CPS miscellaneous Flashcards
School age children and digital media
- potential benefits
- risks
Pros: can be educational, play with peers, make friendships, lower depression risk at 1hr vs. no screen time
Cons: increase conduct problems, depressive sx, unsupervised content, impair problem solving, disrupt efficiency, depressive sx and sedentary activities
Adolescents and digital media
- pros
- cons
Pros:
- psychosocial benefits, social connectedness, support to explore identify, action video games may have benefits
Cons:
- anxiety, depressive sx, lower academic scores, greater impulsivity, risky behaviours online
Digital media and negative impact on PHYSICAL health (4)
- distractedness - e.g. driving
- displace physical activity
- weight/obesity
- sleep
4Ms for screen use
- Manage screen use
- Encourage meaningful screen use
- Model healthy screen use
- Monitor for signs of problematic screen use
Psychosocial aspects of obesity
- bullied
- neglect, maltreatment
- associated with stressers
- inadequate sleep = RF
- weight bias
- depression, social isoaltion
- decreased self-esteem
- behavioural problems
- dissatisfaction with body image
- reduced quality of life
Health consequences of childhood obesity
insulin resistance T2DM dislipidemia HTN OSA non-alcoholic steatohepatitis poor self esteem lower HRQOL
RFs for children being less active
older children female Indigenous "overscheduled" those who do not like sport youth with disability public housing extremes of climate local crime rates
Physical activity guidelines by age
- 1-4 yrs
1-4 yrs: 180min/day (structured and unstructured activity
<2 yrs: no screens
2-4 yrs: less than 1 hr per day
Physical activity guidelines
5-11 and 12-17
60 min MVPA daily
- 3+days / week of vigorous and
- 3+ days / week of muscle strengthening
Physical activity 10-12 yrs and screen
Screen < 2yrs
Physical activity: at least 60 min of moderate-to-vigorous-intensity activity daily
Malignant brain edema syndrome (second impact syndrome)
- complication of head injury
- loss of autoregulation in brain’s blood supply –> cerebrovascular congestion, increased ICP with progression to herniation, coma and death
Risk factors for prolonged recovery from concussion
- previous head injuries
- history of migraines or headaches
- mental health issues
- sleeping difficulties
- learning disability
- ADHD
- younger age
If concussion symptoms persist longer than several weeks consider
- neuroimaging and formal neuropsych testing
- multidisciplinary team
- active rehab with subthreshold activity
Risks of screens and early development
Association between heavy screen exposure and language delays, cognitive development, executive function, attention
Reduces amount and quality of parent-child interaction
Inability of young children to distinguish between reality
Mitigating negative impacts of screen time
- watch educational, age-appropraite with adults
Screen time
< 2yrs
< 5 yrs
<2: screen time not recommended
2-5 yrs: <1hr /day
screens should not be routine part of child care, daily screen free times e.g. meals, avoid screens for >1 hr before bedtime
Risk factors for lead exposure
- older neighbourhood, lead pipes, paints,
- proximity to industrial waste site, old buildings, busy roadway or airfield
- costume jewelr, candles, importe dpainted toys
- food: imported surgar, candy, food prepared or stored in containers with lead, wild game shot with lead bullets, vegetables that accumulate lead
- hobby/occupation: lead mining and smelting, edemolistion, renovations, hunting, pottery glazing
Family: mother exposed to elad before or during pregnancy, lived in a country with higher lead
Symptoms of lead exposure
Asymptomatic or subtle
- cog delay, inattention, hyperactivity, speech delay, hearing impairment, poor balance
Investigation if suspect lead exposure
- blood lead level
- CBC
- ferritin
- calcium, protein, albumin
Health risks of climate change
- heat and cold related morbidity and mortality
- natural hazards and extreme weather events
- air pollution
- contaminated water sources
- infection risks from insects, ticks, rodents
- increasing UV radiation
Azithromycin indications
- 2nd line for life-threatening beta-lactam allergy for acute strep pharyngitis
- considered for pneumonia from atypical bacteria
Factors associated with fatalities from OTC cough and cold meds in children
- age < 2yrs
- use of med for sedation
- use in daycare setting
- combining 2+ meds with same ingredient
- failure to use a measuring device
- product misidentification
- use of products intended for adults
Cough and cold meds/treatment showing little benefit
- cough and cold meds
- humidified air
- NSAIDs
- antihistamines
- echinacea
- zinc
- vitamin C
(honey pretty much only thing potentially beneficial)
Role for medical cannabis
- anecdotal evidence and biological plausibility for refractory epilepsy
- risks with cannabis
Folate for pregnant women
- 0.4-1mg folic acid at least 2-3 months before conception
- if fam hx of NTD: at least 5mg of folic acid at least 2-3 months before conception and continuing 10-12 weeks post conception
Factors known to increase risk of NTDs
- birth of previous child with a NTD (#1)
- family hx of NTD
- maternal obesity
- maternal hispanic origin
- use of some anticonvulsants
- pregestational or gestational diabetes
Unique challenges for pharmacare for youth
- vulnerable population
- unique medication needs
- regulatory neglect
- drug therapies provide significant return on investment that may not be captured
Vanessa’s Law (Bill C-17)
Amendments to Food and Drug Act to enhance med safety:
- strengthening oversight
- improved reporting systems for A/E,
