socpop Flashcards

Question

Outline the process of death registration

Answer 1

- Death certificate is issued by doctor to certify the fact of death, the age and place of death and information on cause of death - death registration by informant (usually relative) within 5 days and to local registrar for births, marriages and death - office for national statistics mortality statistics

Answer 2

the disease or injury which initiated the train of morbid events leading directly to death, the circumstances of the accident or violence which produced the fatal injury

Answer 3

- is not particularly accurate in terms of the what the patients died from - also doesn’t record ethnicity or socioeconomic status.

Answer 4

Live births/1000 people in population.

Answer 5

Live births/1000 women in pop. Of childbearing age. (Aged 15-44.)

Answer 6

The number of live babies that would be born if every woman lived to menopause and gave birth in accordance with the current, age-specific fertility rate.

Answer 7

Used for resource allocation and planning of services. Need to understand what has happened in the past, what is currently happening and make predictions and plan for the future.

Answer 8

is the estimate of population size and structure beween census = Census baseline + births – deaths ± migration.

Answer 9

+’s: More up to date than the census, more accurate than projections. -‘s: Less reliable further away from the census, migration info isn’t great, and says nothing about future trends.

Answer 10

forecast future population size and structure = based on assumptions about the future migration, fertility and mortality. Forecasts future structure of the pop.

Answer 11

+’s: Can aid in planning, more long term. | -‘s: Less accurate the further forward you go. Unforeseen changes can render invalid. Aging population

Answer 12

Cancer registration system... -screening efficacy, research and prevention and care planning. ONS. , improvement of treatment, aiding cancer research, evaluation of screening programmes -Strengths = detailed info updated over time, record linkage to cancer deaths (ONS) -Weaknesses = expensive, access is difficult due to confidentiality Notification of infectious disease: - Public health England. -31 notifiable diseases in England and Wales -Uses: action to prevent further infection, identify outbreak, monitor trends -Dr suspects a case – notifies proper officer at local council or local health protection team, public health England collates and produces national trends each week -Strengths=timeliness as weekly report, representative -Weaknesses = poor or variable completeness for some diseases e.g. some treated at home, diagnostic uncertainty NHS activity data: -Including Hospital Episode Statistics (admissions, outpatients and A&E visits in all of the Trusts in England, info on personal info, clinical info, administrative data such as date of admission and discharge, geographical info where treated and lives) -Uses: trends in NHS hospital activity, supports local service planning, health trends over time, fair access to healthcare -Strengths= completeness as covers all hospital activity, accuracy as standard codes used, representative -Quality and Outcomes Framework – rewarding good practise to improve care, GP practises are scored against indicators, higher score means higher GP income

Answer 13

The key concepts are that patient is treated how they wish to be treated, care is tailored to them, shared in the decision making and holistic care

Answer 14

- person is treated with dignity, compassion and respect - care is personalised = seeing the whole person, putting their needs first, as they define them, tailoring therapeutic plans and services to pts needs Etc. - care is enabling = They are part of the decision making and are taught to manage their own condition – ie. Empowering, pt and public involvement in the design and delivery of services. - care is coordinated = Across multiple episodes and over time. Integrated care between health services, social services, across primary, community, hospital and tertiary care services and through transitions e.g. child to adult services

Answer 15

Evidence of +ve outcomes for patients – Better care satisfaction. Less emergency visits, greater concordance. Social and political drivers – less hierarchical relationships, pts want to be involved, patient dissatisfaction with NHS, spiralling economic cost, low care standards (e.g. Mid Staffordshire NHS trust, Winterbourne View Hospital serious care review) Concurs with the ethical principles underpinning the duties of a Dr. Wider society = Less hierarchical relationships, less defence, more critical public, patients essentially, want to be involved. Pt dissatisfaction with the NHS (surveys.) Helping to reduce the spiralling costs of the NHS.

Answer 16

- Doctor makes the decisions, underlying assumption that the dr knows best. Expectation that patient will agree - Patient takes a passive approach – answering questions.. Works on the premise that “Dr knows best.” - Information flow: largely from dr to pt, often minimal info given

Answer 17

+’s = Appropriate in some situations, such as emergencies. Some pt’s prefer this approach. (Autonomy can be either way) Works with the underlying ethics of best interests of the pt and beneficence. -‘s = May not facilitate autonomy. Creates an environment in which the pt feels they cannot express their ICE.

Answer 18

Two way exchange of info between pt and dr at all stages. Both parties are equally involved in the decision making. Both bring expertise. - doctors bring medical expertise about diseases and treatments - patients bring personal expertise (but have some knowledge about their condition and treatment) - Each participant seen as having some limitations to their knowledge. If they disagree, negotiation begins. Advocated model. - Patient and doctor reach a decision together about best course of action/treatment: - Each reveal treatment preferences - Come to an agreement and decision on how to proceed - Challenge for doctors is to create an environment in which patient feels able to express treatment preferences

Answer 19

``` +’s = Creates an environment in which both parties are equal. Gives the pt autonomy and control over their own care, with the medical guidance of the doctor. Allows autonomy but shares responsibility. -‘s = Careful not to persuade/coercion. Not appropriate for some situations, such as emergencies/mental capacity act. ```

Answer 20

* Doctor communicates all relevant information and treatment options, and the risk and benefits, to patient * Doctor communicates sufficient information for patient to make an informed treatment decision - information giving is doctor’s key contribution * Patient is active and expects to make the decision * Decision making is sole prerogative of the patient

Answer 21

``` +’s = Works on the principle of facilitating autonomy. Good for the expert patient. -‘s = Respecting autonomy is not just about giving information. Information overload possible in some situations, which blocks autonomy. Too much responsibility on pt? Bad decision = psych harm? ```

