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define domestic abuse

any incidence or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members, regardless of gender or sexuality.
can encompass, but not limited to:
psychological, physical, sexual, financial, emotional.


list the different types of domestic abuse


- not limited to these, can be more than one type


give some ways domestic abuse impacts on health

- traumatic injuries following an assault e.g. fractures, miscarriage
- somatic problems or chronic illness consequent on living with abuse e.g. headaches, GI problems, chronic pain
- psychological or psychosocial problems secondary to abuse e.g. PTSD, attempted suicide, substance misuse, depression etc


in triaging a woman in A&E with injuries, what are some flags that could suggest domestic violence?

'reported as unwitnessed by anyone else'
repeat attendance
delay in seeking help
multiple minor injuries not requiring treatment
presenting 7pm-7am


what must you always consider if you identify a woman as being a victim of domestic abuse?

are there any children in the household - child safeguarding is utmost priority!!


what is the role of doctors in responding to domestic/sexual abuse?

- display helpline posters and contact cards, helps create an environment where people feel able to talk
- focus on patient's safety (and safety of children)
- acknowledge and be clear that behaviour is not ok
- give information and refer on where appropriate
- be part of their process of recognising and escaping abuse
- be open to working with other agencies


what are the components of Maslow's hierarchy of needs, from base to top?

physiological - breathing, food, water, sex, sleep etc
safety - security of body, of employment, of resources, of the family, of health, of property
love/belonging - friendship, family, sexual intimacy
esteem - self-esteem, confidence, achievement, respect of others
self-actualization - morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts


what is the main stated cause of homelessness?

"relationship breakdown"

caused by - mental illness, domestic abuse, disputes with parents, bereavement


list some health problems faced by homeless adults

- IDs incl TB and hepatitis
- poor condition of feet and teeth
- respiratory problems
- injuries following violence/rape
- sexual health, smears, contraception
- serious mental illnesses
- poor nutrition
- addictions/substance misuse


what are some of the barriers to healthcare faced by homeless people?

- difficulties with access - opening times, getting appointments, perceived discrimination
- lack of integration between primary care services and other agencies (housing, social sector, criminal justice system, third sector)
- other things on their mind - focussed on pure survival, not getting a smear
- don't know where to find help


what are some barriers to healthcare faced by Gypsies and Travellers?

- reluctance of GPs to register these groups, and to visit sites
- poor reading and writing skills (many are illiterate)
- communication difficulties
- too few permanent and transient sites
- mistrust of professionals
- lack of choice


define refugee

an adult/child that 'owing to a well founded fear of being persecuted for reasons of race, religion, nationality, social group/political opinion is outside the country of his nationality, and is unable, or owing to such fear, unwilling to avail himself of the protection of that country'


define asylum seeker

someone who has submitted an application to be recognised as a refugee and is waiting for their claim to be decided by the home office


define internally misplaced person

someone who's had to leave their home for similar reasons to refugees/asylum seekers, but has not crossed international borders.


what is indefinite leave to remain?

when a person is granted full refugee status and given permanent residence in the UK.
they have all the rights of a UK citizen.
eligible for family reunion - one spouse and any child of that marriage under age of 18


what are asylum seekers entitled to?

money (£35 per week)
housing - no choice dispersal
NHS care
if under 18, have a social services key worker and able to attend school

NOT allowed to - work or claim any other benefits.

FAILED asylum seekers - not entitled to money/housing/NHS care


what are some barriers to accessing healthcare faced by asylum seekers?

- lack of knowledge of where to get help
- lack of understanding of how NHS works
- language/culture/communication
- hyper-mobility
- not homogenous group
- health not a priority


what physical health problems might an asylum seeker/refugee face?

- common illnesses
- illness specific to country of origin
- injuries from war/travelling
- no prev health surveillance/screening/imms
- malnutrition
- torture, sexual abuse
- infestations
- communicable disease / blood borne diseases
- untreated chronic disease / congenital problems


what mental health problems might an asylum seeker/refugee face?

sleep disturbance
self harm

also, any mental health conditions anybody else could get!


what are some flags that might make you consider loneliness in a patient?

- body language, appearance, talkative, clinging
- denial, boredom
- living alone
- male 50+
- bereavement, recent transition
- mobility
- sensory impairment
- close family nearby?
- quality not quantity of social contact


define social exclusion

dynamic process of being shut out, fully or partially, from any of the social, economic, political or cultural systems which determine the social integration of a person in society


what are the 5 domains of social exclusion?

material resources
civic activities
basic services
social relationships


give some causes of social exclusion

poor health, sensory impairment, poverty, housing issues, fear of crime, transport issues, discrimination, poor coordination, fragility of networks


define disability

relates to anyone who has a physical, sensory or mental impairment which seriously affects their daily activities


what is age related macular degeneration?

central part of retina that's used for detailed work is called the macular - macular disease is the collective term for conditions causing damage
no cure but can sometimes be slowed or halted in some cases with medical treatment, drug therapy or laser treatment.
most common eye condition in the UK.


what is retinitis pigmentosa?

inherited diseases of retina - leads to gradual reduction in vision, initially night and peripheral vision then difficulties in reading and colour vision


what is glaucoma?

condition affecting optic nerve.
once affected, can't be reverse.
often the nerve is damaged before vision loss is noticed


what is diabetic retinopathy?

blood supply to retina is impaired.
if caught early can be treated by laser - stops progression but doesn't restore loss.


what are cataracts?

very common - lens changes with ageing, becoming less transparent - turns misty or cloudy.


how do you calculate a unit of alcohol?

% ABV * ml / 1000