Flashcards in Sem 1 ASBHDS Deck (34)
Describe the WHO definition of health. (3)
A state of complete physical mental and social well-being, and not merely the absence of illness or infirmity.
Describe the five major “causes” of the association between ill-health and deprivation. (10)
Artefact - associations aren’t real, just exist in the data due to the way we measure it.
Social selection - health determines socio-economic status due to ability to work.
Behavioural - people I’m deprived areas are more likely to smoke / drink / not exercise.
Psychosocial - stress of working low paid, low autonomy jobs creates ill-health.
Material - direct effects of the poverty.
Explain the difference between the biological model and the biopsychosocial model. (5)
Biological - only biological factors eg pathogens cause all disease, we need to intervene medically always, psychology has no effect on physical health.
Biopsychosocial - biological, social and psychological factors matter eg lifestyle has an influence, mental health can cause physical disease, people have an influence on their own health.
Describe the characteristics that a condition needs to have to be classes as “chronic” (5)
Lasts long time
Significant impact on the patient
Controlled but not cured
Manifestation can change day to day.
Explain “the work of chronic illness”. (4)
Illness work - symptom management
Everyday life work - draining
Emotional work - difficult to keep happy
Identity work - maintain sense of self
Describe the two views of disability and critique them both. (4)
Medical - disability is deviation from medical norms - stereotyping, lack of social and psychological recognition.
Social - environment finals to adjust, so disability is a form of social oppression - body is left out.
Explain the differences between an impairment and a disability. (2)
An impairment is an abnormality in structure of functioning of the body.
A disability is the affect of the impairment on the functioning of the body.
Define “lay belief”. (2)
The meaning of health to different people, and the socially embedded belief of what health is.
Describe the three definitions of health. (3)
Positive - a state of well-being and fitness
Functional - ability to perform certain things
Negative - absence of illness
Define these behaviours:
Sick role behaviour
Health behaviour - activity undertaken to maintain health.
Illness behaviour - activity of ill people to define their illness and find a solution.
Sick role behaviour - the formal response to symptoms including seeking help.
List 7 factors that influence illness behaviour. (7)
Visibility of symptoms
Extent of disruption to normal life
Frequency and persistence of symptoms
Describe the three groups of people that occur when considering adherence to treatments. (6)
Deniers - don’t believe they have the proper disease (eg asthma) and undergo complex strategies to hide it.
Acceptors - normal life achieved, not stigmatised.
Pragmatists - accept it, but see it as unimportant.
Describe the two types of rationing that could be used to allocate new drugs. (2)
Describe advantages and disadvantages for both. (6)
Explicit: defined characteristics for entitlement and transparency.
+ accountable, debatable, evidence-based.
- outcomes assumed to be the same for all, complex, leaves patients in distress if they don’t meet the criteria.
Implicit: care is limited, but decisions not transparent.
+ faster, undebatable.
- discrimination, based on “social deservingness” doctors don’t like it.
Define these concepts:
Scarcity - resources are limited so prioritisation is inevitable.
Efficiency - getting the most out of limited resources.
Equity - the extent to which distribution is fair.
Effectiveness - intervention provides the desired outcome.
Utility - value an individual places on a health state.
Opportunity cost - the cost of an intervention viewed as “other things we could have bought with this money” foregone.
Explain the difference between technical and allocative efficiency. (2)
Technical - most efficient way of meeting a need.
Allocative - choosing between the many needs to be met.
Describe the four ways of comparing cost and benefits. (8)
Cost minimisation - outcomes assumed to be equivalent, choose cheapest input.
Cost effectiveness - compares interventions with a common outcome. Compared in terms of cost per unit outcome.
Cost benefit - all outputs and inputs are put in monetary terms; this is hard, so “willingness to pay” used.
Cost utility - cost per QALY gained.
Describe an algorithm for working out which is the best type of cost benefit analysis. (6)
Are all interventions equally effective?
- yes: cost minimisation analysis
- no >
Can outcomes be measured in money?
- yes: cost benefit analysis
- no >
Can outcomes be measured in QALYs?
- yes: cost utility analysis
- no: cost effectiveness analysis
Describe 1 QALY. (2)
1 year of perfect health
2 years at 50% health
10 years at 10% health
Describe how to work out cost per QALY. (2)
(Expected number of years x cost per year) / QALYs gained = cost per QALY.
Describe 4 disadvantages of the QALY system. (4)
Resented by patients, politicians and pharmaceutical companies.
Don’t assess impact on careers
May not be representative
Not distributed according to needs.
Define PRO and PROM. (2)
Patient Reported Outcome - a report on the patient health direct from the patient.
Patient Reported Outcome Measure - tools used to measure PROs.
Describe 4 types of PROM. (4)
Generic - any patient population
Disease specific - developed for a particular condition
Unidimensional - focused on one specific symptom
Multidimensional - focused on global health related QoL.
Why are PROMS important? (3)
Symptoms burden / psychological impact is often under recognised
QoL important as well as length
Allows clinicians to team with patients in decision making.
Describe the 8 characteristics that a PROM must have to be released to the public. (16)
Appropriateness - is it going to get what we want?
Acceptability to patients
Feasibility of administration and processing
Reliability and reproducibility
Validity (claiming what it says it does)
Responsiveness - is it important to patients.
Describe three learning theories that influence health related behaviour. (6)
Classical conditioning - memories of “the good times” can prompt a relapse
Operant conditioning - withdrawal sucks and unhealthy food tastes good.
Social learning theory - learning through observed behaviours.
Describe the COM-B model. (3)
The impacts that capability to make a decision, motivation to do so, and the opportunity to show the behaviour influence the eventual outcome of behaviour.
Describe the neoliberalism model of health inequality. Give one major criticism of this. (3)
Choosing to be happy and healthy.
Presents being healthy as something that is equally easy for everyone, meaning the poor people who can’t afford healthy foods don’t deserve to be healthy.
Describe 3 treatment models for substance abuse. Explain how each treats addiction. (9)
Medical - Pharm treatment, focuses on physical conditions eg withdrawal, tolerance.
Disease - avoidance is the only treatment, addiction is a genetically predetermined illness with loss of control as the primary symptom. Uses 12 steps
Behavioural - addiction doesn’t exist, it’s just poorly learnt coping mechanisms. Address experiences and teach coping.
Give three examples for harm reduction in substance abuse. (3)
Alcoholism - vitamin B suppliments
Opiates - naloxone
Injecting - needle exchange, BBV screening.