Answer 22

``` shared model Shared decision making.... • Consultations feel more satisfying • Patients seem more engaged • Increased engagement leads to better outcomes • It is what I would want as a patient • It may seem time consuming initially, but in my experience creates less workload Positive outcomes: - Increased patient satisfaction - Reduced anxiety - Improved adherence with medication - Improved self-management of conditions and therefore better outcomes ```

Answer 23

Correlates well with other proxy measures. Highly sensitive to social determinants and epidemics, so a good indicator of what is happening “here and now.” High rates in UK. Sensitive to changes in social and economic conditions

Answer 24

Life expectancy at birth is an estimate of how long a baby born will live, based on the demographics surrounding it. The average number of years can expect to live in a state of general ‘good’ health

Answer 25

the no. of years an individual can expect to live without a limiting chronic illness or disability.

Answer 26

Often indicates the socio-economic climate of a country, as once a country develops from pre-industrial to industrial economies, see a change in demography. Less acute deaths, less communicable disease, less deficiency disease, and longer life expectancy. But chronic disease and non-communicable disease rates become higher. Countries at a later stage of epidemiological transition have high rates of chronic diseases and low rates of infectious diseases

Answer 27

Men: Cancer (lung, prostate, bowel,) circulatory system, resp system. Women: Cancer (lung, breast, bowel,) circ system, resp system. Men live a greater proportion of their life in good health overall The main single cause of death in the UK is dementia.

Answer 28

Systematic differences in health and illness between different social groups. Variations are not random, and some groups live longer than others.

Answer 29

Clear, stepwise gradient in health. With each step down the social ladder, health becomes poorer. Not just between the most privileged and most deprived groups, but evident across the whole spectrum. (Exceptions = breast, prostate and skin cancers.)

Answer 30

Geographical – Variations between regions and neighbourhoods. Town vs country, North vs South. Morbidity and mortality rates consistently higher in north and west and in urban areas. Can be substantial inequalities in morbidity and mortality rates within local areas Socioeconomic (see above) Gender – Women live longer but more health probs throughout life. Men more steeply affected by the social gradient. Ethnicity – Non-white minorities, in general, suffer worse health than the white majority. These inequalities become more pronounced with age.

Answer 31

A number of ways: occupation, income, education, access to or ownership of assets (housing, car), index of multiple deprivation. BUT The Registrar General’s socio-economic classification is based on occupation, which is proxy for status, income, education etc., most commonly used to look at health inequality

Answer 32

Health inequalities are seen as a result of variations in health behaviours and lifestyles, eg. Smoking, diet, exercise, etc. Health behaviour choices are seen as a result of individual choices/knowledge/culture. Rates of smoking etc are higher in more disadvantaged groups, but that obvs doesn’t mean everybody does etc. They have more to worry about than to be thinking about their health in the future. (Marmot review.) BUT this only accounts for about 50% of the difference… - Most important health behaviours follow the social gradient – smoking, lack of physical activity, poor nutrition

Answer 33

- Socio-economic groups have varying access to material resources. Poorer access to income, housing, food, fuel for heating, transport, healthy meals, social activities, exercise facilities. Health = direct effect of pverty and deprivation. Shaped by broader factors, such as place in society, policies etc, so at the community level as well as the individual level. - In general, higher income is associated with a better diet - more fruit and vegetables, higher fibre intake, lower intake of sugars - Lower income groups spend more of their income on food, leaving less money for other things - Higher calorie, low nutritional value foods are cheapest - Social security benefits inadequate for a healthy diet - Poorer access to material health resources at the individual level - Poorer access to material resources at the community level: - Underinvestment in physical, social and health infrastructures has greatest effects on lower socio-economic groups

Answer 34

Health inequality is directly linked to how their environment makes them feel. - Direct = “allostatic load” physical disease and the link to the neuroendocrine pathway. - Indirect = adoption of unhealthy behaviours such as smoking. - Psych stress leads to worse health outcomes. People lower down the gradient are more stressed. Stress associated with position in hierarchy

Answer 35

: ‘Actions aimed at eradicating, eliminating, or minimising the impact of disease and disability, or if none of these is feasible, retarding the progress of disease and disability.”

Answer 36

Actions aimed at increasing the control people have over their health and its determinants, thereby improving health. This involves positive and inclusive model of health, including physical, mental and spiritual wellbeing.

Answer 37

Primary: Pre-disease, Prevention of the spread of disease and contraction of such it in the first place. Eg. Immunisation, health education in schools. Secondary: Latent or early stage of disease, Screening programme to catch and treat disease before it progresses/shows any signs and symptoms. Eg. Breast/prostate cancer screening. Tertiary: Treatment of symptomatic disease that cannot be cured. Minimise the effects of the disease as much as possible, and improve quality of life. Eg. Stroke rehabilitation, palliative care.

Answer 38

High risk = specific individuals, bring preventative care to individuals at high risk. strengths: appropriate to individual, high patient and doctor motivation, ?cost effective weaknesses: high resources on identifying high risk, medicalise prevention, stigmatise individuals, limited effect at population level

Answer 39

Population approach = directed at the whole population irrespective of individual risk levels. Approach is directed towards socio-economic, behavioral and lifestyle changes. Strengths: high benefit for population as a whole, attacks root causes, shifts cultural norms, can work passively weaknesses: benefit is small for each individual, low subject motivation

Answer 40

-medical: screening, immunisation -behaviour change: encourages healthier behaviours -educational: provide information, informed choice -client centered:health issues identified by client/community -societal change: change physical, soocial and economic environment need a mix, no 'right'approach

Answer 41

Quadrant approach. Health Persuasion - behaviour change, education/advice, mass media/social marketing legislative action - legislation, policy making/implementation, health surveillance personal counselling - counselling, empowering individuals to make changes community development - lobbying, community development, action research, skills sharing

Answer 42

