week 12

Question 1

T2DM in First Nations peoples pathophysiology

Answer 1

strongly associated with chronic low-grade inflammation and early-life exposure to nutritional, metabolic, and psychosocial stressors
trigger epigenetic modifications that impair insulin signalling pathways and promote insulin resistance

Question 2

why is T2DM poorly controlled in 1st nations communities

Answer 2

Systemic racism in healthcare and policy
Food insecurity due to high costs, lack of infrastructure
Housing instability and overcrowding- limited storage of food and medications
Reduced access to culturally safe, preventative care

Question 3

Aboriginal and Torres Strait Islander peoples, CKD (kidney disease) higher bc

Answer 3

low Access to Kidney replacement therapy and transplant services as would have to relocate
Cultural incompatibility with urban-based dialysis as would have to relocate
Underrepresentation of First Nations peoples on transplant lists driven by systemic racism
Burden of comorbid infections and environmental exposures: CKD is exacerbated by repeated infections

Question 4

acceleration of CKD in 1st nations people bc

Answer 4

Diabetic Kidney Disease
Hypertension
Glomerulonephritis
Infections and Autoimmune Conditions

Question 5

Rheumatic Heart Disease (RHD) in First Nations Peoples pathophysiology

Answer 5

ong-term consequence of repeated episodes of acute rheumatic fever

Question 6

Aetiology and Disproportionate Burden of RHD on 1st nations people

Answer 6

60x more liikely, with nearly 1/2 people diagnosed as severe cases and median age of death being 50 years/o

Question 7

Community Strengths and the Endgame Strategy for RHD

Answer 7

Healthy environments: Investment in housing and hygiene
Early prevention: Community-led skin and throat programs
Care and support: Improved access to culturally safe care,

Question 7

Social Determinants and Systemic Drivers of RHD on 1st nations people

Answer 7

Overcrowded housing increases transmission of Strepts A
Lack of functional health hardware eg hot water
Limited access to culturally safe primary and secondary care
Travel off-Country for specialist care and surgery is disruptive, emotionally distressing
Racism and systemic inequities create barriers to engagement with health services,

Question 8

People living with severe mental illnesses (SMI) experience substantially higher rates of

Answer 8

Cardiovascular disease (CVD)
Type 2 diabetes mellitus (T2DM)
Chronic obstructive pulmonary disease (COPD)
Metabolic syndrome
Early mortality (14–23 years earlier than average)

Question 9

Aetiology (CAUSES) of People with mental illness are at risk of developing higher rates of preventable physical illnesses

Answer 9

Early-Life Trauma and Adversity
Social Disadvantage and Discrimination
Health System Failures- lack of Dx

Question 10

Biological pathways linking mental and physical illness:
(pathophysiology)

Answer 10

1. HPA Axis Dysregulation and Chronic Stress
2. Antipsychotic-induced metabolic dysfunction
3. Tobacco smoking-related disease

Question 11

1. HPA Axis Dysregulation and Chronic Stress

Answer 11

dysregulate the hypothalamic–pituitary–adrenal (HPA) axis, leading to sustained cortisol elevation
promoting:
Insulin resistance and T2DM
Visceral adiposity
Hypertension
Endothelial dysfunction and atherosclerosis

Question 12

2. Antipsychotic-induced metabolic dysfunction
   associated with significant metabolic side effects

Answer 12

Weight Gain
hyperglycaemia
dyslipidemia
QT Prolongation

Question 13

Strengths-Based and Recovery-Oriented Approaches for People with mental illness developing higher rates of preventable physical illnesses

Answer 13

Integrated physical–mental health services
Peer-led programs using lived experience to support engagement
Culturally safe and trauma-informed models

Question 13

why do LGBTQIA+ experience disproportionately poorer health outcomes

Answer 13

Discrimination and stigma in healthcare, education, and employment
Minority stress, including internalised stigma, concealment, and microaggressions
Violence and exclusion
Legal, financial, and housing instability
Lack of culturally competent care

Question 14

LGBTQIA+ Individuals re mental illness

Answer 14

This includes emotional neglect, family rejection, bullying, and exposure to violence—each independently associated with later development of mood and anxiety disorders
Mistrust of the healthcare system due to previous discrimination, misgendering or lack of provider knowledge
this is minority stress

Question 15

Pathophysiology of LGBTQIA+ Individuals re mental illness

Answer 15

HPA axis dysregulation → cortisol elevation
Altered serotonergic and dopaminergic signalling
Neuroinflammation and reduced neuroplasticity
Immune system activation and allostatic overload

Question 16

LGBTQIA+ Individuals re Cardiovascular Disease (CVD) Aetiology

Answer 16

Chronic psychological stress
Elevated smoking, vaping and substance use
Physical inactivity due to unsafe or exclusionary environments
inadequate preventive and primary care

