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HSPH > Individual and social aspects of diabetes > Flashcards

Individual and social aspects of diabetes Flashcards

1
Q

What does the VIDDA model stand for

A
  • Violence
  • Immigration and isolation
  • Diabetes
  • Depression
  • Abuse
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2
Q

What are management challenges for doctors

A
  • Non-adherence
  • Lifestyle change
  • Burden of treatment for patient
  • Communicating with patients
  • Co-morbidities
  • Co-ordination of health care
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3
Q

What are prevention challenges for doctors

A

Lifestyle changes

  • exercise
  • diet
  • smoking

communication
self management

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4
Q

What are the challenges for implementing NICE guidelines

A

Trade off between benefits & harms of treatment

Trade off between economic consideration & resource use

Quality of the evidence, use of indirect evidence & availability/lack of evidence to support implementation

Size of effect & impact on population

Wider basis for making decisions – ethics, inequities, social value judgments - ethical, practical & scientific

Conceptual framework or logical model

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5
Q

What are the challenges for patients in managing conditions

A

Restricted lives or biographical disruption

Social isolation

Being discredited & marginalised

Feeling of burdening others

Hard work of self-management

Accessing health services that ‘fit’ them

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6
Q

describe how patients change in terms of fit and how the treatment can be taloiroed to the individual

A
  • there might be no fit where the expectation, preference and experience of the individual do not fit at all
  • there might be a dysfunctional fit where there is an overlap between expectation and prefereence and expeirence and preference but not expectation and expereince
  • there might be a degree of fit between expectation, preference and experience where there is a slight overlap in expectation and experience
  • and full fit where all three are integrated
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7
Q

What affects physical accessibility

A
  • social and cultural enablers and barriers

- relevant and effective

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8
Q

What are conceptual challenges

A
  • globally, nationally, locally
  • socioeconomic and political economic basis for societies
  • sustainable development and climate change
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9
Q

What 3 factors are the most important determinant of population health

A

Displacement,

Deindustrialization (main source of income has changed)

vulnerability

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10
Q

What is the VIDDA model a cause of

A

The VIDDA model is a cause of syndemic suffering

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11
Q

describe the factors that make up the syndemic suffering

A

VIDDA model is made up of violence, immigration and isolation, diabetes, depression and abuse

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12
Q

describe the factors that make up the VIDDA model of syndemic suffering

A
  • VIDDA model is made up of violence, immigration and isolation, diabetes, depression and abuse
  • Structural factors, individual factors, relationship factors and sociocultural factors also make it up as well
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13
Q

What is syndemic suffering

A

Syndemic suffering embodies the synergies of epidemics whereby two or more conditions cluster together within a community, interact at biological, psychological or social level and are driven by social or political factors

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14
Q

Describe the syndemic model

A
  • There are disparity of conditions that promote disease clustering
  • then there are two diseases that have adverse interactions with each other
  • this leads to enhanced disease transmission, progression and more negative health outcomes
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15
Q

Name the types of syndemic interaction among diseases

A
  • Enhanced contagiousness
  • Accelerated virulence
  • Alterations of the physical body
  • Alterations of the emotions
  • Gene reassortment
  • Iatrogenic factors
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16
Q

Why do syndemics emerge

A
  • Changing political and economic conditions
  • Shifting ecological and environmental conditions
  • Altering demographics and changing social behaviours
  • Rapidly developing technology
  • Expanding patterns of globalisations
  • Ongoing microbial adaptation
  • Breakdown of public health protective measures
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17
Q

what is the key mediator in why syndemics emerge

A
  • Poverty
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18
Q

Name 6 dimensions of poverty

A 
1, Situational poverty 
2, generational poverty 
3, absolute poverty 
4, relative poverty 
5, urban poverty 
6, rural poverty
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19
Q

What is situational poverty

A

Situational povertyis generally caused by a sudden crisis or loss and is often temporary. Events causing situational poverty include environmental disasters, divorce, or severe health problems.

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20
Q

What is generational poverty

A

Generational povertyoccurs in families where at least two generations have been born into poverty. Families living in this type of poverty are not equipped with the tools to move out of their situations.

21
Q

What is absolute poverty

A

Absolute poverty,a scarcity of such necessities as shelter, running water, and food. Families who live in absolute poverty tend to focus on day-to-day survival

22
Q

What is relative poverty

A

Relative povertyrefers to the economic status of a family whose income is insufficient to meet its society’s average standard of living. Geographically determined.

23
Q

What is urban poverty

A

Urban povertya complex aggregate of chronic and acute stressors (including crowding, violence, and noise) and are dependent on often-inadequate large-city services.

24
Q

What is rural poverty

A

Rural poverty:families often have less access to services, support for disabilities, and quality education opportunities.

25
Q

What is childhood poverty

A

Achildis said to beliving in povertywhen they arelivingin a family with an income below 60% of the UK’s average after adjusting for family size.

