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CPS Statements > First Nations, Inuit and Metis Health > Flashcards

First Nations, Inuit and Metis Health Flashcards

1
Q

What approach should be used for researching social determinants of health of aboriginal children? What does this mean?

A
  • community-based participatory research approach
  • shared power and decision making. Community representatives involved in all stages of research
  • equitable engagement
  • respect and cite traditional knowledge
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2
Q

What are the 3 main ethical principles?

A
  • beneficence
  • nonmaleficence
  • distributive justice
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3
Q

What are some additional determinants are specific to aboriginal youth?

A
  • kinship
  • racism
  • loss of traditional language, land and social identity
  • historical context of mental health and addiction problems given residential schools
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4
Q

What special accommodations need to be made regarding research and informed consent for aboriginal populations?

A
  • materials used need to be provided in the appropriate language and format
  • remember that for some aboriginal communities it may be appropriate to approach the elders first
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5
Q

What are some key principles regarding self-determination of First Nations involvement in research?

A
  • Ownership
  • Control
  • Access
  • Possession
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6
Q

How is scabies transmitted?

A

skin to skin contact

clothing and bed linen

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7
Q

What is the pathophysiology of scabies?

A

-buries into epidermis, mint, faces and ova laid cause irritation that leads to itching and secondary infection

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8
Q

What is the incubation period for scabies?

A

3 weeks

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9
Q

What is the characteristic history for scabies?

A

itches that is worse at night.
Areas in older kids and adults are web spaces, flexors of wrist and elbows, axilla, male genitalia and women’s breasts.
Younger infants more atypical with general distribution but usually concentrated on hands, feet and body folds

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10
Q

How do you diagnose scabies?

A

-usually clinically but can do scrapings and see mites, faces or eggs

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11
Q

What risk factors put aboriginal people at increased risk for scabies?

A
  • crowded housing
  • high paediatric population
  • failure to recognize an infestation
  • reduced access to medical or nursing care
  • faulty application of tx regimens
  • failure to treat close contacts
  • failure to eradicate scabies from clothing or linen
  • lack of running water
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12
Q

What is the first line treatment for scabies and how it is given? Any contraindications?

A

Permethrin 5% cream. Put all over body, leave on for 8-14 hours and wash off. Can be repeated 1-2 weeks later if live mites seen. One dose usually curative.

Do not give to kids

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13
Q

What is the second line treatment for scabies? How is it applied? Any contraindications?

A

Lindane cream or lotion. Put all over and wash off after 6-12 hrs (depends if infant or adult). Reapply one week later if live mites appear. Caution with infants

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14
Q

What is a good treatment for very young infants and pregnant women for scabies?

A

Precipitated sulphur (7%) in petroleum jelly. Put on for 3 days in a row, leave on for 24 hours and wash off before next application

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15
Q

In addition to medical tx of the patient what do you need to do with scabies?

A
  • treat all household and close contacts even if not symptomatic
  • clothing should be changed daily
  • wash all clothes and linens in hot water (60 degrees C)
  • if no access to water put in a bag for 5-7 days
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16
Q

How do you counsel a family to apply scabies treatment?

A

-apply after a tepid bath or shower after drying. Apply to whole body especially the skin folds, fingernails, toenails, behind ears and groin. Need to do face and scalp too.

Advise them that itching may last after the mites are dead due to a reaction to material still in the skin. But could also be inadequate application.

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17
Q

When can a child return to daycare or school after having scabies?

A

The day after treatment is completed.

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18
Q

Is there a role for prophylactic treatment of scabies in a community?

A

maybe in an epidemic

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19
Q

How do you diagnose fetal alcohol syndrome?

A

1) history of prenatal alcohol consumption
2) pre- and postnatal growth deficiency
3) characteristic pattern of facial abnormalities
4) central nervous system dysfunction

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20
Q

What is fetal alcohol effect/atypical FAS?

A

in patients whose mum had alcohol exposure but have an incomplete picture of nonspecific physical and psychological manifestations

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21
Q

Which groups have a disproportionately higher incidence of FAS?

A

aboriginals

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22
Q

What are the effects of alcohol on the brain of a developing fetus in the context of FAS?

A

-microcephaly
-holoprosencephaly (failure of the brain to divide into two hemispheres)
-corpus callosum abnormalities
-brainstem and cerebellum abnormalities
etc

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23
Q

What type of alcohol consumption puts fetus’ at most risk for FAS?

A

-binge drinking (at least 5 or more drinks on one occasion on average at least once a week)

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24
Q

What are the characteristic facial features of FAS?

A
  • short palpebral issuers
  • increased intercanthal distance
  • flattened face
  • short nose
  • absent or hypoplastic filtrum
  • bow-shaped mouth
  • thin- upper lip
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25
Q

What are characteristic neurobehavioural issues in kids with FAS?

A

-problems with intelligence, activity, attention, learning, memory, language, motor abilities, behaviour

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26
Q

What are some characteristic inappropriate behaviours seen in FAS?