- Fairness and social justice - Health as a human right - To reduce the costs associated with premature deaths and illness – to individuals and the state - Good medical practise can make a difference – clinicians, advocates, clinical leads, managers, educators

Answer 43

1. Give every child the best start in life 2. Enable all children, young people and adults to maximise their capabilities and have control over their lives 3. Create fair employment and good work for all 4. Ensure healthy standard of living for all 5. Create and develop healthy and sustainable places and communities 6. Strengthen the role and impact of ill health prevention

Answer 44

• Reduce the social gradient –‘progressive or proportionate universalism’ –Action across all social determinants •Action across all sectors •Participatory decision making at local level

Answer 45

To yield a more even distribution of health across different social groups. Population wide approach •Aim = a more equal distribution of health chances across socio-economic groups – i.e. reduce the gradient •Need absolute improvements for all groups but a rate of improvement which increases at each step downwards on the socio-economic ladder •Provide resources and services at a progressively greater level as needs increase •This is progressive or proportionate universalism

Answer 46

tackle wider influences on health through public policy approaches eg. Taxation, reducing poverty, reducing price barriers.

Answer 47

Tackle health behaviours, lifestyles – e.g. smoking, diet, access to care

Answer 48

* Need absolute improvements for all groups but a rate of improvement which increases at each step downwards on the socio-economic ladder * Provide resources and services at a progressively greater level as needs increase

Answer 49

* Workplace interventions that increase employee control over work environment have positive impact Housing interventions to improve standard of housing, more choice for low income families * Resource provision and fiscal interventions * Free folic acid supplements * Tobacco price increases * Improving educational level for children and young people High quality parenting programmes and smoothing transition form home to school * Incentivised prescribing - e.g. preventive medication for IHD

Answer 50

–Inverse prevention law’ –Even where interventions are successful in improving health across the nation, they may increase health inequalities •Where an intervention benefits advantaged (low-risk) more than disadvantaged (high-risk) groups –‘Intervention generated inequalities’ •Evidence of intervention generated inequalities –Mass media campaigns on ‘stopping smoking’ and folic acid intake –Work place smoking bans

Answer 51

Progressive Universalism - Levelling everybody up, some groups more drastically than others. Therefore, everybody improves, but eventually all on the same level. THIS IS THE GOOD WAY TO DO IT.

Answer 52

Levelling everybody out, but this approach means bringing the higher groups down as opposed to bringing everybody up but at different rates. BAD WAY.

Answer 53

•Knowledge and skills: –Knowledge of social determinants –Practice-based skills: taking a social history, referring patients to non-medical services, placements in disadvantaged areas •Working with individuals and communities •Tackling health inequalities among NHS staff •Working in partnership with other agencies •Working as advocates for individuals, communities and general population

Answer 54

The biologically-determined (and physical) characteristic differences between males and females. The assignment/classification of people as male, female, intersex or another sex, often based on physical anatomy at birth or karyotyping.

Answer 55

- Socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for males and females - Differences in health are more pronounced when younger. - Heteronormativity: society’s assumption that relationships between the opposite binary sex individuals (heterosexuality) are the norm or default

Answer 56

Internal sense of one's own gender

Answer 57

(she/he/they): getting it right is a basic way to respect a person’s gender identity

Answer 58

an umbrella term for people whose gender identity differs from the sex they were assigned at birth. The term is not indicative of gender expression, sexual orientation, hormonal makeup or physical anatomy

Answer 59

a person’s physical, romantic, emotional or other form of attraction to others

Answer 60

Women have a higher life expectancy at birth than men. Men are more likely to die at all stages of the life course than women. Women report more disease and use the health services more. Women are more likely to suffer from mental illness such as depression and anxiety. Morbidity rates: few differenced for many diseases once socio-economic differences are controlled for. However women live a greater proportion of their lives in poor health and with disability. Mental illness rates: higher among women

Answer 61

* Boys more vulnerable in infancy * Immune system differences * Some hormone differences * Cardiovascular reactivity * Neuroendocrine responses

Answer 62

Men: - Higher smoking rates -Consume more alcohol -Strong association between heavy drinking, depression and suicide in men -Men have higher rates of hospital admission for alcohol-related problems Women: -Lower smoking rates but more difficulty quitting -But health behaviour patterns shaped by social and economic contexts

Answer 63

* How social roles and experiences shape health * Gender inequality: damages girls and women’s health globally (WHO, 2007) * UK: * pay gap of 10% between men and women (ONS, 2017) * Slightly higher rates of poverty among women: lone mothers and pensioners * Work environments: improved for men and women but accidents still higher for men - * Expectations about males and females associated with health and other behaviours * Gender-sanctioned health behaviours and health seeking behaviours: * Men’s health-related behaviours are means by which men demonstrate their masculinity; how men gain status as men * Men often use ‘masculine-sanctioned’ coping behaviour to relieve stress despite potential damaging consequences * Accidents: men are at higher risk due to exposure (work, driving, risk-taking) * Women: caring often portrayed as women’s work – is associated with physical and mental ill-health

Answer 64

* Prostate cancer: men only – difference rather than inequality * Breast cancer: * higher rates in women – difference not inequality * Lower survival rates in men: gender inequality

Answer 65

Women are more likely to consult their GP than men. Men are more willing to use A&E and locums instead of the GP. Wellbeing checks are less well attended by men than women. Men are 50% more likely to die from skin cancer than women, despite a 50% lower incidence of the disease.

Answer 66

A concept that concentrated on the presumed differing characteristics between differing group of people. This is a discredited concept, as it is based not on scientific evidence, but prejudice and reinforces racist views. •Historically term used to argue for the existence of inherent biological differences between populations •Observed differences used to support argument that some populations were superior to others and used to justify subjugation of some populations •Populations are physically and genetically more similar than different

Answer 67