- increased transparency
Challenges with compounding
- meds can be weaker, less stable, potent, sterile, bioavailable which can lead to significant concentration related or dosing errors
- may have unpleasant taste leading to poor adherence
- exposure to potentially hazardous substance = risk to patients/caregivers
Reducing risk of ATV injuries
- youth < 16 yrs should NOT operate ATV
- youth operators shoudl wear a government certifed helmet, eye protection, protective clothing and footwear,
- single rider ATVs shoudl not take on passengers
- should not operate with alchol
- should complete approved training course
Children < 3 at high risk of mechanical airway obstruction because
- airway still developing
- eating can be difficult
- do not consistently chew
- swallowing is underdeveloped
- lack experience aborting potential choking episodes
- put more things in their mouth
1 unintentional injury death by age group
- <1 yr
- > 1
<1 = threat to breathing
1-4, 5-9, 10-14, 15-19: motor vehicle traffic crash
1 unintentional injury hospitalization
<1, 1-4, 5-9, 10-14, 15-19: fall
Ethical issues in advanced care planning
- respect for autonomy
- beneficence
- non-maleficence
3 requirements of informed consent
- capacity
- adequate information (what a reasonable person would want to know)
- voluntary and free of coercion
To have “capacity” in medical decision making…
need to understand:
- nature and consequences of the medical problem
- risks and benefits of proposed treatment
Appropriate genetic testing for chidlren
- to confirm a medical diagnosis in a symptomatic child
- to enhance monitoring, prophylaxis or treatment in an asymptomatic child e.g. familial hyperlipidemia, MEN
(dont do reproductive decision-making in child until old enough to participate in decision-making)
Risk factors for CA-MRSA infection
- overcrowding
- frequent skin-to-skin contact
- activities that lead to abraded /compromised skin surfaces
- sharing contaminated personal items
- personal cleanliness and hygiene
- limited access to health care
- lower SES
- exposure to abx
Factors contributing to increased rates of CA-MRSA in Indigenous populations
- overcrowding (10x more frequent on reserve and for Inuit)
2. homes not having potable water
Consequences of early childhood caries
- association with other diseases e.g. RTIs, AOM (weak relationship)
- painful, altered chewing, eating and sleeping
- early tooth loss can lead to speech difficulties, poor self esteem
- increased risk of decay in primary and permanent teeth
- malalignment and crowding of teeth
- association with obesity
- may require treatment under GA
Single greatest risk factor for early childhood caries
- poverty!
other RFs: crowding, family size, nutrition, health behaviours, parenting practices, parent’s oral health, dietary factors (prolonged bottle use or sugar-containing drinks, sugary snacks), environmental tobacco and maternal smoking status
OCAP principles of self-determination in health research with Indigenous ppls
Ownership
Control
Access
Possession
Reporting incidence of inhalant abuse is challenging because
- lack of recognition
- social stigma
- changing trends
- apparent regional differences
- differences in survey methods
- older kids stop reporting because ?less socially acceptable ?forgot
Inhalant abuse is correlated with
- reduced family support
- deviant fam environments
- poor school performance
- poor self-esteem and suicidality
- psych conditions
- other substance abuse
- substance abusing family and peers
Discrepancy in injuries in Indigenous vs. non-indigenous due to
- lower incomes
- less education
- higher unemployment
- more rural
- more likely to live in unsafe housing
- more likely to encounter shortages in health care resources
- historical inequities/cultural alienation/residential school
- depression, alcohol, substance use, rick-taking behaviours
- lack of culturally appropriate injury prevention programs
6Es in injury prevention
Education Empowerment Enabling Engineering Enforcement Employment
Risk factors for scabies
poverty overcrowding bed-sharing families with many children malnutrition reduced access to health care some Indigenous communities/resource poor communities
Features of scabies infection
- prurutiic rash
- worse at night
- characteristic locations (e.g. fingers, wrist, elbows, armpits, genitals or breasts)
- sx in other household members
+/- burrows
Scabies management
1st line: 5% permethrin cream - neck to toes - reapply after 7 days (for babies, head to toe) - treat all household members, launder all linens
Living conditions contributing to high rates of TB in Indigenous populations
- crowded and poor quality housing (moulds, air pollutants)
- food insecurity
- barriers to health care access
Unique challenges for Indigenous youth smokers
- parents/siblings smoking
- family support is important factor in quitting
Low vitamin D
- impacts of fetus/long term effects
Long term: - decreased bone density - worse asthma - T1DM - enamel defects in teeth Short term: hypocalcemia, rickets, small size, dental
Factors affective Vitamin D sufficiency
- exposure to sunlight
- skin pigmentation
- clothing
- use of sunscreen
Vitamin D recommendations for:
- pregnant moms
- prems
- term infants
- term infants in northern communities (>55th parallel)
Pregnant: ~1000-2000 Prem: 200 IU/kg/day to 400IU/day Term: 400IU/day Term in North: 800IU/day October to April
Risk factor for all hockey injuries
- bodychecking or policy permitting
- age (older age)
- session-type (game>practice)
- level of player (higher level)
- player position (goalie=protective)
- size esp if <25th percentile
- previous hx of injury
