EH2 Learning Outcomes Answers PDF

EH2 Learning Outcomes Answers Week 1 • What are the 3 main factors that have shaped Australia’s population structure? Fertility, Mortality and Migration (in and out) • What is crude birth rate? Why is it a limited measurement? This refers to the number of live births per 1000 population. This is...

EH2 Learning Outcomes Answers Week 1 • What are the 3 main factors that have shaped Australia’s population structure? Fertility, Mortality and Migration (in and out) • What is crude birth rate? Why is it a limited measurement? This refers to the number of live births per 1000 population. This is limited in that it includes people not capable of childbearing. Therefore, it cannot be compared with other countries and regions as proportions of women in childbearing years may differ • What is total fertility rate? Why is it more effective? It is the average number of children a hypothetical woman could expect to bear in her lifetime if she experienced current age-specific fertility rates at each age of her reproductive life. Its an age-adjusted measure and therefore can be compared with other populations. • Differentiate between Infant Mortality Rate and Child Mortality Rate Infant mortality rate refers to the number of infants dying before 1 year of age whilst child mortality rate refers to the number of child deaths between ages 1-4. • Why is IMR and CMR effective measures of a country’s development? The causes of infant mortality reflect the economic development, level of illness, social wellbeing and living conditions of that country. • What influences IMR? Influences on IMR include socioeconomic disadvantage and health care factors such as access, hospital services and immunisation. • What are the three leading causes of infant mortality? o Perinatal causes – from complications of pregnancy etc o Congenital abnormalities o Other causes including SIDS • What is crude death rate? Refers to the total number of deaths per 1000 population. • What are the 5 primary causes of death in Australia? o Ischaemic heart disease o Dementia o Cerebrovascular diseases o Lung cancer o Chronic lower respiratory diseases • What are significant differences in Aboriginal and Torres Strait Islander Demographics? (Fertility, IMR, death rates) Younger median age of indigenous mothers and they have higher fertility rate than nonindigenous. As a consequence of TFR being above babies replacement level, the aboriginal population is expanding whilst it is decreasing for non-indigenous. Indigenous populations have higher IMR and child mortality but lower crude death rates due to higher proportion of elderly. • Explain the three models of population pyramids o Expansive – high fertility rates, low life expectancy o Constrictive – declining birth rates, thicker numbers in the middle and each succeeding age group gets smaller and smaller o Stationary – no increase or decrease, population is stable. • Explain epidemiological transition theory This refers to the shift in the disease pattern in which degenerative and man-made diseases displace pandemics of infection as the primary causes of morbidity and mortality. • What did ET arise from? o Rise of living standards o Improvements in hygiene o Introduction of antibiotics o Mass immunization o Progress of medical knowledge and skills • What are the 5 stages of ET? o Stage 1: Age of Pestilence and Famine o Stage 2: Age of receding pandemics – reduction in death due to infection as a result of better medical treatments o Stage 3: Age of degenerative and man-made disease o Stage 4: Age of delayed degenerative disorders – people are living longer due to modern health care, this is increasing the prevalence of degenerative disorders. o Stage 5: Age of emergent and re-emergent infections – emergent (ebola, AIDS), reemergent (pertussis, measles, tuberculosis) • What are the limitations of the ET? Originally, the theory didn’t account for emergent and re-emergent infections. It doesn’t reflect the regional differences within countries such as the co-existence of higher rates of infectious disease and chronic disease – the ‘double burden of disease’. There is a relationship between infections and chronic disease. Infections can influence chronic disease or chronic disease can increase the risk of infection and vice versa. • Explain the demographic transition model The DT model describes how birth rate and death rate influence population growth over time. The model states that societies experiencing modernization, progress from a premodern regime of high fertility and high mortality to a modern one where both are low. • What are the 4 stages of DT? Pre-Industrial Stage o High death, high birth o Slow population growth Urbanizing o Birth rate is high o Death rate falls quickly o Population rises rapidly Mature Industrial o Birth rate falls sharply o Death rate stabilizes o Population still increases Post-industrial stage o Both birth and death rates level off at low levels o Population stabilizes • Describe general demographic patterns for more and less economically developed countries Less economically developed: o High fertility o High infant mortality o High death rates o High out migration More economically developed: o o o o • Low fertility Low infant mortality Low death rates High in migration What is the relationship between DT and ET? DT preceded ET and the ET was derived from the DT. • What is the dependency ratio? A measure of the potential socioeconomic burden on the working age population by the young and elderly. This value is higher for aboriginal populations. Found using the formula: 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅𝑅 = % 𝑜𝑜𝑜𝑜 𝑝𝑝𝑝𝑝𝑝𝑝 𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢𝑢 15 + % 𝑜𝑜𝑜𝑜 𝑝𝑝𝑝𝑝𝑝𝑝 𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜 65 % 𝑜𝑜𝑜𝑜 𝑝𝑝𝑝𝑝𝑝𝑝 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏𝑏 15 − 64 𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦𝑦 Week 2 • Define social determinants of health Social determinants of Health refers to the causes of ill-health, those factors that impact on health and wellbeing – the circumstances into which we are born, grow