Semester 1 - Strand 2

STRAND 2 – SEMESTER 1 LIFE SPAN Describe the psychological and sociological perspectives to health and illness a) health and illness behaviour b) the cause of illness and disease c) response to disease and treatment

Pregnancy and childbirth State the key points of the Barker Hypothesis, discuss the evidence for it and explain its relevance for health and social policy Under nutrition at “critical points” effect the body in ways that translate to pathology in later life. Oxygen critical – slows cell division if not – birth size as marker. -undernourished mothers –thin babies -overweight motheres – high CDH case babies Describe current fertility trends and how these have changed over time Fewer women are having children Women are having fewer number of children in family’s The age of having children from women is increasing. Provide a brief historical account of changing birthing practices Technology is increasing, giving women more options. As of 1920 there are interventions. Women have feelings on the nature of abortion, tests and risks involved. Short stays in hospital As of 1960 sharp increase in hospital births Changed into having “units” of childbirth care at hospitals. Medicalisation of childbirth has resulted in fewer inductions of forceps aided delivery. Reflect on the advantages and disadvantages of hospital and home births Advantages of Home birth – eat what you want, drink what you want, home comfort, less intervention, don’t like control of hospitals, can have whoever you want there with you, feel more comfortable with pain and less embarrassment in home. Disadvantages – If something goes wrong then longer wait until seen by a specialist in the hospital which can mean the life and death of a newborn. “Doctors know best”.

Safer under technological intervention. Can learn skills such as breast feeding within a controlled environment. Understand the experiences and views of woman in relation to childbirth Women in general tend to believe meetings and talks about childbirth in a hospital environment to be fragmented and impersonal. Therefore good relationship and continuity are important. Reflect on how health services can meet diverse needs Important for care to be individualised and personal. Each doctor should be told personal information about the woman and be able to have a continuity of personal care. Protocols should also be shared across the different groups which will be dealing with the woman.

Infancy and childhood Discuss the factors that contribute to infant and early childhood health and illness, with particular reference to ‘infant bonding’ and ‘breast feeding’ Wealth Nutrition improvement Living conditions Vaccines and Sanitation NHS Women have access to more information Medical advances Bonding is important – for it can cause the child to grow poorly in the emotional development and cognitive development (for example women suffering strongly from post-natal depression show more negate towards the child and care more about their own feelings and experience) With lack of ‘warmth’ / Inconsistent and harsh discipline and poor supervision appear to be responsible for about 30-40% of anti-social behaviour cases. More likely to turn to drugs. More likely to develop illness in later life. Breast feeding – promotes early neuro-intestinal development. Avoids antigens in cow milk which can cause viral infections, diarrhoea and diabetes. Lower blood pressure. Early solid feeding associated with obesity and CHD.

Discuss the relationship between poor health in infancy/early childhood and risks of poorer health and/or premature death in later life Poor health in infancy can relate to poor health in later life. This is because of picking up bad habits such as smoking, permanently damaging liver from alcohol abuse. Poor health usually related to being in a lower working class, less money to use on education and health. Child brought up into same environment and ends up “following the parents footsteps” and can end in similar conditions and illness. Discuss the role of parental support during infancy and early childhood Psychological support encouraged. Help teach education, skills, manners which can take with them for entire life. Help from feeling of anxiousness, hopelessness and depression, stop them turning to violence and anti-social behaviour to run away from their problems. Discuss the main causes of ill-health and death in children in Britain Road Traffic accidents Bronchi related diseases Measles TB Discuss the reasons why some children are more at risk of accidents and respiratory illness Passive parental smokers Less safety places for children to play (poverty) Discuss the evidence that ill-health in childhood is associated with increase risk of chronic illness and/or premature death in later life Studies have shown that children brought up in poverty continue to develop diseases and live in similar conditions and life styles. Develop diseases which are not kept in check and end in poverty.

Youth and adulthood Characterise adolescence as a particular phase in the life-span Adolescence is not a disease but a stage. It is not always characterised by rebellion and alienation but is a stage of risk taking behaviour and experimentation of young people.

