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82 Cards in this Set
- Front
- Back
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What are the three types of stigmatisation? (from epilepsy case)
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1. legal discrimination: where people with epilepsy are not allowed to be airline pilots - common sense matters
2. Enacted stigma: where a person with epilepsy is, for example, refused a job in a bank just because they have epilepsy 3. Perceived or felt stigma: this si the shame of being epileptic and fear of encountering enacted stigma. |
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What is "hidden distress"? (from epilepsy case)
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people with epilepsy are fearful of encountering enacted stigma and prusue an active policy of non-disclosure
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Some people with epilepsy fear being seen having a seizure - why?
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Not to do with 'labelling', but rather being perceived as 'out of control' as if mad, and being associated with having mental illness.
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What are the ill-effects of perceived stigma? (epilepsy week)
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impaired self esteem, self efficacy, sense of mastery
greater perceived helplessness, rates of anx and depression, somatic symptomatology reduced life satisfation |
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What is the association between stigma and seizure control? (epilepsy week)
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the extent to which stigma has a negative affect on people's QoL is strongly associated with how well their seizures are controlled
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What is more debilitating and prevalent - enacted or perceived stigma? What can be done about it?
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perceived stigma. it can be 'treated' in the health setting by 'accepting' one's epilepsy
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What is a spinal cord injury?
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the occurrence of an acute, traumatic lesion of neural elements in the spinal canal (SC or cauda equina) resulting in temporary or permanent sensory or motor deficit, or bladder/bowel dysfunction
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What is the incidence of SCI in Australia?
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15-17 cases per million per year
82% male 52% paralegic, 47% quadriplegic |
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What age groups are most likely to have a SCI?
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15-24 and 65-74
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What are the three major traumatic causes of SCI?
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High falls (>1m), 29%
Motor vehicle, 25% Motorcyclists, cyclists, pedestrians, 24% |
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What are some nontraumatic aetiologies of SCI?
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spinal stenosis, intervertebral disc herniation, RA, vascular, inflammatory (infectious, non-infectious (transverse myelitis, MS, polio)), tumour, iatrogenic (radation, contrast arachnoiditis), others (syringomyelia, MND, vit B12, Friedreich ataxia)
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What are the most common spinal levels damaged by the following injuries? 1. compression (axial loading: driving), 2. flexion rotation injury (unilateral dislocation), 3. flexion (bilateral dislocation), 4. hyper extension injury (central cord syndrome)
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1. compression - C5
2. flexion rotation injury - C5-C6 3. flexion - C5-C6 4. hyper extension injury - C4, C5 |
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What is the standard neurological classification of SCI?
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American Spinal Injury Association (ASIA) Impairment Scale (AIS)
Is injury complete --> if no, what muscles below neurological level are graded 3 or better? --> is sensation and motor function normal? |
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What is Central Cord Syndrome?
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The lesion interrupts fibres crossing to enter the spinothalamic tracts, and fibres mediating the tendon stretch reflex. As it enlarges, it affects the intermediolateral columns (autonomic function), and the lateral corticospinal tracts
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What is Brown-Sequard Syndrome of Spinal Cord Hemisection?
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same side as lesion: UMN weakness, loss of position and vibration
Side opposite to lesion: loss of pain and temp |
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What are some consequences of SCI?
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impairment of control of movement and sensation
defective/absent bladder and bowel function impaired fertility and sexuality defective control of autonomic function (blood pressure (autonomic dysreflexia), sweating, temperature) inadequate respiratory function uncontrolled activity of the isolated spinal cord (spasticity, pain) musculoskeletal complications psychosocial impact |
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What is autonomic dysreflexia?
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sudden onset of severe hypertension at or above T6 (isolation of SNS from vasomotor centres of brain). it is a potentially life-threatening condition leading to hypertensive encephalopathy, intracerebral haemorrhage, seizures, cardiac arrhythmias
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What are some causes of autonomic dysreflexia?
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genitourinary- over distension, UTI, stones, epididymorchitis
bowel - impaction, hemorrhoids, gastric ulcers, appendicitis, gallstones sexual stimulation ,labour, menstruation, vaginitis skin - ingrown toenails, pressure areas, burns, insect bites, tight clothing, shoes or appliances MSK- heterotopic bones, #s procedures- urodynamics, cystoscopy others: DVT, PE, temperature fluctuations |
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How can autonomic dysreflexia present?
