Block 5 Soc Pop Flashcards
What is the definition of child disability in the UK?
A person is disabled if they have a physical or mental impairment or condition that has a substantial and long-term effect on their ability to carry out normal day-to-day activities
How is child disability measured in the UK?
Depends on definition of disability
Incidence(rarely available)
prevalence
1. ICD10/DSM: some impairments and conditions
2. Concept of limiting long-standing illness/disability (UK census and
Equality Act)
3. International Classification of Functioning: Children and Youth (ICF-CY)
What is the prevalence of child disability in the UK?
0.8 million disabled children and young people age 0-18 in UK – 8% of all children (Family Resources Survey 2016/17, DWP 2018)
Why has there been an increase in prevalence of ADHD and autism?
- ADHD: rise in prevalence estimate, at least in part, associated with increased recognition and diagnostic practices
- Autism: increase in prevalence likely to be attributable, in part, to increased awareness, new administrative classifications and diagnostic practices
What are the pregnancy risk factors associated with child disability?
- Pregnancy outcomes (birthweight and prematurity)
• Low birthweight associated number of impairments: cerebral palsy,
reduced cognitive function, epilepsy
• Cerebral palsy: risk decreases with increasing birthweight up to weight
of 4.5kgs, before increasing slightly
• Premature births (born alive before 37 weeks gestation):
• 7% of babies born prematurely (ONS, 2015)
• extremely premature babies (born 22-26 weeks gestation) are
at greater risk of poor health outcomes and
neurodevelopmental disabilities than babies born at term
• Increased survival rates for preterm births – associated with
improvements in neonatal care
• EPICure 2 study (children born in 2006): more children born extremely
prematurely (22-26 weeks) are surviving disability free
• But no reduction in proportion of children at age 3 years with moderate
or severe impairments/conditions
• EPICure 1 study (children born in 1995): age 11 years, more than half
had no or only minor impairment
What are the factors relating to sex that are associated with child disability?
• Prevalence of all-cause disability is higher in boys in early years but by late teens prevalence for girls is similar to boys
• Neurodevelopmental disabilities more common in boys
• May be associated with genetic differences, under-identification in girls
due to diagnostic characteristics
What are the ethnicity factors associated with child disability?
- UK studies controlling for socio-economic status have found an increased risk for all-cause disability among children of mixed ethnicity and African/Caribbean origin only
- Complex pattern for neurodevelopmental disability:
- 7-15 year olds, rates of identification lower in minority ethnic groups overall
- Notable exceptions were higher rates of less severe intellectual disability among Gypsy/Roma and Traveller children of Irish heritage
- More severe forms of intellectual disability among Pakistani and Bangladeshi heritage
What are the socio-economic factors associated with child disability?
- Prevalence of disability increases as socio-economic status decreases
- Systematic review of high income countries:
- odds of having an intellectual disability were over 2 times greater for children in low SES households, than for children in high SES households (Spencer, Blackburn and Read, 2015)
- Likely explanation: children in low SES households are more exposed to social and environmental risk factors in prenatal and early childhood periods
What are the parental behaviours associated with child disability?
- Parental smoking, particularly maternal smoking associated with low birthweight and preterm birth and autism
- Alcohol consumption associated with growth before and after birth, educational outcomes, fetal alcohol syndrome
- Unsupportive and unstimulating parenting is linked with some intellectual disabilities and conduct disorders
What are the communicable disease factors associated with child disability?
• Rubella and other infections acquired during pregnancy
• Measles and mumps acquired later in childhood
• Greatest risk for children not immunised: not registered with a GP,
looked after children, some minority ethnic children
What are the unintentional injuries associated with child disability?
• Risk increases as children get older
• At all ages, children in poorer households and neighborhoods at
greater risk
What are the primary prevention strategies to reduce child disability?