up, live, work and age. These determinants impact the risk associated with developing disease, the disease and the capacity that people have to prevent and treat illness/disease. There are the ’10 Solid Facts’ from WHO to know: 1. Social gradient 2. Stress 3. Early life 4. Social exclusion 5. Work 6. Unemployment 7. Social support 8. Addiction 9. Food 10. Transport • What is health inequality? Health inequality refers to the differences in health status among the population. • Why is there health inequality? Health inequality exists because of age, ethnicity, gender, education, income, geography etc. Inequality may also be due to factors we cannot change such as biomedical, constitutional or incidental factors, genetics or hereditary factors. • What is health inequity? If there are differences in health status or outcomes that are due to factors that are unjust, unfair or preventable, then this is health inequity. • Differentiate between health equity and health equality Equality – equal access for all, everyone gets the same Equity – equal access for equal need • What is the Social Gradient? The Social Gradient describes the relationship between socioeconomic status and health which is graded, and where the poorest have the worst health status. • What is the Inverse Care Law? An aspect of the social gradient wherein the poorer consistently gain less from health services than those who are better off. • What are explanations for the social gradient? o Natural Selection -> poor people have a biological inferiority or early events in life predispose them to inequality o Behavioral/Cultural -> behavior/culture of poor people triggers their disproportionate health o Structural -> poor housing, overcrowding, poor access to education, unemployment o Psychological/social capital -> inequalities are due to a range of stress-inducing factors in the community that impact on the poor • What is Victim Blaming? Victim blaming is the tendency to blame all health risk factors on patients and not the circumstances of the patient. We forget to consider the causes when a sole focus on changing people’s health ignores the social process affecting them. • Describe Abraham Maslow’s Hierarchy of Need Tiers of needs that build upon one each other and include: 1. Physiological 2. Safety 3. Love/Belonging 4. Esteem 5. Self-actualization • What is stereotyping? Placing people with certain characteristics in a group and making assumptions about them to predict behaviors. • What is institutionalized racism? It is racism that is structured into political, social or health institutions. This occurs when there is discrimination deliberately or unwittingly against certain groups of people to limit their rights • What is social exclusion? Social exclusion is one of the social determinants and refers to social and institutional factors that put people in an involuntary position of being excluded from accessing resources, assets and services, which restrains freedom of choice and capabilities. • What is health literacy? Health literacy refers to the degree to which individuals have the capacity to obtain, communicate, process and understand the basic health information and services needed to make appropriate health decisions. People with low health literacy are less empowered to: o Participate in decisions about their care o Insist on being care informed o Provide feedback about their experiences • How does health literacy relate to social exclusion? Social exclusion can arise from low health literacy or lead to low health literacy. • What are the three levels at which we can address health inequalities? Health Care Providers, Health Care Services, Health Care Systems • How can health inequalities be addressed at the provider level? Providers need to be patient centered and aware of the social determinants of health so that they can identify those needing additional support. Good communication is fundamental to enhancing patient participation, a good example of this is the ‘teach back’ technique where patients are asked to repeat in their own words what they need to know or do, in a non-shaming way. This is a chance to check for understanding. • How can health inequalities be addressed at the service level? (5 aspects to this) There are 5 areas of service improvement that are a part of the ‘chronic disease model of care’ 1. Organisational Influences - Patient centeredness - Use of local workforce - Providing a culturally secure service 2. Information Services - Use IT to support patients to come to the clinic - Record ethnicity to identify at risk groups - Use IT to audit progress 3. Delivery System - Flexible appointments - Develop care plans - Deliver health promotion - Support disease prevention 4. Health Literacy Support - Empower patients with resources - Be an advocate Refer to CHOs 5. Community Linkages - Partner with CHOs - Patient feedback services • How can health inequalities be addressed at the systems level? (5 Principles) There are 5 principles that allow health care systems to contribute greatest to improving health 1. Universal Coverage 2. Access to primary health care 3. Workforce innovation 4. Financial Subsidies 5. Better integration between health systems for the continuity of care Week 3 • How is culture formed through socialization? Culture and personality development begins at birth. It is influenced by our experiences with family, friends and the wider community groups. It is an ongoing process. Culture is learnt through ‘socialization’ on a primary level – takes place during infancy – and a secondary level – influences beyond immediate family. • Why is cultural competence important? Doctors engage with people, not disease, an you will have to work and care for people of many different backgrounds. • What is acculturation? The process by which individuals who have adapted in one cultural context manage to adapt to new contexts that impinge on them as a result of migration, colonization or other forms of intercultural encounters. • What are the 5 phases of migrant acculturation? 