No reference to biological/genetic traits - A long shared history, of which the group is conscious as distinguishing it from other groups, and the memory of which it keeps alive - A cultural tradition of its own, including family and social customs and manners, often but not necessarily associated with religious observance.

Answer 68

Ethnic minority groups generally have poorer health than the majority white population but the health experience of different ethnic groups is not uniform. Infant mortality rates by ethnicity: there is a significant inequality between white British and the other ethnic minorities such as Pakistani, African or Caribbean. Individuals identifying as Gypsy or Irish Traveller, and to a lesser extent those identifying as Bangladeshi, Pakistani or Irish, stand out as having poor health across a range of indicators Common mental disorders: -Evidence patchy and inconsistent, Gypsy or Irish Traveller people appear to have much higher rates of anxiety and depression than other groups -Black men have higher reported rates of psychotic disorder than men in other ethnic groups -Lower levels of reported ‘wellbeing’ among most minority ethnic groups than the White population CHD + Stroke - People of Bangladeshi and Pakistani origin are most likely to die of circulatory disease. People born in India, East Africa and Ireland are also more likely than average to suffer these diseases. Hypertension and Stroke – Higher rates of these in people born in the Caribbean and West/South Africa. Diabetes – High, but variable rates of diabetes across all non-white groups. • People of South Asian family origin: oup to six times more likely to have type 2 diabetes than the white population (NICE 2011) oLikely to develop type 2 diabetes 10 years earlier (Nicholl et al. 1986) •People of African and African-Caribbean descent: othree times more likely to have type 2 diabetes than the white population (NICE 2011)

Answer 69

some diseases have a strong genetic link, eg. Sickle cell anaemia. But this doesn’t fully explain. - Often based on the notion of ‘genetic homogeneity’- ethnicity and ancestry used as a proxy for genetic risk. - But based on outdated biological concept of ‘race’ – population specific alleles can only approximate relative genetic contribution for major continents. - Some congenital anomalies and haemoglobinopathies strongly influenced by genes but ethnicity not always helpful in helping to identify at risk groups. - Epigenetics: genes are affected by the environment. - Genes and biology cannot explain all ethnic inequalities in health. Sickle cell and thalassemia are strongly influenced by our genes. All pregnant women now are screened for thalassemia.

Answer 70

Concentrates of the customs and traditions of particular ethnic groups. Does not explain why they suffer the same health problems. “Cultural blaming.” •Seek to locate the poorer health of ethnic minority groups in the nature of what it is to be a member of that particular group •Often focus is on health beliefs and behaviours of ethnic minority groups e.g. – ‘Asian rickets’ caused by deficient South Asian diet – High ghee content of some Asian diets •Diverse range of health behaviours and lifestyles among minority groups: – Smoking – Exercise

Answer 71

- Migrants selected by health characteristics – usually have better health among population of origin - Health of migrants tends to revert to the mean standard of the population of origin – produces a relative decline in health compared to health in country of destination - Migration experiences diverse but is evidence that experiences before, during and after can affect physical and mental health - The ‘Salmon Bias’ phenomenon – people returning home when ill could artificially reduce the mortality rate of migrant populations

Answer 72

- Ethnic inequalities in health reflect the broad patterning of socio-economic inequality among ethnic minority groups (Nazroo) - Socio-economic factors make a major contribution to ethnic differences in health - Socio-economic factors have been found to be more important than other more factors - Affects access to health resources: housing, food, exercise etc.

Answer 73

Conducts/words/practices that disadvantage people based on their colour, culture or ethnic origin. Daily occurrence for many people of ethnic minority groups, and whether overt or subtle, it is just as damaging.

Answer 74

- direct - indirect - institutional

Answer 75

People are treated less favourably due to their colour, culture, ethnicity, religion.

Answer 76

People that are unaware that their actions are undermining an ethnic minority group/s.

Answer 77

The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. Encompasses attitudes, behaviour, thoughtlessness, stereotyping and prejudice.

Answer 78

Pneumonic: “The Five Bears Baked Sally A Raspberry Coloured Interesting Cake” * Threat – awareness of a danger or potential threat * Fear – emotional arousal by perceived relevant threat * Barriers – preventing response/behaviour * Benefits – positive reward/consequence * Subjective Norms – the view of others and how relevant * Attitudes – evaluation/beliefs about the behaviour * Response efficacy – perception of response in preventing the threat * Cognitions – awareness of thoughts and perceptions * Intentions – plans to carry out the response/behaviour * Cues to Action –external and internal factors that influence decision making

Answer 79

* Creatures of Habit * Simply just giving information is not effective * Short term vs long term * Being told what to do * Motivation

Answer 80

Encouraging people to make healthier choices for better health by: Systematically promoting the benefits of healthy living. Asking individuals about their lifestyles, responding appropriately and taking appropriate action. It’s a “chat for change.”

Answer 81

* Need to explore patient's perceived susceptibility, severity, benefits and barriers. * Use education for perceptions of threat and goal setting/action planning and problem solving to help overcome barriers. * Example (Changing a risky health behaviour: Smoking) * Exploring perceived susceptibility and severity * How do you think smoking is affecting your health? (current susceptibility) * How might it effect your health in ten years time? (future susceptibility) * What would it be like if that happened to you/you got the illness (Severity) * Exploring perceived susceptibility and severity * Then educate patient about the risks of smoking which can increase the perceived susceptibility and severity. * Perceived benefits and barriers * What are the pros and cons of smoking for you? (current benefits and costs) * Is there anything stopping you from giving up? (current barriers) * Then work with patient to problem solve and overcome barriers and reinforce educate about the benefits of giving up.

Answer 82

* Research shows that the TPB can predict between 55 and 71 percent of intentions for the following health related behaviours: smoking, testicular self examination, exercise, diet and oral hygiene (Ayers and De Visser,2010). * Example (Changing a risky health behaviour: Smoking) * Explore attitude: What do you think about smoking? * Is smoking a good or bad for you? In what way? [Educate!] * Explore perceived norms: What do your family/friends/partner think about you smoking? (normative beliefs) * Whose opinion is most important to you? (motivation to comply) * Would you like to give up smoking for (person)? (motivation to comply) * Explore intentions * Have you ever thought about giving up smoking? * Do you intend to give up smoking in the next few months? * Explore perceived behavioural control * Do you think you can give up smoking? * If control low you can explore further by asking why? Try to normalise situation and explore ways around the obstacles. * If perceived control is high, ready to attempt behaviour change then work with patient to plan next steps.