Requires strategic interventions at national and local levels to:
1. Reduce socio-economic disadvantage across the lifecourse through
‘living wages’ and employment, and adequate welfare benefits
2. Improve material environments: safe and healthy housing, schools and
workplaces
3. Reduce exposure to environmental hazards including air pollutants,
environmental and industrial pollutants, especially lead
4. Reduce exposure to parental and other sources of environmental
tobacco smoke in utero, infancy and childhood.
5. Promote safe alcohol consumption in pregnancy
6. Ensure adequate dietary intake of key nutrients including folic acid and
other vitamins and minerals among women of childbearing age to protect against neural tube conditions and other consequences of vitamin deficiencies. Vulnerable groups may require supplementation around the time of conception
7. Achieve population coverage of immunisation against common communicable diseases: notably rubella, sufficient to ensure herd immunity to protect both the foetus from pregnancy-acquired infection
and children against complications of these diseases
What are the secondary prevention strategies to reduce child disability?
- Screening programmes
- Developmental assessments (Healthy Child Programme)
- Parents – but getting a diagnosis isn’t always easy.
- Contact with other services (non-health)
What are the tertiary prevention strategies to reduce child disability?
May include:
- Tailored medial care
- Physio
- Speech therapy
- Early development play groups
- Personal carers
- Adequate disability payments
What are the major screening programmes in the UK?
Antenatal newborn: · Downs syndrome · Infectious disease in pregnancy · Newborn bloodspot · Newborn hearing screening
Young person and adult: · Abdominal aortic aneurysm · Diabetic retinopathy · Breast cancer · Cervical cancer · Bowel cancer
What are the Wilson and Jungner/National Screening Committee criteria for the implementation of a screening programme?
- The condition should be an important health problem
- There should be a treatment for the condition
- Facilities for diagnosis and treatment should be available
- There should be a latent stage of the disease
- There should be a test or examination for the condition
- The test should be acceptable to the population
- The natural history of the disease should be adequately understood
- There should be an agreed policy on whom to treat
- The total cost of finding a case should be economically balanced in
relation to medical expenditure as a whole - Case-findingshouldbeacontinuousprocess,notjusta”onceandfor
all” project
Name the 4 types of bias in screening
1) Healthy screenee effect
2) Lead time bias
3) Length time bias
4) Overdiagnosis and over treatment
What is the healthy screenee effect?
- People who choose to attend screening tend to be healthier than those that do not
- People who do not take up invitations to screen are more likely to be smokers, drinkers, have a low income, poor diet, existing medical conditions
- Therefore comparisons between self selected screened and unscreened groups are biased
What is lead time bias?
- Screening can detect illness earlier when it is more responsive to treatment and therefore improve survival times
- However useless screening can appear to increase survival time by simply detecting the disease earlier but not actually resulting in longer life
What is length time bias?
- Screening is better at detecting diseases that develop more slowly
- Diseases that develop more slowly mean that you live for longer
- Therefore screen detected disease is likely to have a better prognosis even if
it results in no difference in treatment - Screening can detect illness earlier when it is more responsive to treatment
and therefore improve survival times - However useless screening can appear to increase survival time by simply
detecting disease that develops more slowly but not actually resulting in longer life
What is over diagnosis and over treatment?
over diagnosis
correct diagnosis of a disease, but disease will never cause symptoms within the person’s lifetime
overtreatment
Unnecessary treatment which does not improve health
What is sensitivity and how do you calculate it?
Sensitivity is the proportion of people who have the disease that the test correctly identifies
Sensitivity = TP/(TP + FN)
What is specificity and how do you calculate it?
Specificity is the proportion of people who DO NOT have the disease that the test correctly identifies as NOT having the disease
Specificity = TN/(TN/FP)
What is positive predictive value and how do you calculate it?
Positive predictive value (PPV) is the probability that a person has the disease given that they had a positive test result
PPV = TP/(TP + FP)
What is negative predictive value and how do you calculate it?
Negative predictive value (NPV) is the probability that a person does not have the disease given that they have a negative test result
NPV = TN/(TN + FN)