1. Pre-contact – members of each group bring their own set of beliefs and live in their insular community 2. Contact – members of each group begin to interact 3. Conflict – members of each group struggle with relinquishing their culture in order to accommodate to the new culture 4. Crisis – members of each group experiences stress and conflict 5. Adaption – members of each group adapt to the new culture and develop effective coping strategies • What is acculturation stress? The process of confronting challenges in cross-cultural exchange settings • Why is acculturation stress more prominent for refugees and asylum seekers? There is a lack of control in their transition into new culture, they had no decision to migrate and no choice in where to go. A lack of preparation and uncertainty contributes to them being stressed to a greater extent. • What are the seven components of acculturation stress? Homesickness Rejection Opportunity deprivation Identity threat Cultural Competence Value Conflict Self-confidence • What issues can occur for young children who are trying to adapt to a new culture? Cultural identity Self-esteem Learning skills Social adjustment Self-confidence • What are the four outcomes of acculturation? 1. Integration – when there is interest in both maintaining one’s original culture but embracing the new one 2. Assimilation – when you do not maintain your cultural identity and instead engage with others 3. Isolation – when individuals place value on holding on to their original culture and avoid interactions with others 4. Marginalisation – there is little possibility or interest in having relations with own culture and others culture. • How is language barrier a challenge in health care? It is an expectation of the health system that there is joint decisions in patient care. Language discordance between patients and health professionals can distort the explanation of symptoms and presentation of health related complaints – limiting access to health promotional material. • When do we elect to use an interpreter? When self-management of medication is required. When social and psychologically complex matters are discussed. When the patient’s safety is the concern. When a patient cannot make a full decision without the full info. • What is xenophobia? Xenophobia is a fear and hatred towards anything and anybody outside one’s own social group, nation or country. • What is ethnocentrism? The cooperation with members of one’s own group and non-cooperation with members of other groups based on cultural values. The tendency to evaluate other groups according to the values and standards of one’s own ethnic group. • What are the three levels of racism? Institutionalized – differential access to resources, services and opportunities in society and healthcare by race. Personal – prejudice and discrimination about abilities and intents of others by race Internalized – acceptance by members of the stigmatized race of negative messages about their own abilities and worth. • How can we improve the cultural and linguistic challenges in a consultation? (5 Steps) 1. Accept a role in helping patients develop skills to participate in consultations 2. Be willing to learn cultural knowledge from patients 3. Operate with appropriate levels of intercultural awareness and competence 4. Accept a role in training patients to develop a degree of intercultural awareness and competence 5. Develop awareness of how and when it may be appropriate to modify consultations. Week 4 • How does life expectancy, burden of disease and mortality rate differ between indigenous and non-indigenous populations? The gap in life expectancy between indigenous and non-indigenous is 10.6 years for males and 9.5 years for females. Burden of disease is 2.5 times higher for indigenous. Mortality rate is 2 times higher than non-indigenous. Most deaths in indigenous occur at young ages. • What are the top 5 leading causes of death in indigenous populations? 1. Ischaemic heart disease 2. Diabetes mellitus 3. Lung cancer 4. Chronic lower respiratory disease 5. Intentional self-harm • What are the broad determinants of Aboriginal and Torres Strait Islander health? Socio-economic status Low incomes High unemployment Poor educational attainment • What are the social determinants impacting social and emotional wellbeing? Intergenerational trauma Imbalanced power relations Limited access to service Systemized and individualized discrimination and racism Poverty and ill-health. • Explain three approaches to help ‘Close the Gap’ 1. Managing upstream environmental factors – for something like trachoma, this is done by addressing issues such as overcrowding and providing access to washing facilities 2. Access to patient-centered health care services – by identifying the patients agenda and understanding the whole patient 3. Recognition of cultural influences – being culturally competent can enhance trust and tailor health care to the needs of the patient. • Describe the impact of culture on Prevention of Disease Cultural beliefs can interfere with patient adherence to disease prevention. Take tobacco for example. Smoking is influenced by a number of cultural values such as obligations (to share), kinships (elders who smoke) and its role as a social activity. However, the impact of smoking on children is the primary motivating factor for indigenous people to quit. • Describe the impact of culture on Diagnosis Beliefs of fear and distrust due to generational trauma cause delayed diagnosis. There can be incorrect belief that some diseases are ‘normal’. Connection to country prevents patients from leaving their land to seek health care until the disease is well advanced and consequently diagnosis can be made at too late a stage. • Describe the impact of culture on Treatment Aboriginal patients are more likely to self-discharge from hospital prior to completion of treatment due to their connection to country, beliefs that they have been sung (cursed) or that traditional medicine is the only viable option. Familial obligations also play a factor. • What is ACCHS? Why was the ACCHS established? Aboriginal Community Controlled Health Services. These are a means of self-determination of indigenous peoples – taking matters into their own hands. They were established on the basis that aboriginal people didn’t trust the existing services, they received poor level and there was poor access, they could not afford the services and the existing services didn’t address the differing health needs or priorities of the Aboriginal population. • What are the targets for ‘Closing the Gap’? Close the life expectancy gap within a generation and increase the proportion of indigenous babies in a healthy birthweight. Week 5 • Compare maternal death rate for indigenous and non-indigenous Maternal death rate is almost 4 times higher for indigenous. • What are the most common causes of maternal mortality? 