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pounding headache, SOB, sweating, nasal congestion, goosebumps, restlessness/anx, slow pulse, flushing or blotching of skin, systolic BP rise of 20-40mmHg above resting systolic BP
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How is autonomic dysreflexia treated?
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sit pt as upright as possible
call for help, monitor BP remove or loosen all tight clothing (TEDS and abdo binder) check drainage system for kinks/clots/sediment empty leg bag attempt to identify cause refer to AD treatment card/algorithm |
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What is the pharmacological treatment of autonomic dysreflexia?
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meds may not be needed if cause of AD, but if BP is over 170mmHg and no cause found
glyceryl trinitrate (do not use if PDE5I or other nitrate containing med has been used) captopril sublingual adequate analgesia when appropriate admit to hospital if not resolved |
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How is autonomic dysreflexic bladder treated?
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irrigate blocked catheter
if no urine flow, replace catheter after lignocaine gel injected into urethra |
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How many people with SCI develop pressure ulcers?
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50-80%, has significant morbidity and mortality
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What is the clinical relevance of spasticity? (SCI week)
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disabling if interferes with positioning of ADLs (eg transferring, dressing, bathing, toileting, sitting balance, pushing wheelchair, gait, driving)
exacerbated by noxious stimuli below lesion implicated in falls may cause contractures, pain or skin breakdown |
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What is the association between personality and aspects of adjustment in SCI?
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younger people tend to be more accepting of SCI
greater risk of depression for older people with SCI major depression is not a normal, necessary or essential part of the process of adjustment to SCI |
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What factors affect psychological adjustment to SCI?
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pain, med complcatications, body image, isolation, boredom, cognitive problems, family/friends/social supports
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What is the employment rate of those with SCI?
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40% (70% in general pop)
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What are the leading causes of death following SCI?
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1. pneumonia and influenza
2. septicaemia 3. cancer 4. Ischaemic HD 5. urinary system diseases 6. suicide 7. cerebrovascular disease |
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How can SCI be prevented?
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primary - seat belts, safer roads/cars, random breath tests, legislation, helmet use, driving education, workplace safety, falls prevention measures
secondary- improved retrieval, specialised care, early decompression tertiary - rehab programs, education and self-management (regular checkups, nutrition, exercise, pressure area care) |
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T/F.. MS prevalence is mainly dependent on latitude?
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False. Latitude plays a part, but ethnicity and genetic susceptibility are also important. ie. Uzbekistan ethnic Russians have 14x PR than Uzbeks and 28x that of Bokhara Jews.
MS also very rare in Australian Aborigines and NZ maoris |
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Where is MS most prevalent in Australia?
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Hobart (2x that of Perth and Newcastle and 7x that in tropical Qld)- but no major ethnic PR differences.
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What are the effects of migration on MS, when moving from a place of high latitude to somewhere else?
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Studies on MS in immigrants to South Africa and the USA have shown that when people move from a high to a low prevalence environment, they take with them the high risk of disease if they migrate after puberty, whereas if they emigrate before puberty they acquire the low risk of the country of destination. These findings suggest the disease is acquired in the critical period preceeding puberty.
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What is the strongest HLA assocation of MS?
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Class II allele DR15 (formerly DR2), which increases MS risk by about 2
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T/F... pets, milk consumption, bovine density per inhabitant and/or head trauma may increase risk of MS
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false. epidemiological studies don't support any of these factors
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What are good study types to evaluate aetiology, prognosis, intervention and diagnosis?
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cohort study - aetiology, prognosis
intervention - randomised trial diagnosis - diagnostic test evaluation |
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What is the definition of a stroke?
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rapidly developing symptoms and/or signs of focal, and at times global, loss of cerebral function, with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin
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What are the three levels of prevention?
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primary - protecting healthy people from developing a disease or experiencing an injury in the first place
secondary- the goal is to halt or slow the progress of disease (if possible) in its earliest stages tertiary- goals include preventing further physical deterioration and maximising QoL |
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What are primary prevention strategies for stroke?