Question 17

LGBTQIA+ Individuals re Cardiovascular Disease (CVD) pathophysiology

Answer 17

• Endothelial dysfunction via cortisol and cytokines
• Chronic stress and inflammation impair vascular endothelial function, reducing nitric oxide availability and increasing vasoconstriction.
• Atherosclerosis progression
• Persistent low-grade inflammation, oxidative stress and dyslipidaemia contribute to plaque formation and coronary artery disease
• Heightened cardiovascular reactivity and autonomic dysregulation

Question 18

LGBTQIA+ Individuals re Type 2 Diabetes Mellitus & Metabolic Syndrome Aetiology

Answer 18

Cortisol-induced insulin resistance
Limited access to exercise spaces and affirming care
Elevated smoking/alcohol use
Hormonal effects from gender-affirming therapy

Question 19

LGBTQIA+ Individuals re Type 2 Diabetes Mellitus & Metabolic Syndrome pathophysiology

Answer 19

Impaired insulin sensitivity (muscle, hepatic)
Visceral fat accumulation
Dysregulated glucose metabolism, chronic inflammation

Question 20

LGBTQIA+ Individuals re Tobacco and vaping related diseases Aetiology

Answer 20

as coping mechanisms. Plus there is historic and ongoing targeting by tobacco and vaping industry

Question 21

LGBTQIA+ Individuals re Tobacco and vaping related diseases pathophysiology

Answer 21

Oxidative stress damaging lung and vascular tissue
Carcinogen exposure → cancers (e.g., lung, oropharyngeal)
Acute lung injury (vaping) and chronic bronchial inflammation (smoking) → COPD

Question 22

LGBTQIA+ Individuals re HIV and Other STIs Aetiology

Answer 22

Barriers to PrEP and STI screening
Syndemic factors: homelessness, substance use, trauma
Lack of inclusive sexual health education

Question 23

LGBTQIA+ Individuals re HIV and Other STIs pathophysiology

Answer 23

HIV → progressive CD4+ T cell depletion and immune dysfunction Long-term ART may increase metabolic burden Co-infections and chronic inflammation accelerate systemic damage

Question 24

Strength-Based and Inclusive Approaches for LGBTQIA+

Answer 24

Peer-led mental health and support programs Gender-affirming Inclusive services and professional bodies that provide education and professional development opportunities

Question 25

Culturally and Linguistically Diverse (CALD) Populations experience worse health because

Answer 25

Language barriers and health literacy gaps Racism and discrimination in health systems Delayed or avoided care due to fear, mistrust, or visa insecurity Socioeconomic disadvantage and housing precarity Inadequate culturally responsive healthcare models

Question 26

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Chronic Disease (e.g., Cardiovascular Disease, Diabetes) aetiology

Answer 26

Higher rates of cardiometabolic risk factors Stress associated with migration, Nutritional transitions and dietary acculturation leading to increased processed food intake and reduced traditional dietary patterns Reduced physical activity due to unsafe environments or social isolation

Question 27

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Chronic Disease (e.g., Cardiovascular Disease, Diabetes) pathophysiology

Answer 27

Chronic activation of the HPA axis leads to cortisol-mediated insulin resistance, visceral adiposity, and endothelial dysfunction Sustained inflammatory responses elevate risk for metabolic syndrome, T2DM, and atherosclerosis Undiagnosed or poorly managed conditions due to late presentation result in higher rates of organ damage and complications

Question 28

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Infectious Disease Burden and Late Diagnosis aetiology

Answer 28

- Barriers to access vaccination, screening, and early diagnosis - Structural racism, migration policies, and limited Medicare access - Limited trust in services or past trauma associated with medical systems

Question 29

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Infectious Disease Burden and Late Diagnosis pathophysiology

Answer 29

Prolonged untreated infection leads to chronic inflammation, fibrosis, and increased cancer risk Tuberculosis may progress to disseminated or drug-resistant forms if untreated due to late presentation or interrupted care

Question 30

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Maternal and Perinatal Health Disparities aetiology

Answer 30

Communication challenges and unfamiliarity with antenatal systems Limited access to culturally competent midwifery care Higher rates of gestational diabetes in certain ethnic groups

Question 31

Culturally and Linguistically Diverse (CALD) Populations experience worse health re Maternal and Perinatal Health Disparities Pathophysiology

Answer 31

Hyperglycaemia in pregnancy increases risk of foetal macrosomia, preterm birth, and future development of T2DM in mother and child Delayed diagnosis of pregnancy complications may result in increased maternal and neonatal morbidity

Question 32

Strength-Based and Culturally Responsive Approaches for CALD

Answer 32

Community-led health promotion and peer-based education using interpreters and bicultural workers Health professional trainingLinks to an external site.in cross-cultural communication