1. Obstructed labor 2. Thromboembolism 3. Hypotensive disorders 4. Rheumatic heart disease 5. Anesthesia-related • Why have maternal mortality rates decreased dramatically? - Increased family planning and therefore fewer babies - Better general health and nutrition - Better health care - New medical interventions, antibiotics and safe anesthetics - Professional birth attendant training • Why is there concern that maternal mortality may increase again? - Increasing maternal age - Increasing obesity – which decreases fertility, increases pregnancy complications • What is the purpose of National Core Maternity Indicators (NCMI)? These present information on measures of clinical activity and outcomes. Their purpose is to assist in improving the quality of maternity services in Australia by establishing baseline date for monitoring and evaluating practice change • What 10 indicators does the NCMI include? 1. Smoking in pregnancy 2. Antenatal care in the first trimester 3. Episiotomy 4. Apgar score of less than 7 at 5 minutes 5. Induction of labor 6. Caesarian section 7. Normal vaginal birth 8. Instrumental vaginal 9. General anesthetic for caesarean section 10. Small babies among births or after 40 weeks • What are the most common causes of infant mortality? Congenital conditions, SIDS, accidents and respiratory infections. • What factors contribute to producing a healthy baby? - Child spacing - Maternal education - Living standards - Quality standard care Breast feeding Screening Antibiotic and medical advances • What are the 5 main features of Routine Antenatal Care? 1. Pregnancy Surveillance 2. Educate about healthy lifestyle, pregnancy, delivery options and care of new baby 3. Preventative Interventions 4. Early recognition and management of pregnancy related problems 5. Manage pre-existing medical problems • Describe universal neonatal screening Is conducted for all babies and involves a physical examination for congenital abnormalities. Also involves a heel prick, Guthrie card and dry blood is sent to the lab. This screens for PKU, hypothyroidism, cystic fibrosis, galactosemia and some others. • What is postnatal follow up? Hospital stays for delivery are now very short so there is now a lot of community based care. Post-natal follow up is often made via contact from a midwife or child health care nurse within 10 days of discharge. • What is involved in the postnatal check for the mother and baby respectively? Mother - Physical recovery - Coping and mood - Contraception needs - Parenting skills Baby - Growth and development Feeding Physical examination to screen for congenital abnormality Vaccines • What are the main causes of child mortality? Deaths due to accidents and congenital conditions are most common • Why has child mortality decreased? Improved access to and quality of neonatal health care. Increased community awareness of risk factors for infant and child deaths. • What is FASD? Fetal Alcohol Spectrum Disorder. It refers to the range of problems caused by prenatal exposure to alcohol. • What are the effects of alcohol on the fetus? Harm to the development of the nervous system, decreased mental capacity, fine motor skills impairment and learning disability. Undernourishment of the growing baby as well as a number of developmental changes in the child’s face including; widely spaced eyes, small eye openings, smooth philtrum, hooked nose, low set ears and microcephaly. • Why is it difficult to diagnose FASD? There is no set medical test for these conditions and it requires evidence of prenatal alcohol exposure and severe impairment in three or more divisions of CNS structure or function. Many clinicians also are not educated on the topic and are concerned about stigmatizing families by delivering the diagnosis. Finally, effects of FASD may only surface later in life. • What is the role of Positive Parenting Programs? Positive parenting programs such as Triple P are family support systems designed to prevent as well as treat behavioral and emotional problems in children and teenagers. It is delivered a s a public health initiative and the principle of this is to destigmatize the idea of parenting support. Triple P does this through a public communications campaign called ‘Stay Positive’. Week 6 • Define youth Youth is best described as a period of transition from the dependence of childhood to adulthood’s independence as members of a community • Identify barriers for young people in accessing health care services - Cost - Transport - Fears about confidentiality - Judgmental health professionals - Rurality - Arranging time away from school/work - Stigma • What are aspects of good health care for youth? (Include HEADSS screening) - Youth friendly service - Confidentiality - Holistic care with follow up - HEADSS Screen o Home and environment o Education and Employment o Activities o Drugs o Sexuality o Suicide/Depression • What are the top 3 causes of death in youth? 1. Suicide 2. Transport Accidents 3. Accidental Poisoning • What are the top 3 causes of morbidity in youth? 