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assess based on absolute risk of CVD in next five years
apply to people aged 45-74 (and indigenous people >35) use Framingham risk equation (stroke risk factors: HT, smoking, cholesterol, diabeasties, ECG left ventricular hypertrophy, male, age) |
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What are secondary prevention strategies for stroke?
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assess absolute risk
modify risk factors with intensity based on absolute risk (smoking, BP, lipids, waist circumference and BMI, nutrition, physical activity level, alcohol intake) |
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What are the nonmodifiable risk factors of stroke?
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age and sex, family hx of premature CVD, shx including cultural identity, ethnicity, SES and mental health
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What are related conditions to stroke?
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diabetes, kidney function (microalbumin +- urine protein, eGFR), familial hypercholestrolaemia, evidence of atrial fibrillation (hx, exam, ECG)
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How many Australians have strokes each year and which age group has the most?
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60,000 strokes per year
50% in people aged >75 years |
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What is the prognosis of stroke?
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the rule of thirds
1/3 die 1/3 recover 1/3 have persistent disability (applies to outcome at about 1 year after stroke) |
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why is prognosis poor in stroke?
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stroke is a fatal illness
stroke recurs frequently older people have strokes, and they are likely to die of something else |
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What are tertiary prevention strategies of stroke?
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Use clinical guidelines
Use stroke ward (17% reduction in death, 25% reduction in death or institutionalisation, 31% reduction in death or dependency, 8% reduction in length of hospital stay) |
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What are the results of stroke treatment (NNT)?
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NNT to prevent death - 22
NNT to prevent major adverse outcome in mild HT - 141 NNT to prevent death or stroke after TIA - 6 |
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What is the equation for number needed to treat (NNT)?
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1 / absolute risk reduction % x 100
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What are characteristics of stroke units?
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multidisciplinary care (weekly meetings)
nursing integrated carers routinely involved in rehab regular staff training routine info to caregivers nurising and physician interest in rehab nursing and physician interest in stroke high proportion of patients receive PT or OT |
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What are key factors associated with stroke unit effectiveness?
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coordination of rehabilitation
education and training specialisation of staff |
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What is the most appropriate treatment for Mrs Bernstein and other stroke patients?
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tertiary prevention:
-treatment of hypertension -use of antiplatelet therapy -use of statins specific issues: -mobility training -communication treatment -return to driving |
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How long should a person not drive following a stroke?
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4 weeks
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What are some ill-effects of being diagnosed with a chronic illness? (from 6.06)
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anger, guilt, resentment, dosplacement of these feelings onto other family members, disharmony of marital and other relationships. A substantial proportion of people with chronic illness and disability become clinically depressed
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What factors limit the ability to cope with a chronic health condition? (6.06)
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brain related conditions (incl mental illness), economic distress,
limited social life and career opportunities if caring for chronically ill child leading to overall life dissatisfaction and siblings feel neglected |
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What should treatment for a chronically ill patient entail? (6.06)
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generally speaking, should care for a family as a whole, because attention is being focused on one member of the family so others may not seek advice. this also helps their wellbeing so they can provide support and care to the chronically ill person
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What is the strongest risk factor of Alzheimer's disease?
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age (exponential increase in risk over age 60)
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What are the main causative genetic mutations of families with dominantly inherited AD?
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amyloid protein precursor (APP) gene on ch21, presenilin-1 (PS-1) gene on ch14, presenilin-2 (PS-2) gene on ch1
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What genetic factors (not causative) are involved in the majority of AD cases?
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AAPOE4 allele (on ch19) - POE lipoprotein (involved in synaptic repair in response to injury - maintains neuronal structure and cholinergic function)
Down syndrome (on ch21, carries the APP gene) - extra APP gene (trisomy 21) increases amount of abnormal breakdown formation in brain, just like in AD |
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What are some env risk factors for AD?
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heavy metals (especially Aluminium) - weak evidence
high level of education cognitive activity - ie playing games at younger and older ages |
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Does exercise reduce dementia risk?
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in the short term it improves cognition, but long term is unconfirmed
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Do diets rich in fish, fruit and veg lower dementia risk?
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yes, due to antioxidants, polyunsaturated fatty acids and reduction in CVD risk
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Does HRT prevent memory loss?
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no, in fact it may increase risk (1 in 1000) for 65-69 year old women
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Does head trauma increase dementia risk?