26
Q

What is food poverty

A

Food poverty is the inability to afford, or to have access to, food to make up a healthy diet. It is about the quality of food as well as quantity.

27
Q

What do patients feel like when they visit their GP if they live in low income communities

A
  • Inferior and stupid - worried about not understanding what is said
  • embarrassed, ashamed, and underserving
  • perceived as time wasters especially when the issue is mental rather than physical
  • judged because of their background and appearance
  • they will not be listened to
28
Q

What does marmot and wilkinsons model highlight

A
  • This highlights the idea that you can look at factors in order to prevent people from getting ill
29
Q

Describe the marmot and wilkinson model

A

Upstream

  • Upstream you have environemental factors - these include physical, political, economic and socio-cultural
  • this leads to stress, anxieyt, depression, occupation, and relationhsiop
  • whcih can lead to diet, inactivity, smoking, alcohol/drugs, pollution
  • markers include - obesity, BP, lipids, alt
  • which leads to the key chronic diseases such as CHD, storke, T2DM, cancers
30
Q

What are the key chronic diseases in the Marmot and Wilkinson model

A
  • CHD
  • stroke
  • T2DM
  • Cancers
31
Q

What is a key mediator for bioarkers and allostatic load

A

stress

32
Q

Describe how stress can impact someone

A
  • increases inflammation
  • increases lipid metabolism
  • increases glucose metabolism
  • activates the sympathetic nervous system
  • effects the cardiovascular system - resting heart rate, blood pressure
  • impacts the neuroendocrine system such as its effect on cortisol
33
Q

What are the proposed outcome objective for healthy lives in Tower hamlets

A
  • Stop the increase in levels of obesity and overweight children
  • Reduced prevalence of tobacco use in Tower Hamlets
  • Higher rates of physical activity
  • Reduced prevalence of sexually transmitted infections and promote sexual health
  • Reduced levels of harmful or hazardous drinking
  • Reduced rates of drug use
34
Q

What are the arguements that Mendenhall have

A

The arguments are that
1. diabetes must be understood as a disease of poverty without obscuring this fact and concomitant health inequities;

  1. diabetes is always syndemic;
  2. A diagnosis transforms how people perceive and experience their physical condition;
  3. The social life of diabetes is significant across contexts and
  4. Interventions should employ syndemic thinking for both upstream and downstream locations.
35
Q

what is the lifetime prevalence of physical violence

A

~ 1in 3 (10-40%)

36
Q

What is the prevalence of physical violence in the past year

A

~ 1 in 10 (2-20%)

37
Q

What counts as domestic abuse

A
  • partner abuse (non-sexual)
  • family abuse (non-sexual)
  • any sexual assault
  • stalking
38
Q

What is the second most cause of disability adjusted life year

A

Intimate partner violence is the second most common cause of disability adjusted life year in women aged 20-24 years

39
Q

What is a disability adjusted life year mean

A

= measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.

40
Q

What is the definition of domestic violence

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality.

41
Q

name types of abuse that can happen with domestic violence

A
  • psychological
  • physical
  • sexual
  • financial
  • emotional
42
Q

What is the definition of controlling behaviour

A

: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

43
Q

What is the definition of coercive behaviour

A

an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.
This definition includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage

44
Q

What is intimate partner violence

A

Any behaviour within an intimate relationship that causes physical, psychological or sexual harm

45
Q

What are the factors that make up intimate partner violence

A

Physical: slapping, hitting, kicking, beating

Sexual: forced intercourse, sexual coercion

Psychological: intimidation, constant belittling

Control; isolation, monitoring, deprivation of basic necessities

46
Q

What are the co associations with domestic violence

A
  • depression
  • PTSD
  • Alcohol abuse
  • Suicidal thoughts
47
Q

What are the indicators for intimate partner abuse

A

Physical

  • chronic GI symptoms
  • chronic abdominal pain
  • lethargy
  • chronic headaches

Gynaecological

  • chronic pelvic pain
  • sexual dysfunction
  • vaginal bleeding
  • STI
  • frequent bladder or kidney infections

Psychosocial

  • anxiety
  • depression
  • eating disorders
  • panic disorders

Situational

  • frequent healthcare service use and hospital admissions
  • frequent high level medication use
  • abuse of a child in the family
  • delays in seeking treatment
  • inconsistent explanations of the injuries
48
Q

What are the NICE guidelines for creating a disclosing environment

A

Clearly display information about the support on offer for those affected by DVA

Ensure information on where to get support is available in a range of formats and locally used languages

Ensure people who use the service are given maximum privacy

Ensure frontline staff know about the services, policies and procedures of relevant local agencies in relation to DVA

Provide ongoing training and regular supervision for staff who may be asking people about DVA

Establish clear policies and procedures for staff who have been affected by DVA.

Ensure staff have the opportunity to address issues relating to their own personal experiences, as well as those that may arise after contact with patients or service users.

HSPH (26 decks)

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