1. Mental health issues 2. Accidents and injuries 3. Asthma, migraine, substance use • What are causal factors for youth suicide? There are factors which are viewed as correlations and NOT causal: - Mental illness - Unemployment - Substance abuse - Social isolation - Sexuality/Gender Dysphoria - Environmental factors • What factors affect sexual health and wellbeing of youth? I don’t know to be honest. It was a learning outcome. I’m tired. Week 7 • Differentiate between chronological and functional age Chronological Age refers to the number of years lived. Functional age refers to the ability to function physically and socially + quality of life. • Explain biological, psychological and social ageing Biological Ageing is the physical changes that reduce efficiency of organ systems Psychological ageing – increase in negative emotions, there is no decline in crystalized (preexisting) knowledge and poor performance in fluid intelligence (ability to solve new problems). Social Ageing – increased loneliness and boredom and loss of independence. • What are the two broad ageing theories? Programmed Ageing Theories. Non-Programmed (Error or Damage) Ageing Theories. • Explain the three aspects of programmed ageing o Programmed Longevity  The switching on and off of certain genes  Hayflick Phenomenon – cell division is limited and will only replicate a certain number of times • o Endocrine Theory  Hormones control the pace of ageing o Immunological Theory of Ageing  Ageing is attributed to faults in the immune system over time leading to increased vulnerability to infectious diseases Explain the two aspects of programmed ageing o Free Radical Theory  Damage is caused by build up of chemical products produced by metabolizing cells o Wear and Tear Theory  Accumulated damage at a molecular level  Internal and external stressors  Influence of chemical by-products on metabolism • Identify common health issues in elderly populations - Arthritis - Vision and Hearing loss - Falls - Nutrition - Diabetes - Sleep Disorders - Cancer - Depression • How is social isolation related to the health of the elderly? Biological affects of ageing can greatly contribute to social isolation and social isolation can greatly contribute to biological ageing. Social isolation has been linked to increased heart attacks, depression and earlier death. There is a community-based solution to this issue in volunteering, community events and fitness classes. • Describe the challenges to Aged Care Services in Rural Areas with specific reference to Telehealth Challenges to aged care services rurally include: - Small resident workforce - Difficulties attracting staff - Long distance to travel for workers and patients - ‘For profit’ models don’t work. Telehealth is an initiative designed to combat these issues. It involves the use of advanced telecommunication to exchange health information and provide healthcare services across geographic, time, social and cultural barriers. This increases access to health services in rural areas at a low cost. • Describe the aspects of death Death is a biological process but has a number of aspects: - Social – loss of relationships, disengaged from society - Biological – brain death or cardiac arrest We are a death avoiding society and see it as a failure. • Explain legally recognized death Legally recognized death has two types: - Cardiac Death – irreversible cessation of circulation of blood in the body. The heart has stopped - Brain Death – irreversible loss of whole brain function. Confirmed by two independent and qualified doctors. • Describe the requirements of the Age Pension - Must be 67+ years old - Lived in AHS for at least 10 years - Pass income and assets tests • What is advance care planning? Advance Care Planning enables individuals to: - Identify their values - Reflect upon the meanings and consequences of serious illness - Define goals and preferences - Discuss these with families and health providers • What are Advanced Health Directives? Identify benefits and challenges An Advanced Health Directive is what a person wants their medical treatment to achieve. Views, wishes and beliefs about a person’s quality of life are included. Enduring power of attorney – a person who has legal authorization to act on someone else’s behalf in legal and financial matters Benefits of health directives - Protects patient autonomy - Less stressful for patients - Medical staff know patient values Challenges - Upsetting - Family members could disagree - Patients’ words could be misinterpreted • What is Ageism? Ageism is a negative bias or stereotypic attitude toward ageing and the aged. • How does Ageism relate to Medicine? There can be dismissal of abnormal disease processes as part of ageing. Care can be rationed to the old. Week 8 • Briefly outline the history of disability Early in history, people with disabilities were sub-human, need to protect society from them. In 1948, UN: Declaration of Human Rights – more people with disabilities recognized in a community. Normalization was introduced in 1958 and in 1992, the Disability Discrimination Act was introduced. Between 2012 and 2017 the National Disability Insurance Scheme was introduced and implemented. • Identify the types of disability - Physical - Intellectual - Mental Health - Sensory - Neurological • What is some common historical terminology? - Mentally retarded - Mentally deficient - Handicapped - Subnormal - Crippled • Differentiate between impairment, disability, and handicap Impairment – the loss or an abnormality of psychological, physiological or anatomical structure or function Disability – the functional impact of impairment – any restriction or lack of ability to perform an activity normally Handicap – a disadvantage for a given individual resulting from impairment or disability that limits or prevents fulfillment of the role that is typical for that individual • Describe what is meant by the personal effects of disability Disabilities affect individuals differently dependent on: - Age of onset - Cause - Severity - Attitude and awareness - Family support - Background - Opportunity • What is the problem with labels? Labels can be negative, stigmatize and entrench myths about the individual characteristics. • What is Normalisation? Normalization is the belief that people with a disability should enjoy the same rights, privileges, opportunities and access to services and facilities as those without disability. • Outline the major aims of the Disability Discrimination Act - Eliminate discrimination against the disabled - Promote the community acceptance of people