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head trauma is uncommon enough to make most research inconclusive.
yet, people who carry the APOE4 genotype may be more likely to develop AD after a head unjury |
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Can inflammatory mechanisms facilitate AD development?
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although the brains of AD patients show evidence of mild active inflammation including microglial and complement activation, there is recall bias to such studies and no cognitive benefit has been shown from anti-inflammatory agents
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What is dementia?
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A broad term used to descirbe a loss of memory, intellect, rationality, social skills and what would be considered normal emotional reactions
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What are common symptoms of dementia?
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first seem to notice a problem with memory, particularly in remembering recent events
progressive and frequent memory loss confusion personality change apathy and withdrawal loss of ability to do everyday tasks |
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What are the warning signs of dementia?
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1. memory loss that affects day-to-day function
2. difficulty in performing familiar tasks 3. confusion about time and place 4. problems with language and abstract thinking 5. problems misplacing things 6. changes in personality or behaviour 7. a loss of initiative |
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What is the most common dementia in Australia?
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Alzheimer's disease (50-70% of all types of dementia)
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What are the top three causes of death in Australia in 2012 and what will it be in 2030?
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2012: 1. heart disease, 2. stroke, 3. dementia
2030: 1. dementia |
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What is the prevalence of dementia?
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doubles every 5 years past 60 years (from age 60-64 male 1.2%, female 0.6% to age 95+ male 37.2%, female 47.3%)
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What was the global cost of dementia in 2010? What is the projected cost of dementia in Australia by the 2060s?
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US$604bil or 1% of world's GDP
In Aus year 2060, cost will be $83bil (in 2006-7 dollars) |
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What constitutes the 'big 5' chronic conditions in terms of healthcare costs?
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dementia, resp diseases, digestive diseases, CVD, diabetes
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What will be the shortfall of paid/unpaid carers by 2030?
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150,000
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What is the role of the carer for someone with dementia?
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act as the pts memory, mind, minder and voice
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How many family carers provide 40 or more hours a week of care? Do so for more than one year? More than 5 years? Perform phsyuically demanding forms of care (bath, feed, help with incontinence)? Miss work because of caring? Have emotional stress?
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1 in 4 care for > 40 hours per week
71% do so for more than a year 32% do so for >5 years 65% perform physically demanding tasks 2/3 miss work because of caring responsibilities 40% report high levels of emotional stress |
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What is the national 'gateway' for access to care entitlements? (dementia case)
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1. information
2. assessment --> entitlements (not-capped) - more equitable 3. care coordination (if required) 4. personal equity in homes to support care |
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What are the major reform movements of mental health delivery? (week 6.10)
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moral treatment (180001850; in asylums, focuses on human, restorative treatment)
mental hygeine (1890-1920; in mental hospital/clinic; prevention, scientific orientation) community mental health (1955-1970; in community mental health centre; focus on deinstitutionalisation and social integration) community support (1975-present; in communities; focus on mental illness as a social welfare problem (ie. treatment, housing, employment)) |
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Has the national trend been to increase or decrease acute psychiatric beds in general hospitals compared to psychiatric hospitals?
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increased beds in general hospitals, decreased beds in psychiatric hospitals (from data from 1993 to 2003)
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How many prisoners in NSW have a serious mental illness?
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10% (long waiting list for prisoners for new Forensic Hospital)
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How common are mental disorders in Australia?
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3.2mil Australians reported symptoms of a mental disorder (20% of adult pop)
Any depressive disorder (male: 4.2%, female: 7.4%) Any anxiety disorder (male: 7.1%, female: 12,0%) Any substance use disorder (male: 11.1%, female: 4.5%) Any mental disorder (male: 17.4%, female: 18%) |
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What is DALY?
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a measure of overall disease burden
time lost due to premature death AND years of 'healthy' life lost from poor health or disability years of life lost + years of lived with disability |
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What are the three highest projected DALYs in 2020 worldwide and in developed regions?
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worldwide: 1. ischaemic heart disease, 2. unipolar depression, 3. road-traffic accidents
developed regions: 1. IHD, 2. cerebrovascular disease, 3. nipolar major depression |
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Do antidepressants reduce suicide risk?
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yes
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