A
  • overly affectionate and does not discriminate between family and strangers
  • lack of social skills to make and keep friends
  • unresponsive to social clues
  • communication problems
  • difficulty making transitions
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27
Q

What are the longterm implications of the neurocognitive and behavioural issues in kids with FAS?

A
  • poor social skills
  • difficulty with setting boundaries so increased trouble with the law
  • difficult with day to day living
  • serious life adjustment problems including substance abuse, depression, etc
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28
Q

What are the different aspects of a proactive approach to FAS?

A
  • prevention - changing attitudes towards drinking in young people
  • identify at risk drinkers before pregnancy
  • identify at risk infant
  • start intervention as soon as possible for infant
  • identify comorbid conditions
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29
Q

What is the difference between a low-risk, at risk or problem drinker?

A

low-risk: 1-2 drinks per day 3x a week or less, no effect on health
at-risk: 7-21 drinks per week, more than 3-4 per occasionor drink in high risk situations
problem-drinker: >21 drinks per week, negative consequences (health, low, job, etc)

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30
Q

Why is it important to diagnose FAS early?

A
  • to get mum to stop drinking/breastfeeding to prevent further exposure to alcohol
  • to help the kid asap with interventions to prevent secondary long term complications
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31
Q

What are some signs in an infant of possible FAS?

A

-poor sleep, irritable, hypersensitive to light and sound, trouble with routines, poor feeders
(at risk for abuse b/c irritable babies)

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32
Q

What bloodwork helps with the diagnosis of FAS?

A

none is a clinical diagnosis

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33
Q

What are some key strategies you can tell parents who are looking after a baby or kid with FAS?

A
  • baby - handle and stroke gently, cuddle often, avoid sudden movements or bouncing, establish a strict routine
  • kids - keep tasks simple, use concrete examples, keep instructions simple and give them one at a time, concentrate on life skills

-offer parenting classes

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34
Q

What are risk factors for the development of type 2 diabetes?

A
  • genetic markers associated
  • gestational diabetes (risk for the kid to get DMII)
  • obesity
  • physical inactivity
  • positive family history
  • aboriginal
  • smoking
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35
Q

What are physical signs of insulin resistance and metabolic syndrome?

A
  • acanthosis nigricans
  • PCOS
  • hypertension
  • dyslipidemia
  • steatohepatitis
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36
Q

What are some things that can be done in Aboriginal communities as primary prevention for type 2 diabetes?

A
  • diabetes prevention campaigns
  • projects in schools where teach about healthy living
  • healthy foods offered at the school
  • physical activity encouraged
  • advocacy for changes in the school and store environment
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37
Q

Is there a role for universal screening for type 2 diabetes?

A

Not enough evidence for this at present so we use “opportunistic screening” for those at high risk

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38
Q

Who should be screened for type 2 diabetes?

A

Need all of:
aboriginal descent + BMI > 85 + age age > 10 (or equal to)

PLUS ONE OF:

  • sedentary lifestyle
  • children born to mum’s with GDM
  • first or second degree relative with type 2
  • acanthosis nigricans
  • dyslipidemia
  • HTN
  • PCOS
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39
Q

How should kids be screed for type 2 diabetes?

A
  • fasting BG (>7 is dx)
  • random BG (>11.1 is dx)
  • oral glucose tolerance test with a fasting and 2 hours post-glucose load test
40
Q

What are some recommendations to help prevent type 2 diabetes?

A
  • culturally based and community-based diabetes prevention programs
  • traditional values and diets should be encouraged
  • breastfeeding encouraged and reduces obesity
  • daily physical activity for 60-90 mins a day with 1/3 at moderate intensity
  • schools should have 30 mins a day of high energy physical activity
  • schools to incoroporate teaching about healthy active living
  • discourage schools from selling candy for fundraisers
  • use the food guide for northern aboriginal communities
  • safe physical activities and access in the community
  • community members as active role models
  • encourage local stores not to sell junk or put it in a less obvious place
  • limit screen time to 1.5-2 hrs per day
  • do opportunistic screening for DMII
41
Q

What are the potential negative outcomes of smoking for a fetus?

A
  • increased perinatal deaths
  • placental problems
  • higher preterm deliveries
  • fetal growth retardation
  • congenital abnormlities eg gastroschisis
  • SIDS
  • higher rate miscarriages
  • learning disabilities
42
Q

What are negative outcomes of second hand smoke?

A
  • increased rates of lower resp infections
  • decreased lung growth
  • increased AOM
  • increased risk SIDS
  • increased risk of asthma
43
Q

Are there genetic differences related to nicotine metabolism that explain the higher nicotine addiction rates in aboriginal populations?

A

-no racial or genetic differences

44
Q

What is one of the best predictors of a child becoming a regular smoker?

A

easy access to cigarettes

45
Q

What are some problems associated with the cost of tobacco?

