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22 Cards in this Set

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How many people are under the care of the UNHCR* worldwide?

United Nations High Commissioner for Refugees
Around 16 million. Many spend as long as 20 years in refugee camps.
How does someone go about joining the 'waiting list' to resettle in Australia as a refugee?
1. They need to register with the UNHCR. (Which can be very hard, esp. if there's no 'office' at the camp.)
2. They must demonstrate that they are at a significant safety risk, and that integration in the local community or return home is impossible.*
3. They can then be referred to Australian authorities.

* There are special options available for 'women at risk', or for people who have family members in Australia who can sponsor them. (A very small % of these applications are accepted.)
What kind of medical examination would a refugee undergo before leaving for Australia?
1. Visa medical*, often 6-12months before departure.
2. Full departure screening** 72hrs before departure from certain places.

** Visa medical: Includes CXR and urinalysis, and testing for HIV, HBV, syphilis, and TB.

** Full departure screening: Africa, Malaysia, Pakistan, Thailand. Includes: physical exam & CXR, pregnancy test, testing for malaria and various parasites, and MMR vax.

These examinations are often minimal, and cannot be assumed to have been conducted in full.
Can a refugee come to Australia if they have HIV?
If HIV is detected during their visa medical, they will not be resettled in Australia. (HIV is only screened for in over-15's.)

If, however, they test positive upon arrival, they will be allowed to stay.
There is a free interpreter service for doctors and allied health within hospitals and in the community. True/false?
FALSE.

There is no interpreter service for allied health outside hospitals.

The Translating and Interpreting Service has no charge for doctors or pharmacists.
What is the difference between 'asylum seekers' and other refugees? How does their eligibility for healthcare differ?
Asylum seekers are those who apply for asylum after arriving in Australia, with or without a visa.

Unlike other refugees, some asylum seekers are ineligible for Medicare; their options for free medical care are limited to public hospitals and or GP's willing to waive a fee (including those providing care through Refugee Health Queensland).
Why do many refugees tend to use public hospital emergency rooms?
Asylum seekers may be ineligible for Medicare, necessitating the use of public hospital emergency rooms.

Many refugees, while eligible for Medicare, are accustomed to waiting for health care rather than making appointments.
Name 6 barriers to health care access for refugees.
1. Health a low priority compared to other settlement tasks (finding housing, a job)
2. Used to poor health.
3. Distrust authorities.
4. Fear of being sent home for being sick.
5. Language/culture barriers to adequate consultation.
6. Financial constraints
When first consulting with a refugee patient, it is important to be culturally competent. What are some content areas to cover in a cultural assessment?
Mnemonic: BE FRESH

1. Birthplace & other countries they've lived in
2. Ethnicity & language
3. Food preferences
4. Religious & cultural practice, both day-to-day and related to birth, death, etc.
5. Employment: past & present
6. Supports in place
7. Health-related beliefs
What contributes to acculturative stress?
Sources of chronic acculturative stress include inability to:
- learn English & fit in
- gain employment & have a work-ordered day
- have friends & a relationship

Mental health issues related to chronic acculturative stress will often arise 10 years post-settlement.
What does health management of a refugee patient focus on?
1. PREVENTATIVE health: Immunisation & health education.

2. Issues related to PREVIOUS POOR HEALTH CARE: Chronic diseases, dental health issues, and poor nutrition.

3. Issues endemic to PARTICULAR REGIONS: Infections, particular genetic predispositions to illness, and exposure to toxins

4. PSYCHOLOGICAL issues: Mental health issues (both post-traumatic and acculturative) and harmful cultural beliefs (eg. female genital mutilation)
Since the 1960's, global incidence of dengue has:
a) Decreased by 99%
b) Decreased by 90%
c) Halved
d) Remained steady
e) Doubled
f) Increased ten-fold
g) Increased one hundred-fold
h) Increased one thousand-fold
i) Increased one million-fold
h) It has increased one thousand-fold.
In the global burden of disease, what are "the big three"?
HIV/AIDS, malaria, and TB.
What are some neglected tropical diseases?
LETHAL SET

1. Leishmaniasis (cutaneous or systemic, caused by sandfly)
2. Elephantiasis (lymphatic filiarisis)
3. Trichuriasis (whipworm)
4. Hookworm (roundworm)
5. Ascariasis (roundworm)
6. Leprosy (Mycobacterium leprae)
7. Schistosomiasis (flukes)
8. Eye infections (trachoma (Chlamydia) & onchocerciasis (roundworm))
9. Trypanosomiasis (American = Chagas disease, African = African sleeping sickness)

These diseases combined account for a greater loss of DALYs than malaria or TB (but still less than HIV/AIDS).
In 2006, the relative risk of Indigenous people, compared to other Australians, for ischaemic heart disease was 0.78. Why?
3% of Indigenous people were aged 65 years and over, compared with 13% of the total Australian population
What's the difference between the effect of a risk factor and the impact of a risk factor?
The effect is the risk it poses to an individual.

The impact is the risk it poses to the whole population.
What are the 5 A's of smoking cessation counselling?
Ask about smoking at every opportunity
Advise all smokers to stop
Assess willingness to stop
Assist the smoker to stop
Arrange follow-up
Name some effective population-wide strategies that have reduced tobacco usage.
1. Taxes.
2. Advertising bans
3. Counter-advertising
4. Restrictions on sale (eg. age limits)
5. Public smoking bans

Less smoking → denormalisation of smoking → less smoking
What are the 'geriatric giants'?
'5 I's'

1. Immobility (physical, social, and mental barriers)
2. Instability (falls, OA, osteoporosis)
3. Incontinence
4. Intellectual impairment (dementia, delirium, depression)
5. Iatrogenic (inc. polypharmacy)
In health promotion, what is the difference between 1º, 2º, and 3º prevention?
1º prevention: decrease incidence (eg. hygeine)
2º prevention: early detection (eg. screening)
3º prevention: avoid complications (eg. rehabilitation)
For bupropion and varenicline, name:
- a trade name
- the basic mechanism of action
- an important adverse effect
Bupropion: Zyban. MOA: Atypical anti-depressant. AE: Seizures (avoid in anyone with hx).

Varenicline: champix. MOA: partial nicotine agonist. AE: depression & suicide ideation.
Top 10 causes of lost DALYs in Australia.
Completely stupid (but somewhat effective in my experience) 'mnemonic': "I ADS CLA CAB". Note that none of the top 5 are cancers.
1. IHD
2. Anxiety/depression
3. Diabetes mellitis
4. Stroke
5. COPD
6. Lung cancer
7. Alzheimers & other demential disease
8. Colorectal cancer
9. Asthma
10. Breast cancer