CPS First Nations Volume 2 Flashcards
How much higher is the rate of unintentional death in Canadian First Nations children?
a) 2x
b) 3x
c) 4x
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
What percentage of all deaths among first nations people in Canada is caused by injury
a) 5%
b) 25%
c) 50%
d) 75%
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
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
b) drowning
in females
True or false : the rate of injury in Metis children is similar to that of other Canadian children
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
Name the major determining factor for seatbelt use in lack of seatbelt usage
alcohol (unclear if this applies to aboriginals only or everybody).
Name 4 factors that may contribute to increased risk of drowning for aboriginal children
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)
Name 4 factors that contribute to increased house fires in First Nations children
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.
True or false: Metis children are entitled to Non-Insured Health Benefits, same as other aboriginal children
false - they are not entitled to the same benefits, difficult to target this particular population
What are the 6 Es of injury prevention?
- 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.
- empowerment: incorporate culture and local participation in the design
enabling: easy access and affordability of the interventions (i.e. cheap car seats) - engineering: design safer environments (i.e. better lit roads)
- enforcement: involve police and band council leaders in policy implementation and enforcement
- 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
Name the 4 features of FAS
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.
What is the incidence of FAS
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
Name 4 CNS abnormalities that can be associated with the use of alcohol in pregnancy
- holoprosencephaly
- a genesis/hypoplasia of the corpus callosum; abnormalities of the cerebellum (especially the vermis); abnormalities of the brainstem
- 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
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
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
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
b) in fact, increased intercanthal distance
the others are all features; there are established standards for these
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
a) the opposite, they list hypotonia
also need history of alcohol exposure, facial abnormalities
also may sleep poorly, be poor feeders
Name 4 characteristics a child with FAS may display in the preschool years
- Friendly, talkative and alert
- Temper tantrums and difficulty making transitions
- 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
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
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.
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
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
What is the key difference between ADHD and FAS presentation?
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
What are some of the social issues a child with FAS may experience?
inability to keep friends
excessively friendly to strangers, trouble discriminating between friends and strangers
What is the IQ of a child with FAS
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
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
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
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
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
What are two things you can counsel a family about for their newborn diagnosed with FAS
- at risk for child abuse, support them and counsel them about behavioural strategies
- minimize further effect of alcohol by counselling them about alcohol and breastfeeding
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
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.
discuss issues with funding for FAS in Canada
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
True or false - early intervention can help with FAS outcomes
true - even though the consequences are lifelong
parenting advice for a newborn with FAS
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
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
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
What is the criteria for full FAS diagnosis
- confirmed alcohol exposure (doesn’t need o be confirmed if adopted/foster care)
- facial features -
- growth small
- neurodevelopment (need 3 or more of problems with ) neuro signs/symptoms, structure, cognition, memory, communication, attention)
Criteria for partial FAS
alcohol exposure facial features (can be partial) evidence of impairment in 3 or more CNS domains
What is alcohol related neurodevelopment disorder
alcohol in utero
no facial or growth features
impairment in 3 or more CNS domains
cardiac anomaly most common in FAS (Zitelli)
VSD