Answer 83

Smoking – Don’t. 4 times more likely to quit if have help. Over 50 diseases and conditions. Drinking – No more than 14 units weekly for M and F. Binge drinking is 6 units or more in women and 8 units of more in men. 2 days detox per week. Healthy eating – “The Eatwell plate.” 0.5-1kg per week = healthy weight loss. Normal BMI is 18.5-25. Diabetes, heart disease, stroke etc… Physical activity – 30mins x 5days per week. Lower risk of many chronic diseases, depression, dementia, stress.

Answer 84

Tackles lifestyle factors such as maintaining a healthy weight and diet, stopping smoking, drinking in moderation, mental health and sexual health. Most serious illnesses are caused by or perpetuated by unhealthy lifestyles. Adopting healthier lifestyles can have a huge positive effect on people’s health, triggering the thought to do so through MECC. Improved outcomes for patients. Education can help to narrow the health inequalities in society. Plus, it is part of the duty to care.

Answer 85

Beliefs of non-medical professionals. Assumptions about the world, things we believe to be true. Often complex roots, ideas about how disease/illness should be treated, who should do so etc. •Beliefs are things we believe to be true •Perspectives of ‘ordinary’ people •Often complex and sophisticated •May be sensible or irrational

Answer 86

• Rooted in socio-cultural contexts in which we live •Shaped by people’s: – place in society – culture – personal biography (experience) – social identify e.g. gender, sexuality, middle class, ethnicity – Not simply due to lack of knowledge or diluted versions of medical knowledge

Answer 87

- Allows insight into the needs of the patient – ie. Education, support. - Allows us to understand health-seeking behaviours. Ie. Response to symptoms, expectations about the treatment, concordance with treatment plans and decisions about consulting.

Answer 88

• The values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world.

Answer 89

•Shapes how people make sense of experience: –is not homogenous, static or consist of a list of traits or beliefs shared by a social group •Culture shapes the way we think, feel and experience our lives •We all participate in multiple cultures: –linked to our ethnicity, nationality, social class, and other aspects of our identity like gender, sexual orientation or religion.

Answer 90

Only the tip of the iceberg actually come to the GP, the rest do nothing/self-medicate/see somebody else. One third do seek help and then two thirds don’t. The decisions to consult are influenced by perception, explanation and evaluation of symptoms.

Answer 91

•Interference with social and personal relationships •Interference with vocational or physical activity •‘Sanctioning’ by others – influence of lay referral system •A ‘temporalising’ of symptomology •Interpersonal crisis Delays in seeking help Case study: Transient ischaemic attack •Perception of symptom relevance/seriousness: – infrequent symptoms, short duration • Symptom explanation: – make sense of symptoms by finding alternative explanations: – ‘it’s my eyes’, ‘it’s my age/I’m too young’ ‘I’m over tired’, ‘it’s probably my new tablets’ • Symptom evaluation: – often not perceived as serious as short-lived, will seek help if it happens again, may discuss with family or friend (lay referral system), recover so not much doctor can do

Answer 92

Explanation of symptoms: How they make sense of it in the context of their lives. Perception of symptoms: Frequency, severity etc. Evaluation of symptoms: Costs and benefits of seeking help.

Answer 93

Behaviours that are related to the health status of an individual. Good health behaviours: Sleeping (7-8 hours), regular exercise, healthy eating, eating breakfast every day etc... Health protective behaviours: Wearing a seatbelt, attending regular check-ups, health screening etc… Health impairing habits: Smoking, eating a high fat diet, alcohol abuse etc…

Answer 94

psychological processes direct path to physical health psychological processes and physical health indirect path related to behaviour see diagram in notes

Answer 95

* Background factors: Characteristics that define the context in which people live their lives * Stable factors: Individual differences (personality) in psychological activity that are stable over time and context * Social factors: Social connections in the immediate environment * Situational factors: Appraisal of personal relevance that shape responses in a specific situation

Answer 96

•Stable factors: i.e. individual differences, personality •Refer to variations between people in psychological activities that, within people, produce responses that are stable across time and context •Influence appraisal in three key ways: –they determine if, and to what extent, an event is salient, i.e. sensitivity towards particular types of event –they provide a generalised framework for understanding and evaluating the event, e.g. as threat or challenge –they make available, or suggest, potential responses, i.e. initial response options

Answer 97

–Emotional dispositions: Psychological processes involved in both the experience and expression (Present) –Generalised expectancies: Psychological processes involved in formulating expectations in relation to future outcomes (Future) –Explanatory styles: Psychological processes involved in explaining the causes of negative events (Past)

Answer 98

- Openess to new experiences = intellect and interest in culture;artistic, curious, imaginative, wide range of interest - Conscientiousness=the will to achieve; self-disciplined, efficient, organised, reliable, thorough - Extroversion=outgoing;talkative, enthusiastic, assertive and active - Agreeableness=loving, friendly and compliant; sympathetic, appreciative, trusting, kind, forgiving, generous - Neuroticism = experience more negative emotions; anxious, tense, worried hostile, self-pitying, vulnerable

Answer 99

Belief in one’s own ability to organise and execute a course of action, and the expectation that the action will result in, or lead to, a desired outcome

Answer 100

Expectancies: • Locus of control: Expectations that future outcomes will be determined by factors that are either internal (self) or external (powerful others, and chance) – Internal locus of control is generally associated with more favourable outcomes, and performance of health behaviours, but is dependent on situational factors People with an internal locus of control believe: – they are responsible for their own health, – Illness can be avoided by taking care of themselves – ill health results in part from not eating correctly or not getting enough exercise

Answer 101

Deterministic: inevitability Validation of hypothesis by systematic observations to predict with certainty future events e.g. Tubercle bacillus is the cause of tuberculosis –Newtonian thinking –Mechanistic, can take apart to study –Objective, quantifiable and certain –Whole is the sum of the parts –Very useful in thinking about a single cause for a single disease

Answer 102