with disabilities - Ensure people with disabilities have same rights to equality before the law • What is the NDIS? What does it not cover? The NDIS provides supports to Australians with a disability and their family, necessary supports to live an ordinary life, helps people with disabilities achieve their goals and independence. NDIS does not cover: - Rehabilitation - Medications • Explain Social Role Valorization? Social Role Valorization is the dynamic set of ideas, useful for making posture change in the liver of people disadvantaged because of their status in society. • Outline the role of medical practitioners with respect to disabilities Medical Practitioners have the responsibility of establishing a ‘patient-centered plan’ whereby an individual profile is developed with consideration of cultural background and involvement of informal supports – this is funded by the NDIS. Doctor’s positive attitudes: - Speak to them as you would anyone else - Additional focus may need to be put on:  Establishing support  Simplifying language  Speaking slowly  Taking more time  Repeating what the patient has said Week 9 • What are health behaviours? Health Behaviors are any activity that are undertaken by an individual regardless of actual or perceived health status for the purpose of promoting, protecting or maintaining health. • Describe positive health behaviour Positive health behavior is dependent on the level of behavior: ○ No tobacco use is recommended ○ Low to no alcohol consumption ○ Moderate physical activity regularly ○ High vegetables, moderate fruit, grains & nuts, low fat ○ No illicit drugs is recommended ○ Healthy sexual practices (contraception & regular checks) ○ Follow the Aust Govt vaccination schedule • Describe risk-taking health behaviour Risk taking behaviour is when there is personal risk to self and/or others ○ Driving risks: being angry, stoned, drunk, texting ○ Self injury: skin cutting & burning, suicide ○ Substance use: illicit drugs, alcohol, cigarettes ○ Risky sexual behaviour: produces STI’s, unwanted pregnancy ○ Obesity and anorexia: too much or too little food • What are health risk factors? Health risk factors can be behavioural and biomedical, usually behavioural factors worsen or cause the biomedical factors - Behavioural  Daily smoking  Physical inactivity  Risky alcohol consumption  Inadequate consumption of fruit and vegetables and consumption of whole milk - - Biomedical  Obesity  High blood pressure  High cholesterol Other factors that influence health related factors include ○ Media ○ Language ○ Geographical location ○ Education ○ Income and wealth ○ Age ○ Gender • How do factors influence behaviour? Cumulative effect over time - may develop a poor health habit in childhood and present no symptoms, however, its effect may be more apparent in later life • Why are unhealthy behaviours difficult to change? - They are pleasurable - Resistant to change - Automatic - Addictive  Reinforcement through overwhelming craving  Tolerance increases amount needed to satisfy cravings - The same factor does not control the same behavior in each person • What are health habits? Describe the role of medical professionals in influencing this. Health behaviors that are done automatically become health habits. e.g. wearing a seatbelt, eating a healthy diet The core of what health professionals do is encourage and coordinate behavior changes and attempt to get people to: - Stop smoking - Reduce alcohol consumption - Increase physical activity - Eat more healthily • What determines health behaviours? Health behaviors are determined by: - Values -> how much worth is attached to something like health - Belief -> how much it is believed the person can influence their health - Attitude -> the way we express or apply our values and beliefs • Describe the Transtheoretical Model of Health The Transtheoretical Model of Health is also described as the Stages of Change. 1. Pre-Contemplation - don't recognize a need for change o Never occurred to them they need to change a behaviour o May be unwilling to change the behaviour o Timeline - behaviour change not likely to occur within the next 6 months o Role of medical practitioner - moving people from pre-contemplation to contemplation 2. Contemplation - considering a change but not read,ky yet o Is now on the cycle of considering change o Not yet ready to actively plan change o Timeline - behaviour change may occur within the next 6 months o Role of medical practitioner - become more focused on the change and provide information and encouragement to prepare for change 3. Preparation - not yet made a change, but actively preparing o Has actively decided to make change o Worked out a plan Timeline - behaviour change probable to occur within the next 30 days Role of medical practitioner - assist with support programs, create follow up appointments following the change 4. Action - has stopped the behaviour o The patient has stopped or changed their behaviour o Timeline - occurred in the last 6 months o Role of medical practitioner - encouragement and support, arrange follow up visits to maintain motivation and confidence 5. Maintenance - successful in practicing behaviour modification o Is actively working to maintain the change long term o Timeline - has successfully practiced the behaviour for 6 months o Role of medical practitioner - support and congratulations 6. Relapse - can occur o Not to be judged, instead to be seen as experience o Many patients need several attempts before succeeding o More likely to occur if depressed, anxious or under stress o Timeline - relapse is risky up to 30 days o Role of medical practitioner - non-judgmental, encouragement to restart o o • How can relapse be prevented? Relapse prevention is most successful when: - There is cue elimination or avoidance - Individuals see behavior change as a long term goal - Develop coping techniques for high stress situations - Integrate the change into a generally healthy lifestyle • Discuss the importance of self-motivation and its maintenance Self-motivation is fundamental for change, it is required before an individual can consider an intervention strategy. There are three components to self-motivation: - Willing - Able - Ready • Describe the Health Belief Model The Health Belief Model revolves around identifying motivation and strategies. Has three comprising factors: 1. The degree to which the individual perceived a personal health threat - Are they susceptible? - If they are, how severe? 