day care centre respite care benefits - carers allowance psychological support - counselling

Question 63

List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a respiratory patient

Answer 63

not expected to be alive in 6-12 months breathless on rest/minimal exertion spends more than 50% of day in chair long term oxygen therapy three acute exacerbation hospital admissions in past year symptomatic right heart failure BMI below 21 FEV less than 30%

Question 64

List two emotional reactions to receiving bad news

Answer 64

shock - news completely unexpected, patient may be tearful anger - anger with themselves for previously unhealthy habits or behaviour denial - patient does not believe it can be true bargaining- perhaps if I change something in my life things will be better sadness/depression fear/anxiety - distressed about end of life/death/ issues surrounding dying shock anger denial = SAD

Question 65

List ten factors that should be taken into consideration before starting a screening programme

Answer 65

will the test detect changes at an early preclinical stage? Is the disease an important public health problem? is the natural history of the disease understood? is a test available for this condition? Is the test sensitive? (low false negatives) is the test specific? (low false positives) Is the test safe? Is the cost of the test reasonable? Is the method of the test acceptable to the public and GPs carrying it out? Are facilities for diagnosis and treatment available?

Question 66

List 5 factors that may contribute to tiredness in a child that aren't physical illness

Answer 66

poor diet inadequate sleep excess screen time lack of exercise/too much exercise academic issues home/relationship difficulties bullying loneliness

Question 67

List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a dementia patient

Answer 67

unable to dress, walk or eat without assistance, unable to communicate meaningfully worsening eating problems (dysphagia) or needing pureed diet recurrent febrile episodes/aspiration pneumonia urinary and faecal incontinence

Question 68

List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a liver patient

Answer 68

advanced cirrhosis with: intractable ascites hepatic encephalopathy recurrent variceal bleeds bacterial peritonitis low serum albumin prolongued INR over 2 not fit for liver transplant hepatocellular carcinoma

Question 69

List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a kidney disease patient

Answer 69

stage 4/5 chronic kidney disease (eGFR under 30ml/min) deteriorating on renal replacement therapy/dialysis or with persistent symptoms

Question 70

List 5 aspects in a patients history that could indicate that they are a suitable patient to receive palliative care if a cardiac patient

Answer 70

NYHA class III or IV heart failure, extensive valve disease, or coronary heart disease breathless or chest pain at rest or on exertion cardiac cachexia renal impairement (eGFR under 30 ml/min) two or more acute episodes needing hospital care in last 6 months

Question 71

What scale can be used in palliative care to assess patients function

Answer 71

Palliative performance scale

Question 72

What are the WHO aims for palliative care

Answer 72

provide relief from pain and other distressing symptoms affirms life and regards death as a natural process intends neither to hasten or postpone death integrates the psychosocial and spiritual aspects of patient care offers a support system to allow patients to live as fully as possible until they die offers a support system for the patient and family during the patients illness and for bereavement uses a team approach to address the needs of the patients and family

Question 73

What specialists can be involved in a palliative patients care?

Answer 73

marie curie nurse macmillan nurse CLAN religious groups

Question 74

What are the main components of a 'good death'

Answer 74

pain free death open acknowledgement of iminent death death at preferred place surrounded by family and friends personal conflicts and practical matters settled death as personal growth person centred and tailored to the patients individual wishes and individuality

Question 75

Where is most peoples preferred place of death? what percentage of people achieve this?

Answer 75

Home 25%

Question 76

What framework offers tools to support palliative care patients at home?

Answer 76

The golden standards framework including - setting up a cancer register -reviewing these patients - reflective practice (e.g. significant event audits)

Question 77

Define: voluntary euthanasia non voluntary euthanasia physician assisted suicide

Answer 77

voluntary euthanasia = patients request non voluntary euthanasia = no request physician assisted suicide = physician provides the means and advice for suicide

Question 78

List three reasons people may request euthanasia

Answer 78

1) depression - 60% of patients that request are depressed 2) fear of unrelieved symptoms and dread of further suffering

Question 79

Define sociology

Answer 79

the development, structure and functioning of human society

Question 80

List the characteristics of a 'profession'

Answer 80

1) systematic theory (has a theoretical basis) 2) authority recognised by its clientele (patients and government come to it for help) 3) broader community sanction (no one is allowed to practice without a licence) 4) code of ethics 5) professional culture sustained by professional sanctions

Question 81

What are the social/socio-economic influences on our health?

Answer 81

gender ethnicity housing education employment financial security health system environment

Question 82

List five reasons why employment is a social factor

Answer 82

Provides income and financial security; this obviously varies and relates in part to the previous slide on social class. (Deprivation is a major determinant of health inequalities) Provides social contacts Provides status in society Provides a purpose in life Unemployment is associated with increased morbidity and premature mortality

Question 83

Define health inequalities according to WHO definition

Answer 83

The WHO states that health inequalities can be defined as the differences in health status or in the distribution of health determinants between different population groups

Question 84

List some main health inequalities in scottish children

Answer 84

Birthweight Dental health breastfeeding obesity/overweight teenage pregnancy

Question 85

What health inequalities are present for the homeless population?

