CPS First Nations Volume 2

Question 1

How much higher is the rate of unintentional death in Canadian First Nations children?

a) 2x
b) 3x
c) 4x

Answer 1

4x higher than in other Canadian children (one study 4x in infants, 5x in preschoolers, 3x in teenagers)
leading cause of potential years of life lost
burden on families and on communities
1.2 million Canadians ID as aboriginal
no tracking system for injuries in aboriginals in Canada
Manitoba, Saskatchewan and BC: 6.5x higher
and some specific rates of injury in certain populations are as high as 22 times the Canadian average

Question 2

What percentage of all deaths among first nations people in Canada is caused by injury

a) 5%
b) 25%
c) 50%
d) 75%

Answer 2

26% of all deaths in first nations people caused by injury
accounting for more PYLL than all other causes of death combined at approximately 4.5 times the Canadian average
rates of death from injury

metis - leading cause of death is injury also, Manitoba slightly higher study

Question 3

Which of the following is not one of the top 2 leading causes of death from injury in First Nations children <10 year old?

a) fires
b) drowning
c) MVC

Answer 3

b) drowning

in females

Question 4

True or false : the rate of injury in Metis children is similar to that of other Canadian children

Answer 4

true - it is a similar rate (but look above for other bits about the metis in this extremely confusion statement).

other pearls about why FN have more accidents : lower SES at risk, less safe living conditions, less car safety, substance abuse etc contribute to the increased prevalence of injuries in these kids. more severe in jury in aboriginal kids overall. also more likely to have consequences because less rehab/supports/health care

Question 5

Name the major determining factor for seatbelt use in lack of seatbelt usage

Answer 5

alcohol (unclear if this applies to aboriginals only or everybody).

Question 6

Name 4 factors that may contribute to increased risk of drowning for aboriginal children

Answer 6

hypothermia
proximity to water
snowbiling on ice
alcohol (64% over limit vs 27% for non aboriginal drowning victims)
less likely to use pFD (only 6% wearing PFD)

Question 7

Name 4 factors that contribute to increased house fires in First Nations children

Answer 7

higher proportion of smokers at home, wood-framed, substandard housing, the underuse of working smoke detectors, longer travel times for fire rescue equipment and personnel [12], and a shortage of trained firefighters.

Question 8

True or false: Metis children are entitled to Non-Insured Health Benefits, same as other aboriginal children

Answer 8

false - they are not entitled to the same benefits, difficult to target this particular population

Question 9

What are the 6 Es of injury prevention?

Answer 9

1. education: identify community champions to spread the message of safety and educate community, anticipatory guidance (i.e. PFD),develop programs such as first aid, CPR, swimming lessons etc.
2. empowerment: incorporate culture and local participation in the design
   enabling: easy access and affordability of the interventions (i.e. cheap car seats)
3. engineering: design safer environments (i.e. better lit roads)
4. enforcement: involve police and band council leaders in policy implementation and enforcement
5. employment: build capacity while designing and implementing programs
   the end of the statement talks about improving advocacy, better research/surveilance, improve SES status, give resources

Question 10

Name the 4 features of FAS

Answer 10

history of alcohol exposure **needed for diagnosis combined with
poor growth
characteristic facial features
neurological abnormalities - brain dysfunction rated on a

A rating of 2 (possible brain dysfunction), referred to as ‘neurobehavioural disorder’, is based on personal observations and historical information about behaviour, suggesting the possibility of brain damage.

Question 11

What is the incidence of FAS

Answer 11

unsure of exact numbers, most recent approx 9.1/1000
higher in first nations
nowadays refer to typical and atypical FAS, in the past lots of discussion about what to call different FAS

Question 12

Name 4 CNS abnormalities that can be associated with the use of alcohol in pregnancy

Answer 12

1. holoprosencephaly
2. a genesis/hypoplasia of the corpus callosum; abnormalities of the cerebellum (especially the vermis); abnormalities of the brainstem
3. Other findings may include absent olfactory lobes, hypoplasia of the hippocampus and abnormal or absent basal ganglia; commonly hypoplastic or absent caudate nuclei.
   some studies showed abnormalities of glucose metabolism in the brain, even with normal structure, still being study all the effect on the brain; spectrum of effects depends on how much alcohol, mom’s vulnerability, pattern and timing of the drinking