2. The perception that a particular health practice will be effective in reducing the threat 3. If there are cues to make a change in action and perceived confidence to make a change HBM does not account for: - Positive health habits people perform everyday - • Non-rational behavior such as delay in seeking medical attention No standard way of measuring components such as perceived susceptibility and seriousness of the illness Outline what is involved in motivational interviewing and its barriers Motivational interviewing includes collaboration, evocation and honouring the patient’s autonomy. This does not include confrontation, education and authority. Motivational interviewing has four guiding principles – RULE R = Resist the right to solve (fix problems) U = Understand your patient’s motivations L = Listen with empathy E = empower the patient Week 10 • Define illness perception Illness perceptions are organized thoughts or beliefs that patients have about their illnesses. This includes ideas of: - Causes - Length of Illness - Personal consequences - Treatment • Define stress Stress can be both positive or negative: - Positive (eustress) - leaves a sense of accomplishment and an achievement of goals - Negative (distress) - where we are out of control, this is prolonged and recurrent and hinders performance • Identify the three types of stress There are three different types of stress: - Acute Stress - short term stress, produces fight or flight response - Episodic acute stress - acute stress suffered over and over again - Chronic stress - long term stress, caused by stressful events and arises when a person never sees a way out of the situation they are in • Define coping Coping is any strategy we have in place by which an individual attempts to manage the perceived discrepancy between stress and resources. • What are the components of stress? - Physiological e.g. Headaches - Behavioral e.g. Increased self-destructive behavior, Self-harm - Emotional e.g. Burnout - Cognitive e.g. Narrowing of perception, Inability to concentrate • What are the 4 reaction phases of acute stressors? Outline their features with respect to the components of stress. When a person has experience a sever acute stressor there are four stress reaction phases: 1. Acute phase (last minutes, hours or days) o Physical Symptoms • Fight or flight response • Release of adrenaline • Rapid breathing o Cognitive symptoms • Decreased ability to think • Hard to concentrate o Emotional symptoms • Disbelief • What happened might be denied o Behavioral symptoms • Narrow minded behavior • Withdrawal from others 2. Reaction phase (one to six weeks) o Physical symptoms • Aches and pains • Constipation • Nausea • Loss of sex drive o Cognitive symptoms • Memory problems • Poor judgement • Only negative mindset o Emotional symptoms • Moodiness • Irritability or short temper • Feeling overwhelmed o Behavioral symptoms • Eating more or less • Sleeping too much or too little • Procrastinating or neglecting responsibilities 3. Repair phase (one to six months) o Stress response is the same as in the reaction phase but reactions are less intense and not so overwhelming o Future plans are formed 4. Reorientation phase (six months plus) o Stress substantially reduced o Most reactions diminish • What is the Diathesis-Stress model? According to this model, people inherit a tendency towards mental disorder - diathesis. • What factors affect illness reactions? • The Illness itself: o Severity o Long term impacts o Spread of impact in patients life o Perceptions to others about disease o Treatment options - are they harmful? o Environment o Individual emotional reactions • • Stages of Loss and Grief o Denial o Anger o Bargaining o Depression o Acceptance o Reorientation • The situation o Social support networks are available • The environment o Illness reaction due to the health care system • Individual emotional reactions o Some people experience extreme fear o Some experience moderate fear - these patients are best able to cope o Some experience little fear Identify some adaptive and maladaptive coping strategies. Adaptive Coping - Positive reinterpretation and growth - Seeking instrumental social support - Active coping - Restraint - Acceptance - Suppression of competing activities - Planning Maladaptive Coping - Mental avoidance - Disengagement - Focus on venting emotions - Seeking negative emotional support - Alcohol drug use - Denial • What are some long-term effects of stress? - Anxiety ○ Panic attacks - Depression ○ Withdrawal - Illegal drugs and alcohol - Obsessive compulsive behavior - Eating disorders - Workaholic disorder • What is Cognitive-Behavioral Therapy? Psychological treatment for both depression and anxiety - that which recognizes how the way we think affects the way we feel Week 11 • What is adherence? Adherence is the extent to which a person’s behavior taking medications, following a diet or executing a lifestyle changed – corresponds with agreed recommendations off the health care provider. • What is compliance? Compliance assumes that patients are passive followers of the instructions from health care professionals • Compare medication adherence and compliance Medication adherence is a partnership but compliance is not. The term compliance is doctor focused rather than patient-focused. The term adherence to medication more accurately reflects the dual responsibility of health care providers as well as clients/patients to the taking of medications • Describe what medication non-adherence looks like These are some examples o Failure to fill a prescription o Missing doses o Wrong dose - deliberate  Sharing or halving medications to save money o Wrong dose - mistake  Taking one instead of two tablets, taking a dose at the wrong time o Prematurely stopping medication o