``` Stochastic: probability Assessment of hypothesis by systematic observations to give risk of future events e.g. Overcrowded cause of tuberculosis accommodation increases incidence of Tuberculosis –Quantum thinking –Whole greater than sum of parts –Whole not predictable from knowledge of parts –Probabilities cf certainties –Systems theory; complexity theory •The observer influences the observed •Emergent phenomena ```

Answer 103

An additional, unmeasured variable that is connected to both the dependent and the independent variable. Eg. Obesity and CHD, smoking may be a confounding factor. An exposure is independently associated with the outcome after taking confounding factors into account

Answer 104

Rejection of unflavoured outcomes. Prefers studies that support favoured theories. Ie. That a drug works

Answer 105

– Caused by differences in the accuracy/completeness of the recollections obtained from study participants. This is a type of information bias, as it affects the information received as data.

Answer 106

Bias in choosing who will take part in the study. Ie. One might choose patients with less severe symptoms in order to prove that a drug works.

Answer 107

- publication bias - recall bias/information bias: (data collection phase),Interviewer, questionnaire, recall, diagnostic suspicion and exposure - selection bias (design phase, plus execution): Admission, prevalence/incidence, detection, volunteer, loss to follow up - confounding

Answer 108

- strength of association - specificity of association - consistency of association - temporal sequence - dose response (biological gradient) - reversibility (experiment) - coherence of theory - biological plausibility - analogy

Answer 109

``` Systematic reviews Experimental studies Randomised Controlled Trials Controlled trials Observational studies Cohort studies Case control studies Descriptive studies Cross sectional (Qualitative studies) ```

Answer 110

* Studies where data are collected from a sample at a point in time * Can be repeated (usually with a different sample) * Can be descriptive (what is the prevalence?) or analytical (which exposures/risk factors are associated with a specific outcome?) * Good for hypothesis generation * …but can only establish association, not causation

Answer 111

* Analytic studies comparing exposure for a group with a condition (cases) and a group without the condition (controls) * Look backwards * Especially useful for diseases that are rare or have long latent (undetectable or undetected) periods * Can have matched (1+ per case) or unmatched controls * Fast and cheap, and loss to follow-up is not an issue * Good to examine multiple exposures/risk factors * Cannot measure incidence (or prevalence)

Answer 112

* An analytical study in which a group of people e.g. a population sample (UK) or occupational sample (US Nurses Health Study) is followed up over time to compare incidence of an outcome in exposed and unexposed groups * Useful for rare exposures – but not for rare diseases * Usually prospective but can also be retrospective, or historical using administrative data * Can be lengthy and expensive * Can establish incidence * Can estimate dose-response relationships * Evidence of causality when cannot do an RCT

Answer 113

“The experience of living with a long term condition for which there is no other cure, which may be managed with drugs and other treatment.” •Wide range of chronic conditions : –diabetes, chronic obstructive pulmonary disease, arthritis, hypertension, some mental health conditions •Chronic conditions are often degenerative over time •Conditions are the most preventable and costly of conditions

Answer 114

1 in 3 live have at least 1 chronic illness condition

Answer 115

•Search for meaning and explanation – lay health beliefs –Uncertainty and unpredictability –Of the condition •Diagnosis: ‘to suddenly have a name for this thing … was wonderful’ • Daily life: E.g. flare and RA tretment regimes: ‘It’s like a juggling act’ –Of healthcare: ‘More than just minutes of stiffness in the morning •Coping and Resilience: –coping and adaptation –‘Everyone assumes a man to be quite strong’ You’ve got limits, but you’re back to being you again’ (remission in RA) –‘’I’m hurting, I want to kill myself’’ –Shifting normalities •trapped in disrupted normality -Uncertainty/Unpredictability.

Answer 116

``` Areas affected: -ADLs -Sense of self -Social relationships -Social identity (How others see you.) Biopsychosocial impact. Biographical disruption. Reduced quality of life. Make changes to accommodate for coping with/managing the disease. Financial, occupational, social, relationships. ```

Answer 117

* Denial :early stages, helps person take stock, presents difficulty if persists * Normalisation:‘Passing’ as normal): * try to maintain pre-illness state/identify by concealing illness * reluctance to give up activities:Re-designation of ‘normal’ life: * new ‘normal’ develops / new normality * Resignation: embrace illness * Accommodation: deals with the problems of illness, illness not central to their life, becoming an expert

Answer 118

• Often a combination of health (and social) care professional and peer-led activities •Evidence-based programme •Six-week programme suitable for any long-term health condition –Patients –Carers (‘Looking after me’) –Aims to improve self-management: –Motivation, confidence, day-to-day self-care –Confidence to work in partnership with HSCP •Range of topics: –healthy eating, exercise, pain management, relaxation, action planning and problem solving

Answer 119

Pain management = psychological and social factors. Crisis Management = Coping requires finding social and psychological equilibrium. Challenges, set-backs and family (social influences) all contribute to coping and are all important.