Describe the health of young people and their health care needs Healthiest of all the age groups. Likely care required in sectors of long term diseases such as asthma and so people at this age can learn how to best deal with and live with their chronic illness. Happiness a huge factor to concentrate on. Understand risk-taking behaviour and its consequences, with particular reference to teenage pregnancy Adolescents at the stage of experimentation and risk taking behaviour. Usually because of ignorance or trying to control own path. For example with sexual health and not wanting to use a condom because you prefer not to. Ignorance and the feeling of invincibility, thinking it won’t happen to them. Usually takes something to happen to them or someone close to realise. Unable to see the consequences. Usually results from poor education. Reflect on how health professionals might best meet the health care needs of young people Ensure information is clear, promote bonds with family, friends and teachers, be sure to make adolescents aware of the dangers involved in different behaviours during consultation. Need to be able to reach out on the adolescents level and keep up to date with adolescent culture in order to relate. Discuss the psych-social factors that constitute to ill-health and premature death in adulthood Martial status, relationships, sexual activity and reproduction, caring responsibilities, living conditions and life style. The work / life balance. Discuss the psycho-social factors associated with mental ill-health in men and woman Begins usually as mental health problem and progresses to mental illness. Factors are complex and very personal and relate to sex, ethnic origin and life conditions. Bereavement and chronic unhappiness are factors. As a child or young adult being bullied or under cared for can result in mental ill health. Depression is the largest. Many working days lost. Many people suffer. From being mistreated, abuses or made to feel worthless. Effects immune system directly, is a symptom for many diseases, can be the cause also. More likely to be single or lonely. From lower social class, lower intelligence. Individual factors – prenatal brain damage. Prematurely, insecure, low IQ. Family factors – poor bonds with family, teenage mother or single parent. School – rejection, failure, bullying Life events – rape, death, divorce, unemployment, homeless Community – racism, isolation, lack of services, crime and disorder.

Ageing Discuss the social and demographic changes in society that affect people’s experiences of growing old and the types of support that they need Life expectancy is increasing and birth rate is decreasing. Therefore we are being plunged into a society of an ageing population. With medical advancements and technology, it’s being sought that growing old is not as bad as once thought, with the care being made more available to compensate for the larger numbers of elderly people. More population at this age group means more money to be put in by the government. Discuss the particular difficulties involved in maintaining health in old age Loneliness, lack of social interaction – resulting in mental health problems. Transport difficulties and lack of facilities to accommodate also responsible for depression and feeling of worthlessness and nobody caring. Biologically the body needs more care and higher requirements to remain healthy which cannot always be afforded on a pension which is increasingly becoming smaller and more difficult to live off. Dying and Death Discuss the demography of dying and death in Britain More people dying in hospitals, increased by over 50% in the last 100 years. People living till older ages with increase in medical care. Discuss the setting in which different types of dying and deaths take place and the implications of care

Discuss the changes in attitudes to death, dying and bereavement in British society More of a ‘taboo’ subject. Less familiarity of death in society since smaller families, greater health care so people usually not exposed to death until older, also dying is a far slower process which can lead to uncertainty. Discuss the psychological issues involved in dying and bereavement Types of awareness – Closed / Suspected / Mutual Awareness / Open 5 stages – Denial, Anger, Bargaining, Depression, Acceptance. Anxieties include – inability to breath, pain and self competence and dignity.

Bereavement stages – Numbness / yearning / despair / reorganisation Accepting reality of loss Working through pain Adjusting to environment Moving on with life. Problems with grief Delayed grief Chronic grief Masked grief Exaggerated grief

Discuss the issues in appropriate care and support for dying people and their family, relatives and friends To know when death is coming, to be given chance to prepare, have control of who to be with, and who to have the chance to say goodbye to. Have access to information and expertise, along with emotional and spiritual support. To have control of pain and privacy. Be able to leave a will. Most important word and ongoing trait, is to have control.