Improperly using medication administration devisces o Storing medicines in the wrong pllace o Using old medicines • What are the 5 dimensions of factors causing non-adherence to medicines? Describe each of these The World Health Organization have categorized factors impacting adherence into five dimensions: o Patient related • Age • Motivation • Health beliefs • Health literacy • o Condition related • Co-morbidity • Cognitive impairment • Diseases that may be asymptomatic o Therapy related • Complexity of the drug regimen • Adverse effects of medications o Socio-economic factors • Overcrowding and homelessness • Lack of transport to pharmacy to fill prescriptions • Lack of social support • Unable to meet costs of medicines or co-payment o Health Care Team/Health System • Inaccessible/inappropriate • Poor provider-patient relationship • Poor 'quality use' of medicines • Restricted formularies • Lack of appropriate informational resources Describe the purpose and outline the AIDES method AIDES Method • Assess Determine what medications the patient is taking (prescription and nonprescription) Individualize o Explore reasons for non-adherence o Undertake shared-decision making o Simplify the regimen • Dose Administration Aids - DAA (Webster Pak) Document o Keep medications list up to date o Share the patients information onto their My Health Record o • • • Educate o • Provide education about the medication. Requires acquisition of skills, access to resources that are readable, clear and appropriate Supervise o Maintain continuity of care to monitor the patient's progress o Elicit feedback from the patient on how they are managing • What is meant by ‘quality use of medicines’? Quality Use of Medicines refers to judicious selection of treatment options, safe and effective use of medicines and appropriate choice of medicine when medicine is required • Differentiate between placebo and nocebo A placebo is an inert substance or procedure. There is no specific pharmacoactive ingredient in the medication A nocebo effect is where the patient's expectation of negative symptoms precipitates those symptoms • What is polypharmacy? The concurrent use of multiple medications by a single patient (5 or more) Week 12 • What is chronic disease? These are diseases that are long lasting with persisting effects. Non-communicable, degenerative diseases. • What are the three main determinants of chronic disease? Determinants of Chronic Disease Three main risk factors: 1. Foetal Origins of Adult Disease (FOAD) 2. Psychosocial stress 3. Behavior or lifestyle factors Social factors influence these determinants of disease • Describe the fetal origin of adult disease? What is the process that leads to FOAD? FOAD is a result of programming or imprinting. This can be observed through the impact of maternal nutrition: Impact of Poor Maternal Nutrition (evident at birth) - Has long been known to lead to congenital abnormalities  Vit D deficiency  FASD  Folate deficiency Impact of Poor Maternal Nutrition (not evident at birth) - Infants who are supposedly normal at birth, except for variations in birth weight, are at higher risk of developing chronic disease in adulthood • What is the thrifty phenotype hypothesis? The thrifty phenotype describes the fetal programming that occurs when the fetus is exposed to a nutritionally poor in-utero environment. The metabolism and physiology is permanently altered to adapt to a nutritionally poor environment, including after birth. This is a permanent phenotypic change. It predisposes the child to adult disease. • Define developmental plasticity This is the sensitive period of development during which the developing embryo, fetus or infant adapts itself, the genotype can produce different phenotypes in response to different environmental cues. This can occur anytime after fertilization. • What is survival advantage? The thrifty phenotype can provide survival advantage only in the event that the environment into which the baby is born continues to be poor as the baby has been adapted to endure the worst. The adaptations are detrimental when the postnatal environment differs from the mother’s forecast. • What are the in-utero influences of chronic disease (fetal stressors)? We know that many factors result in poor fetal growth and can cause metabolic imprinting and subsequent risk of adult disease o Maternal nutrition o Maternal infection o Maternal smoking o Maternal stress o Materno-foetal Endocrine Disturbances • What two adaptive responses predispose the offspring to chronic disease? Structural – they have altered organs and reduced function in key organs, such as the kidney Metabolic – they have altered settings for metabolism and hormonal feedback • What are psychosocial stressors? Psychosocial risk factors are those that cause stress. The impact of psychosocial risk factors may be o Acute o Chronic • Describe psychosocial stress and cardiovascular complications with reference to social support Stress cardiomyopathy is a acute psychosocial risk factor – extreme stress can cause heart failure. In most cases, this is reversible. These can be a consequence of anxiety, bereavement, acute work stress. Chronic psychosocial stress can activate neuroendocrine pathways that have been implicated in the development of CVD and CV risk factors. Social support refers to resources provided by others and is a cardioprotective. This works physiologically by: - Promoting oxytocin release - Oxytocin then inhibits HPA axis - Oxytocin also has a positive feedback effect on social interaction. • How do behavioral/lifestyle factors influence chronic disease? We need to consider the four primary lifestyle dimensions: - S – Smoking - N – Nutrition - A – Alcohol - P – Physical activity The attitudes of the patient and their participation in these dimensions has a major influence on their development of chronic disease. • What is a community health needs assessment? A health needs assessment is a process for identifying the health issues facing a community or population. It is designed to work logically through primary and secondary risk factors and contributing factors (Root Cause Analysis).