Individual and social aspects of diabetes

Question 1

What does the VIDDA model stand for

Answer 1

• Violence
• Immigration and isolation
• Diabetes
• Depression
• Abuse

Question 2

What are management challenges for doctors

Answer 2

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

Question 3

What are prevention challenges for doctors

Answer 3

Lifestyle changes

• exercise
• diet
• smoking

communication
self management

Question 4

What are the challenges for implementing NICE guidelines

Answer 4

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

Question 5

What are the challenges for patients in managing conditions

Answer 5

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

Question 6

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

Answer 6

• 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

Question 7

What affects physical accessibility

Answer 7

• social and cultural enablers and barriers

- relevant and effective

Question 8

What are conceptual challenges

Answer 8

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

Question 9

What 3 factors are the most important determinant of population health

Answer 9

Displacement,

Deindustrialization (main source of income has changed)

vulnerability

Question 10

What is the VIDDA model a cause of

Answer 10

The VIDDA model is a cause of syndemic suffering

Question 11

describe the factors that make up the syndemic suffering

Answer 11

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

Question 12

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

Answer 12

• 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

Question 13

What is syndemic suffering

Answer 13

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

Question 14

Describe the syndemic model

Answer 14

• 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

Question 15

Name the types of syndemic interaction among diseases

Answer 15

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

Question 16

Why do syndemics emerge

Answer 16

• 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

Question 17

what is the key mediator in why syndemics emerge

Answer 17

• Poverty

Question 18

Name 6 dimensions of poverty

Answer 18

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

Question 19

What is situational poverty

Answer 19

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.

Question 20

What is generational poverty

Answer 20

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.

Question 21

What is absolute poverty

Answer 21

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

Question 22

What is relative poverty

Answer 22

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

Question 23

What is urban poverty

Answer 23

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

Question 24

What is rural poverty

Answer 24

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

Question 25

What is childhood poverty

Answer 25

A child is said to be living in poverty when they are living in a family with an income below 60% of the UK's average after adjusting for family size.

Question 26

What is food poverty

Answer 26

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.

Question 27

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

Answer 27

- 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

Question 28

What does marmot and wilkinsons model highlight

Answer 28

- This highlights the idea that you can look at factors in order to prevent people from getting ill

Question 29

Describe the marmot and wilkinson model

Answer 29

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

Question 30

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

Answer 30

- CHD - stroke - T2DM - Cancers

Question 31

What is a key mediator for bioarkers and allostatic load

Answer 31

stress

Question 32

Describe how stress can impact someone

Answer 32

- 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

Question 33

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

Answer 33

* 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

Question 34

What are the arguements that Mendenhall have

Answer 34

The arguments are that 1. diabetes must be understood as a disease of poverty without obscuring this fact and concomitant health inequities; 2. diabetes is always syndemic; 3. A diagnosis transforms how people perceive and experience their physical condition; 4. The social life of diabetes is significant across contexts and 5. Interventions should employ syndemic thinking for both upstream and downstream locations.

Question 35

what is the lifetime prevalence of physical violence

Answer 35

~ 1in 3 (10-40%)

Question 36

What is the prevalence of physical violence in the past year

Answer 36

~ 1 in 10 (2-20%)

Question 37

What counts as domestic abuse

Answer 37

- partner abuse (non-sexual) - family abuse (non-sexual) - any sexual assault - stalking

Question 38

What is the second most cause of disability adjusted life year

Answer 38

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

Question 39

What is a disability adjusted life year mean

Answer 39

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

Question 40

What is the definition of domestic violence

Answer 40

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.

Question 41

name types of abuse that can happen with domestic violence

Answer 41

- psychological - physical - sexual - financial - emotional

Question 42

What is the definition of controlling behaviour

Answer 42

: 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.

Question 43

What is the definition of coercive behaviour

Answer 43

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

Question 44

What is intimate partner violence

Answer 44

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

Question 45

What are the factors that make up intimate partner violence

Answer 45

Physical: slapping, hitting, kicking, beating Sexual: forced intercourse, sexual coercion Psychological: intimidation, constant belittling Control; isolation, monitoring, deprivation of basic necessities

Question 46

What are the co associations with domestic violence

Answer 46

- depression - PTSD - Alcohol abuse - Suicidal thoughts

Question 47

What are the indicators for intimate partner abuse

Answer 47

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

Question 48

What are the NICE guidelines for creating a disclosing environment

Answer 48

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.