Answer 85

Average age of death of longer-term homeless is 47 years for men and 43 years for women Death by unnatural causes has been found to be four times more common than average amongst rough sleepers, and suicide 35 times more likely Rough sleepers are more likely to be assaulted than the average person Alcohol and drug problems are very high amongst rough sleepers, and people being resettled from the streets are more likely to face problems sustaining a tenancy if they have these problems The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, is significantly higher than in the general populations This population experiences poorer oral health than the general population. Access to health care for this population is different to that of the general population: one third of rough sleepers are not registered with a GP; attendance at accident and emergency is at least eight times higher than the housed population.

Question 86

List barriers that prevent people with a learning disability accessing healthcare

Answer 86

a lack of accessible transport links patients not being identified as having a learning disability staff having little understanding about learning disability failure to recognise that a person with a learning disability is unwell failure to make a correct diagnosis anxiety or a lack of confidence for people with a learning disability lack of joint working from different care providers not enough involvement allowed from carers inadequate aftercare or follow-up care

Question 87

What challenges do refugees face in accessing healthcare?

Answer 87

Family integrity and social adjustments trump medical issues for most arriving refugees Competing demands of distinct services such as: social welfare, education, housing, transportation, public health, mental health, primary care, and specialty care encountered by refugees may overwhelm them and limited resources Language barriers impede the adjustment process Some refugees with urgent and complex medical conditions are unable to establish care and specialty referrals in a timely manner Underdeveloped or eroding health care systems in the countries of origin or first asylum leave many refugees with poorly controlled or undiagnosed chronic medical conditions Most refugees are unfamiliar with the biomedical practice of preventive medicine and primary health care Public health’s infectious disease screening results are not communicated to those providing ongoing medical care Exposure to violence, torture, warfare, and internment is common, even among children Loss upon loss is the nature of refugee life and so depression, PTSD, and anxiety are prevalent and often unrecognized Anti-immigrant sentiments further burden refugee life in the U.S.

Question 88

What health inequalities do prisoners face?

Answer 88

more likely to smoke more likely to use illicit drugs more likely to have mental health conditions more likely to be involved in violence, accidents and higher suicide rate

Question 89

What health inequalities do LBGTX people face?

Answer 89

higher suicide rate more likely to have mental health condition depression/anxiety

Question 90

What factors can reduce health inequalities?

Answer 90

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, Keep Well campaign Time to invest in the 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 Ensuring equal access to education in all areas Improved housing in deprived areas

Question 91

What is the difference between equality and equity?

Answer 91

Question 92

What are the benefits of volunteering

Answer 92

gain confidence learn a new skill meet people take on a challenge

Question 93

Why is global sustainability important to healthcare?

Answer 93

Material Inequality * Population and Consumption * Resource Depletion * Climate Change * Loss of Biodiversity * Crisis in Healthcare

Question 94

List some actions that could be taken to slow global warming

Answer 94

Increase use of renewable energy resources ( that is any natural energy resource that can be replenished with the passage of time) Modifying human behaviour, being more active Move back to more plant based diet Educate on carbon literacy and numeracy Promote patient resilience Teach healthcare students that as well as human anatomical systems we are also part of a wider ecological system

Question 95

List some ways the NHS could improve sustainability

Answer 95

Prioritise Environmental Health Substitute harmful chemicals with safer alternatives. Reduce and safely dispose of waste Use energy efficiently and switch to renewable energy. Reduce water consumption 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 96

What questions should you ask in an occupational history?

Answer 96

A description of the present and previous jobs from leaving school. Identifying any exposure to chemicals or other hazards ( may need to see confirmation from labels). Did the symptoms improve when not exposed e.g. at weekends, holidays? Determine the duration and intensity of exposure e.g. was it so noisy it was impossible to communicate Is personal protection used e.g. what kind of mask? What maintenance is in place for the protection measures? Do others suffer similar symptoms? Are there known environmental hazards in use? Any hobbies, pets, worked overseas, moonlighting?

Question 97

Describe the components of the Fit Note

Answer 97

 It’s purpose is to facilitate earlier discussion about returning to work and about rehabilitation. It now includes items of consideration for employers when signing a patient’s return to work. It can only be completed by a Doctor It is advice to patients as employees, is not binding on the employer and does not affect Statutory Sick Pay It is required if the patient has been off more than 7 consecutive days ( including non working days)

Question 98

What are the aims of realistic medicine?

Answer 98

●Build a personalised approach to care ●Change our style to shared decision-making ●Reduce unnecessary variation in practice and outcomes ●Reduce harm and waste ●Manage risk better ●Become improvers and innovators

Question 99

What areas of health are affected by health promotion?

Answer 99

access environment lifestyle

Question 100

Define health promotion

Answer 100

an overarching principle which enhances health. It includes health education, disease prevention and health protection It may be opportunistic or planned

Question 102

Define health education

Answer 102

An activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.

Question 103

Define health protection

Answer 103

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

Question 104

What are the benefits of empowerment?

Answer 104

An ability to resist social pressure. An ability to utilise effective coping strategies when faced by an unhealthy environment. A heightened consciousness of action.

Question 105

Draw out the circle of change

Answer 105

Question 106

Give some examples of health promotion in 1) primary care 2) governmental level

Answer 106

Primary Care : Planned or Opportunistic Government : Legislation, Economic, Education

Question 107

Define primary prevention and give an example

Answer 107

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

Question 108

Define secondary prevention

Answer 108

Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology”

Question 109

Define tertiary prevention

Answer 109

measures to limit distress or disability caused by disease