Question 13

Which of the following is not linked to the severity of effects of maternal alcohol use?

a) amount of alcohol consumed
b) presence of specific biochemical markers in mom’s blood
c) age - worse if younger

Answer 13

c) false - worse when older
use over 15 ml, more effect in moms over 30 yo (infants 20-4 x more likely to be functionally impaired)
significant effects in moms who drank >5 drinks/day

the others are associated
biochemical markers - carbohydrate-deficient transferrin, gamma-glutamyl transpeptidase, mean red blood cell volume and whole blood-associated acetaldehyde.
>29.6 ml of alcohol/day - at least one marker, and babies were smaller

Question 14

Which of the following is not a facial feature of FAS?

a) short palpebral fissures
b) decrease intercanthal distance
c) flattened face with short nose
d) absent/hypoplastic philtrum
e) bow shaped mouth with thin upper lip
f) microcephaly

Answer 14

b) in fact, increased intercanthal distance

the others are all features; there are established standards for these

Question 15

Which of the following is not a common feature of FAS in an infant?

a) hypertonia
b) small weight/height/HC
c) jittery, tremulous, weak suck
d) difficulty getting used to stimulation

Answer 15

a) the opposite, they list hypotonia

also need history of alcohol exposure, facial abnormalities

also may sleep poorly, be poor feeders

Question 16

Name 4 characteristics a child with FAS may display in the preschool years

Answer 16

1. Friendly, talkative and alert
2. Temper tantrums and difficulty making transitions
3. Hyperactive; may be oversensitive to touch or over-stimulation
   Apparent skill levels may appear to be higher than their tested levels of ability**this one is key
   Attention deficits, developmental delays-speech, fine motor difficulties

in school years and beyond, key features include impulsivity, issues with emotional regulation/affection, behavioural issues, ADHD like picture, trouble with organization and decision making (see list of details), understandably leads to problems down the line

Question 17

Which is the most consistent features of FAS in the newborn period?

a) hypotonia
b) poor growth
c) jittery, tremulous, weak suck
d) difficulty getting used to stimulation

Answer 17

b) poor growth, especially small head circumference
facial features are also quite consistent, but may be difficult to recognize

Hearing disorders [25], eye abnormalities [26] and assorted congenital abnormalities may also be found.

Question 18

A woman wants to know what the effect of her binge drinking will be if she ends up getting pregnant. What do you tell her?

a) not nearly as big of a deal as regular alcohol consumption
b) will not lead to FAS
c) places her child at great risk of FAS, more so than mild drinking based on multiple studies
d) will definitely lead to FAS

Answer 18

binge drinking - number of drinks at a time more important than average consumption
the spectrum of effects on development from alcohol vary a lot and there is no established “safe” level of alcohol

Question 19

What is the key difference between ADHD and FAS presentation?

Answer 19

FAS more likely to score normally on tests of vigilance and reaction time**
social alcohol consumption level - associated with poorer attention span, but not more hyperactivity

Question 20

What are some of the social issues a child with FAS may experience?

Answer 20

inability to keep friends

excessively friendly to strangers, trouble discriminating between friends and strangers

Question 21

What is the IQ of a child with FAS

Answer 21

broad range, one study said 50-115
performance IQ higher - i.e. apparent intelligence seems higher
may have trouble with language, writing etc
ttention, short term memory, flexibility and planning, auditory memory (tapping memory and number sequences), and spatial visualization all may be affected