MEDICAL ETHICS

Outline the basic principles of medical ethics and methods of moral enquiry Two forms of ethical argument Deontological and Teleological Deontological – Logic of duties – what is right Teleological – Base on final outcome, greatest amount of happiness. 4 basic principles – Beneficence, Non-maleficence, Patient Autonomy, Justice Think for yourself / Think from the standpoint of others / Decide consistantly

Discuss professional responsibility, with reference to working with patients and the human body

Examine examples of moral dilemmas in medical practice

Consent and Confidentiality Discuss professional responsibility with particular reference to consent and confidentiality It is important for the doctor to act in the best interest of the patient at all times. A doctor must inform the public if it will danger them, but otherwise is under strict responsibility to maintain a patient confidence at all times. Examine the relationship between consent and decision-making capacity at different stages of the life-cycle Younger than 16 – only if gillick competent 16 and above in Scotland old enough to employ their own decisions on treatment Parents or guardians can make choices as long as it’s in the best interest of child If they are either unable to understand, believe, process the information, then they are not deemed competent to make the decision. In particular the ability to keep a hold of the information and make a decision. Describe the medico-legal aspects of consent and confidentiality and discuss the practical implication for clinical care, treatment and patient/doctor communication with special reference to the following – Children and adolescence Mental health and old age Children usually the parents are told, but under certain circumstances if Gillick Competent then no information has to be disclosed. With a mental health patient, then the doctor must act in the best interests, taking into account family wishes, past experiences and information from a carer if possible if the patient themselves is unable to satisfactorily destroy their case. Old age patients are often asked a 2nd opinion as well to ensure they are clear on the procedures. It is absolutely necessary to have consent before an operation but also for research purposes or for using patient information in evidence surveys.

Termination of pregnancy Discuss the clinical, legal and ethical aspects of termination of pregnancy Clinically if it will impose greater risk upon the mother with the baby being born, than if it were aborted. This covers mental health and physical health. Also if the baby will have a high enough chance that it will be severely handicapped it’s clinically thought right. Legally has to be before 24 weeks, doctor has to act in good faith and must have a doctors 2nd opinion. However in an emergency the doctor does not need a 2nd opinion. If you feel strongly about the matter, you must send them to a colleague for advice. A doctor does not have to participate in the abortion process if they feel strongly against. Ethics revolved again – moral rights of fetus, women’s reproductive rights, responsibilities to existing children and world populous. Neonate Discuss the clinical, legal and ethical aspects of decision-making regarding neonates Babies with most concern – extremely premature, serious congenital abnormality, babies who receive injury during or just after birth. Clinical framework for withholding treatment to neonates – Brain dead child Vegetative state child The ‘no chance’ child The ‘no point’ child The ‘unbearable’ situation Who takes part in the decision making process Health Care Team Doctors Parents Religious or Spiritual advisors Courts Social workers The double effect – increasing a course of action to relieve pain and suffering, understanding that the consequence is to hasten death. Ethically – minimise child suffering, maximise family interaction, ensure all decisions and consent is in writing. (legal)

Children and adolescents Describe the medico-legal aspects of consent and confidentiality with special reference to children and adolescents Gillick competent children – i.e under 16 in Scotland but over 12 are thought to have formation of their own opinions on what happens to them. In E&W they ought to be listened to but not given full control. Parental consent often sought for but not always required. Always act in the appropriate manner to save a child’s life or to prevent serious harm. The child’s health is paramount. Involve the courts if the parents do not give their consent for something the medical practice believe to be in the child’s best interest. Discuss the practical implications for clinical care and treatment and patient/doctor communication Ensuring the child understands, believes and remembers the information in order to judicate a decision in their best interests.