Answer 120

Reinforces the message of gate theory, and a combination of psychosocial and physical factors can open and close the gate. Intense, residential or spread over 6-8 weeks. Led by MDT. +’s = Helps patients manage their pain rather then the pain managing/controlling them. Learn to change cognitive perceptions of pain, less catastrophising, challenging unhelpful thoughts Management of stress and anxiety as well as low mood, depression. Not feeling so isolated with the condition when in a group. -‘s = Managing group dynamics Stages of change – are they ready to change their behaviours Commitment Managing fears

Answer 121

: “Caring for somebody that is unable to look after themselves.” - Displaying kindness and concern for others - The work or practice of looking after those unable to care for themselves .... - Can be unpaid or paid, non-contractual or contractual, private or public

Answer 122

staff who work with people in residential care homes, in day centres and who provide personal care in someone’s home

Answer 123

Usually have a more personal relationship with the person. Need extra support because they often need a job as well, so finance etc. Also must consider the burden on the relationship – change in roles for both parties etc. - A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support

Answer 124

•6.5 million adult carers – 10% of adults - black and minority ethnic carers - LGBT carers - young carers: 166,000 young people between the age of 5 and 18 provide care (average age is 12 years)

Answer 125

Keeping an eye, physical care, personal care, practical help, taking them out, paperwork/financial matters etc.

Answer 126

+’s = Identify need for services that are available, recognition to demands and the valuable contributions that carers make, may give them a sense of identity – support groups etc. -‘s = Loss of identity – may end up defining them, locked in a role they don’t want to have, may prefer to define themselves as a son, brother, etc, person being care for may feel undermined by this label.

Answer 127

1. Financial 2. Health (mental and physical,) -May have poorer mental and physical health than non-carers –92% said it had a negative impact on mental health (Carers UK 2014) –Evidence that caring for a child with LLTI/disability increases risk of parent developing LLTI/disability (Blackburn et al, 2011, Kelly et al, 2007) -Injuries due to manual handling -Lack of time to care for own health 3.work - Lower incomes -Higher costs: laundry, heating bills, assistive equipment etc. -Carers UK (2018) –A third report struggling to make ends meet –Almost half report cutting back on essentials –A third report having given up a job to care for someone –1.2 million carers are in poverty in the UK 4.Relationships and social exclusion -Difficulty accessing holidays, leisure pursuits and other social activities -May be harder to maintain relationships and social networks -May get few or no breaks from caring responsibilities •Individuals cared for by relatives less likely to receive services •Black and minority ethnic carers less likely to receive practical support 5.education of young carers.