Question 22

What category of drinker is a young woman who drinks 5 drinks a week, usually only on the weekend days (friday-sunday)

a) abstainer
b) low -risk
c) at -risk
d) problem drinker

Answer 22

b) low-risk: 1-2 drinks/day, no more than 3 days a week, no effect on health, don’t use when “at risk (i.e. pregnant, driving, breastfeeding, with meds)

at risk - 7-21 drinks/week, no more than 3-4 at a time, drink in high risk situations

problem drinker - >21 drinks /week, may experience negative consequences

Question 23

When administering the TACE questionnaire, a woman responds that it takes 2 drinks for her to feel the effects of alcohol, the remainder of the questioning is negative.
What is her score and risk level?
a)1 - no concern
b)2- no concern
c)2- at risk behaviour 
d) 3 - at risk behaviour

Answer 23

c) 2- at risk

Tolerance - if 2 or more drinks, score is 2, for the other items, positive response score is one
A - annoyed - has anyone annoyed you by saying you should cut down
C - Have you thought you should cut down
E - eye opener

overall score of 2 or more identifies an at-risk drinker

should always ask women about drinking
goal of pregnant woman should be complete abstinence

Question 24

What are two things you can counsel a family about for their newborn diagnosed with FAS

Answer 24

1. at risk for child abuse, support them and counsel them about behavioural strategies
2. minimize further effect of alcohol by counselling them about alcohol and breastfeeding

Question 25

Please provide the four digit “score” for FAS for the child described:

impaired growth (small size)
mom drank heavily
typical facial features
significant behavioural issues

Answer 25

2442 (figure out deets, but this seems to be the gist of what to do). if you don’t have the characteristic facial features, may not get the official diagnosis, which is needed for funding
this is recommended

growth
maternal exposure
facial features
neurological state: scale of 1-4, 4 is static encephalopathy, 1 is normal
very hard to categorize the degree of brain abnormality. 4 - static encephalopathy, depends on evidence of problem microcephaly, abnormalities of brain imaging, persistent neurological findings of prenatal origin and/or an IQ score of 60 or lower.
**hard to make definitive diagnosis but 4 digit scoring system based on these characteristics
A rating of 3 (probable brain dysfunction), also characterized as ‘static encephalopathy’, is based on abnormalities in three of four areas of brain function affecting cognition, achievement, adaptation, neurological ‘soft’ signs and language.
A rating of 2 (possible brain dysfunction), referred to as ‘neurobehavioural disorder’, is based on personal observations and historical information about behaviour, suggesting the possibility of brain damage.

Question 26

discuss issues with funding for FAS in Canada

Answer 26

not universal
often need a diagnosis of disability
status indians may have more coverage than non status
intervention should include the family and community - try to keep with birth family is safe/possible but if not, aim for a stable foster home with lots of support
need to help with social behaviours - i.e. excessive friendliness
window of opportunity to help with behaviours should be embraced as much as possible
multi-D team important

Question 27

True or false - early intervention can help with FAS outcomes

Answer 27

true - even though the consequences are lifelong

Question 28

parenting advice for a newborn with FAS

Answer 28

handle/stroke gently, cuddle, lots of eye contact
don’t like bouncing
routine is very important (since transitions may be handled poorly)
early childhood - del-worth, interpersonal, independent, decision making

Question 29

A school age child is having lots of difficulty in the home and keeps getting in trouble for not completing tasks. give 4 pieces of advice to the parents

Answer 29

Keep tasks simple.
Use concrete examples.
Keep instructions simple and give them one at a time.
Concentrate on life skills.
bad short term memory may make it hard to remember tasks
tantrums should be handled with short time outs
teach child friend/foe
hard to deal with these kids - ensure the parents are supported and that there is respite

Question 30

What is the criteria for full FAS diagnosis

Answer 30

1. confirmed alcohol exposure (doesn’t need o be confirmed if adopted/foster care)
2. facial features -
3. growth small
4. neurodevelopment (need 3 or more of problems with ) neuro signs/symptoms, structure, cognition, memory, communication, attention)

Question 31

Criteria for partial FAS

Answer 31

alcohol exposure
facial features (can be partial)
evidence of impairment in 3 or more CNS domains

Question 32

What is alcohol related neurodevelopment disorder

Answer 32

alcohol in utero
no facial or growth features
impairment in 3 or more CNS domains

Question 33

cardiac anomaly most common in FAS (Zitelli)

Answer 33

VSD