Individual and social aspects of diabetes Flashcards
What does the VIDDA model stand for
- Violence
- Immigration and isolation
- Diabetes
- Depression
- Abuse
What are management challenges for doctors
- Non-adherence
- Lifestyle change
- Burden of treatment for patient
- Communicating with patients
- Co-morbidities
- Co-ordination of health care
What are prevention challenges for doctors
Lifestyle changes
- exercise
- diet
- smoking
communication
self management
What are the challenges for implementing NICE guidelines
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
What are the challenges for patients in managing conditions
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
describe how patients change in terms of fit and how the treatment can be taloiroed to the individual
- 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
What affects physical accessibility
- social and cultural enablers and barriers
- relevant and effective
What are conceptual challenges
- globally, nationally, locally
- socioeconomic and political economic basis for societies
- sustainable development and climate change
What 3 factors are the most important determinant of population health
Displacement,
Deindustrialization (main source of income has changed)
vulnerability
What is the VIDDA model a cause of
The VIDDA model is a cause of syndemic suffering
describe the factors that make up the syndemic suffering
VIDDA model is made up of violence, immigration and isolation, diabetes, depression and abuse
describe the factors that make up the VIDDA model of syndemic suffering
- 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
What is syndemic suffering
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
Describe the syndemic model
- 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
Name the types of syndemic interaction among diseases
- Enhanced contagiousness
- Accelerated virulence
- Alterations of the physical body
- Alterations of the emotions
- Gene reassortment
- Iatrogenic factors
Why do syndemics emerge
- 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
what is the key mediator in why syndemics emerge
- Poverty
Name 6 dimensions of poverty
1, Situational poverty 2, generational poverty 3, absolute poverty 4, relative poverty 5, urban poverty 6, rural poverty
What is situational poverty
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.
What is generational poverty
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.
What is absolute poverty
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
What is relative poverty
Relative povertyrefers to the economic status of a family whose income is insufficient to meet its society’s average standard of living. Geographically determined.
What is urban poverty
Urban povertya complex aggregate of chronic and acute stressors (including crowding, violence, and noise) and are dependent on often-inadequate large-city services.
What is rural poverty
Rural poverty:families often have less access to services, support for disabilities, and quality education opportunities.
What is childhood poverty
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.
What is food poverty
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.
What do patients feel like when they visit their GP if they live in low income communities
- 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
What does marmot and wilkinsons model highlight
- This highlights the idea that you can look at factors in order to prevent people from getting ill
Describe the marmot and wilkinson model
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
What are the key chronic diseases in the Marmot and Wilkinson model
- CHD
- stroke
- T2DM
- Cancers
What is a key mediator for bioarkers and allostatic load
stress
Describe how stress can impact someone
- 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
What are the proposed outcome objective for healthy lives in Tower hamlets
- 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
What are the arguements that Mendenhall have
The arguments are that
1. diabetes must be understood as a disease of poverty without obscuring this fact and concomitant health inequities;
- diabetes is always syndemic;
- A diagnosis transforms how people perceive and experience their physical condition;
- The social life of diabetes is significant across contexts and
- Interventions should employ syndemic thinking for both upstream and downstream locations.
what is the lifetime prevalence of physical violence
~ 1in 3 (10-40%)
What is the prevalence of physical violence in the past year
~ 1 in 10 (2-20%)
What counts as domestic abuse
- partner abuse (non-sexual)
- family abuse (non-sexual)
- any sexual assault
- stalking
What is the second most cause of disability adjusted life year
Intimate partner violence is the second most common cause of disability adjusted life year in women aged 20-24 years
What is a disability adjusted life year mean
= measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
What is the definition of domestic violence
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.
name types of abuse that can happen with domestic violence
- psychological
- physical
- sexual
- financial
- emotional
What is the definition of controlling behaviour
: 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.
What is the definition of coercive behaviour
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
What is intimate partner violence
Any behaviour within an intimate relationship that causes physical, psychological or sexual harm
What are the factors that make up intimate partner violence
Physical: slapping, hitting, kicking, beating
Sexual: forced intercourse, sexual coercion
Psychological: intimidation, constant belittling
Control; isolation, monitoring, deprivation of basic necessities
What are the co associations with domestic violence
- depression
- PTSD
- Alcohol abuse
- Suicidal thoughts
What are the indicators for intimate partner abuse
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
What are the NICE guidelines for creating a disclosing environment
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.