Answer 128

``` Absence from school Lower educational attainment Behavioural problems/bullying Social exclusion/isolation Stress Physical health problems Traumatic life changes Poverty Lack support and benefits ```

Answer 129

Financial support (from April 2019): -Carer’s Allowance (£66.15p a week) if caring for at least 35 hours a week for someone on a qualifying disability benefit and your earnings are not more than £123 per week Carer Premium payable with means-tested benefits Carer’s Assessment: -Care Act (2014) gives local authorities a responsibility to assess an adult carer’s own needs for support •Social services: legal entitlements: Since April 2015 a social worker from the local authority must visit to carry out a “young carer’s needs assessment” •Schools •Young carers projects

Answer 130

* Opportunities for young carers to take a break from their caring responsibilities, spend time with other young carers and share experiences * They may also: * Support young carers to use local services such as sports clubs, support groups, and health centres. * Provide advice and emotional support through counselling and drop-in sessions * Liaising with schools so that teachers can better support their students * Providing opportunities for young carers to learn more about their parent’s illness or disability Most important: Help the family to find the support they need, and are entitled to, from local services, so that a child’s caring responsibilities can be reduced.

Answer 131

•Identify whether someone has caring responsibilities when discussing their health •Provide responsive health care for carer and person they care for •Consider carer when planning care of patient and discharge planning –Involve carer in all stages of discharge planning (NHS guidance: Ready to Go (2010)) –Carer, as well as patient, can have an assessment prior to discharge –Families and friends have a choice whether to take on caring –Use Carer’s Passport if available –Give early information about rights and entitlements –Signposting carers to services

Answer 132

* Carers Action Plan 2018 to 2020 (UK Gov) * Better access to social care * Better social security benefits for carer and person cared for * Carer-friendly employment policies * Increased awareness of and services for: * Black and minority groups * Child Carers

Answer 133

* Helps patients manage their pain rather then the pain managing/controlling them. * Learn to change cognitive perceptions of pain, less catastrophising, challenging unhelpful thoughts * Management of stress and anxiety as well as low mood, depression. * Not feeling so isolated with the condition when in a group.

Answer 134

* Managing group dynamics * Stages of change – are they ready to change their behaviours * Commitment * Managing fears

Answer 135

The tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions •Promoting good self-management seen as important goal for doctors and health service (RCGP 2011; DH 2014) •Patients not passive recipients of care: actively manage condition •Lay knowledge: knowledge and expertise –‘I know what works for me’ Able to share knowledge and expertise •Self-help groups: individual and collective –Informal support for people with similar conditions –Solidarity, some act as pressure groups

Answer 136

•Patients can take the lead in managing their condition –better outcomes •An expert patient is someone who (aims to): –feels confident and in control of their life –manages their condition and its treatment in partnership with HCPs –communicates effectively with professionals and is willing to share responsibility for treatment –is realistic about how their condition affects them and their family –uses their skills and knowledge to lead a full life

Answer 137

•Often a combination of health (and social) care professional and peer-led activities •Evidence-based programme •Six-week programme suitable for any long-term health condition –Patients –Carers (‘Looking after me’) –Aims to improve self-management: –Motivation, confidence, day-to-day self-care –Confidence to work in partnership with HSCP •Range of topics: –healthy eating, exercise, pain management, relaxation, action planning and problem solving

Answer 138

- felt more confident that their symptoms would not interfere with their lives - felt better prepared for appointments with HCPs - fewer visits to GP and ED

Answer 139

- not attractive to everyone - everyone not able to participare - extra pressure on patient organizations

Answer 140

- Has been applied to a range of chronic illnesses to help understand adaptation and coping - Illness perception questionnaire - Develop appropriate management plan, work with the patient

Answer 141

* Observational studies observe distributions and determinants of health: they do NOT involve interventions * How much disease is there? * What causes a disease? * What puts people at greater or less risk for a disease? * Observational studies can inform health policy, planning and provision and future research

Answer 142

Descriptive studies: - examine distributions - designs:ecological,cross-sectional - e.g.how much measles is there in different regions in the UK Analytical studies: - examine determinants - designs:cross-sectional, case control, cohort - e.g. is vaccination rate related to measles incidence?

Answer 143

1) Measure of effect size - how big is the effect? - how strong is the association? - assess clinical significance - different measures for different types of data/study designs 2) confidence interval (usually 95%) - how precise is our measure of effect? - if we repeated the study 100x, 95% of the effect sizes should be in this range - depends on error factor 3) p-value - how likely is it that we'd have got the size of the effect we have found IF the null hypothesis of no effect/difference is true - assess statistical significance

Answer 144

* Studies where the “unit” of analysis is NOT the individual but a group e.g. school, area, region, country * Generally use available administrative or population-level data * Good for hypothesis generation * …but can only establish association, not causation * Cheap and simple to do * …but data may be unreliable

Answer 145

* Ecological fallacy * Confounding variables * Quality of data (timing) * Selective reporting

Answer 146

* Sample selection bias * Response bias * Recall bias * Responder/Social desirability bias * Confounding variables * Direction of causation

Answer 147

* Response bias (particularly for controls) * Recall bias (particularly for controls) * Confounding

Answer 148

* Selection bias * Response bias * Loss to follow-up * Confounding

Answer 149

- A clinical trial is a scientific way of testing a clinical question. - May want to assess treatments, devices, screening programmes, diagnostic tests, information, supportive care, biomarkers - Need to compare with control group

Answer 150

Therapies allocated by a chance mechanism Neither patient nor physician know in advance which therapy will be assigned Advantages: 1. Eliminate selection bias 2. Balance prognostic factors 3. Validity of statistical tests

Answer 151

* A controlled clinical trial is a prospective study comparing effect(s) and value of an intervention against a control in human subjects * A randomised clinical trial (RCT) is a controlled clinical trial where the therapies are allocated by a chance mechanism * An uncontrolled clinical trial involves no control group

Answer 152

We want groups to differ only in treatment they receive Random allocation •gives equal chance of receiving each treatment •in long run leads to groups that are likely to be similar in characteristics by chance •reduces selection bias if patients enter trial before randomisation •is used in other experimental settings

Answer 153

a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment. “Even if the therapy is irrelevant to the patient’s condition, the patient’s attitude to his or her illness, and indeed the illness itself, may be improved by a feeling that something is being done about it” A difference between ‘new treatment’ group and ‘no treatment’group could be due to.... true treatment effect OR ....placebo effect as one group is receiving care

Answer 154

-strengthens randomisation -Single blind – one of patient, clinician, assessor does not know the treatment allocation (usually patient) -Double blind – two or more of patient, clinician, assessor does not know the treatment allocation (usually patient + clinician/assessor) -Aims to remove differential placebo effect that could bias comparison between treatments

Answer 155

- make treatments appear identical in taste, appearance, texture, dosage regime etc. - Compare active drug with a placebo (inert substance identical in appearance, taste, texture etc.) - Use a designated pharmacy to label identical containers with code numbers

Answer 156

•Analyses only those who completed follow-up and complied with treatments •Compares the physiological effects of the treatments But loses effects of randomisation •Non-compliers are likely to be systematically different from compliers Þ selection bias and confounding

Answer 157

•‘As-Treated’ analyses tend to give larger sizes of effect •‘Intention-to-Treat’ analyses tend to give smaller effect sizes and reflect effect in clinical practice Definitive clinical trials should normally be analysed on an ‘Intention-to-Treat’ basis

Answer 158

Definitive clinical trials should normally be analysed on an ‘Intention-to-Treat’ basis

Answer 159

Clinician should provide best treatment for each individual patient Scientific integrity requires treatment chosen randomly Can these requirements be reconciled? Clinical equipoise: reasonable uncertainty about which treatment (including non-treatment) is better Randomisation does not deny any patient the best treatment

Answer 160

It should be explained – that the patient is invited to be in a trial – what the alternative treatments are (including known side effects) – that treatment will be allocated at random – that patients may withdraw at any time Information should be given – verbally and in writing with ‘cooling off’ time – by a knowledgeable informant

Answer 161

Disability : intrinsic to the individual Restrictions: attributed to physical or cognitive impairments Interventions/services: changing or curing the disabled person It’s a medical problem: people need treatment and central

Answer 162

Individualises the issue of disability Negative /disempowered image ‘Personal tragedy’ Medicine defines and controls disabled people e.g. Zachary/Lorber conflict

Answer 163

Disability is extrinsic to individual - social, attitudinal and physical barriers prevent disabled people from participating in society to the same extent as other people Problem primarily caused by by the way society is organised Public issue: needs socio-political responses

Answer 164

Impairment: Bodily, mental or intellectual limitation or condition Disability: Loss or limitation of opportunities to take part in society on equal basis

Answer 165

Bodily, mental or intellectual limitation or condition

Answer 166

Loss or limitation of opportunities to take part in society on equal basis

Answer 167

Advantages: Disability is not seen as an inevitable consequence of living with impairment Emphasises the need to remove physical, attitudinal and social barriers to full social participation Calls for social and political change rather individual adaptation Disadvantages: Can fail to acknowledge the significance of impairments for individuals

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