Mental health and Old Age Describe the medico-legal aspects of consent and confidentiality with special reference to mental health and old age Someone is thought to be incompetent if they are incapable to act, make the decision, understand the decision remember the decision or communicate the decision. Under these circumstances a family member can be discussed with to make the decision and also now in Scotland a “Proxy” decider can make the decision as long as it’s in the patients best interest, and goes as far as possible with what others would also agree on. Examine the practical implications for clinical care and treatment and patient/doctor communication

Terminal Illness Explain the different kinds of medico-moral questions raised in the care of terminally ill patients Moral to allow someone to continue to suffer? Fear that right to request becomes obligation to request, voluntary becomes non-voluntary. Is it just that a few must suffer greatly for the purpose of the general society ruling.

Discuss the moral arguments related to euthanasia, acts and omissions, double effect, and advance statements and examine the practical implications for clinical care, treatment and patient/doctor communication Double Effect – death as a side effect, not as a mean to end pain. Advanced Directive – Decision was required for the set case, was competent, not forced, was informed correctly.

Medical research Describe and discuss the ethical principles associated with conducting medical/health service research Research most ethical under equipoise. Only should be undertaken if the question of results are for the betterment of the population. Population undertaking said research should be aware of side effects, benefits of participating AND not participating and have access to all available comprehensive knowledge on the study and research to be taken. Describe the process and issues to be considered when applying for ethical approval for medical/health service research

KEY PSYCHO-SOCIAL CONCEPTS/HEALTH AND ILLNESS IN THE COMMUNITY

Health and illness Define the terms: health, illness, disease Health is different for many people. But the basic given definition is state of being in good physical health but also mentally and socially sound. Not just the absence of disease and illness. Health is what people make of it however. Disease is a medical condition of abnormal pathology diagnosed by history taking and diagnosis. Illness is by definition problems related to health. Describe the ways of measuring health, illness and disease and their limitations with particular reference to health and illness in Edinburgh, Scotland and the UK Expectation of Life Quality of Life Birth and Death Rates In Scotland it’s worse for Lung cancer and CHD. Social class and poverty Describe the relationship between social class and health Artefact – the different observed can be explained by how the concepts of social class and health are measured. This may inflate or mask differences. Social selection – where ones health status may determine ones social class through social mobility especially due to ill-health Behavioural/cultural – health damaging or health promoting behaviours are differentially associated with social class, resulting in social class position causing good or poor health. Material – material circumstances, such as poor housing, poor work conditions and bad environments account for social class differences in health. Low social class – low health – Inverse Care Law.

Understand how social circumstances influence health and life chances Less money from income, less affordable area, less doctors. Less money to spend on health products, less money for education, for sports, for holidays. Consider some of the difficulties involved in measuring social class Artefact Illness can render your employment chances useless, so you can lose your job. Yet still be in a socially predictable situation. Women working a lot more. Understand the experience of those living in poverty Discuss the importance of psycho-social factors, in particular poverty, in the accumulation of risk factors for ill-health and premature death throughout the life-course Reflect on the implications for health care policy, medical practice and health professionals

Families and Gender Describe the demographic trends and the diversity in Scotland’s families Many more single parents, and diverse family trees than before since divorce and remarriage is more common. Explore how important the family is in health maintenance Family is important as a structure to maintain health. Especially proven for men. Describe and discuss the different health experiences of men and women at different ages

Reflect on changing gender roles Women getting into employment more, men helping with children Consider the implications of this topic for medical practice

Risk and Screening Describe how screening programmes have developed Describe and discuss the aims and objectives of screening Appraise the ethical issues associated with screening Consider the different ways in which risk is perceived by different people Reflect on the role of preventative medicine in modern health care system

Deciding to consult and consulting a doctor Discuss the psycho-social factors that influence whether or not someone decides to consult a doctor, with particular reference to pregnant women and parents with a sick child Discuss the personal relationship and organisation factors that affect the process and outcome of the consultation Describe and analyse patients compliance and discuss the value of the concept of concordance Discuss the place of placebos in clinical practice

Complementary medicine Define Complementary and Alternative Medicine Outline the main CAM therapies Describe and discuss the reasons for using CAM therapies Consider how complementary medicine fits with and relates to orthodox medicine

Research Describe the main features of conducting qualitative research