A
  • prices range across canada

- there are tax-free tobacco available on reserves

46
Q

Is there a role for tobacco in aboriginal culture?

A
  • tobacco used traditionally in ceremonies, rituals, prayer and for medicinal purposes
  • in some groups has a powerful spiritual meaning establishing a direct communication link with the spirits
  • not a traditional part of Inuit culture
47
Q

What are some government programs that have targeted tobacco?

A
  • smoke free work and public places
  • efforts to standardize legal age limits for tobacco use
  • keeping tobacco products ‘out of sight’ in stores
  • banning tobacco advertising and displays
  • taxing tobacco at a high level
  • use of health warnings on cigarettes
48
Q

What are some proactive ways to deal with tobacco misuse?

A

-smoking cessation programs
-antismoking measures (like smoke free spaces)
-target pregnant and postpartum women
-continue to ban smoking advertisements
-

49
Q

What is the role of the physician in addressing tobacco misuse?

A
  • antismoking medication (patch, gum) or bupropion should be encouraged
  • enforce age limits on tobacco sales
  • routine ask about the five As (ask, advise, assess, assist, arrange)
  • educational opportunities
  • advocacy in schools and policy level
  • discourage non-traditional use of tobacco products
50
Q

What are some features of community-acquired MRSA that make it different from hospital acquired?

A
  • CA-MRSA
  • generally more susceptible to antimicrobials (except beta-lactams)
  • cause primarily skin and soft tissue infections (but can cause invasive infections)
  • different strain/genetic makeup
51
Q

What are risk factors for CA-MRSA?

A
  • overcrowding
  • frequent skin-to-skin contact btwn ppl
  • participation in activities that result in abraded or compromised skin surfaces
  • sharing of potentially contaminated personal items
  • challenges in maintaining personal cleanliness and hygiene
  • limited access to health care
52
Q

How should CA-MRSA infections be treated?

A

infected scratches, impetigo with wet warm compresses and topical antibiotics

Abscesses with I+D

53
Q

Should we use decolonization as strategy for CA-MRSA?

A
  • no unless endemic infection or an outbreak

- is also unnecessary to determine carriage rates among asymptomatic household contacts

54
Q

What are some strategies to help protect indigenous youth for CA-MRSA infections?

A
  • build awareness
  • monitor resistance
  • be advocates (for running water etc)
  • use evidence-based guidelines when prescribing abx
  • promote hand hygiene
55
Q

What are some specific things you would tell a family about how to manage MRSA skin and soft tissue infections?

A
  • keep wounds covered with clean dry bandages (excuse from contact sports or daycare until wound healed if cannot keep covered)
  • dispose of used dressing in plastic lined garbage contained with sealed lid
  • proper hand hygiene with dressing changes
  • bathe regularly
  • wash clothes and linen regularly
  • avoid sharing person items including soap
56
Q

What is considered recurrent infection for MRSA?

A

-3 or more infections in 6 month period

57
Q

When should you call public health about MRSA?

A

-when recurrent infections in one person or if outbreak in a closed population (eg. daycare)

58
Q

What is the leading cause of death in canadian children?

A

injuries

59
Q

What % of the population is Indigenous?

A

5% (includes Metis)

60
Q

What is the most common cause of death due to injury in kids

A
61
Q

True or false: While indigenous populations are more likely to experience serious trauma, they are much less likely to receive rehabilitation or have access to other post-discharge resources.

A

True.

62
Q

What are some risk factors that put aboriginal people at increased risk for death from MVCs?

A
  • isolated communities
  • health care facilities are harder to get to
  • road conditions are generally poor
  • ATVs and snowmobiles used often and in poor conditions often out of necessity
  • underuse of child restraints
  • lack of helmet use
  • substance abuse
63
Q

Why are Aboriginal people at increased risk of death in a fire?

A
  • more smokers in the home
  • wood-framed, substandard housing
  • underuse of working smoke detectors
  • longer travel time for fire rescue equipment
  • shortage of trained firefighters
64
Q

What are the 6 “E”’s of a successful intervention program?

A 
Education
Empowerment
Enabling
Engineering (eg infrastructure)
Enforcement
Employment
65
Q

To what chronic systemic diseases has vitamin d deficiency been linked?

A
  • osteoporosis
  • asthma
  • autoimmune diseases (Rhematoid arthritis, Multiple sclerosis, IBD)
  • disturbed muscle function
  • resistance to TB
  • pathogenesis of specific types of cancer
66
Q

What are the effects of maternal vitamin D status during gestation and lactation on the health of a child later in life?

A
  • increased severity of asthma
  • susceptibility to type 1 diabetes
  • newborn hypocalcemia
  • rickets
  • smaller head size
  • dental malformations
67
Q

What type of vitamin d do we use to look at vitamin d status?

A

25(OH)D

68
Q

What is the opitmal level of vitamin D? what is deficient? Insufficient?

A

Optimal 75-225 nmol/L
Insufficient 25-75
Deficiency

69
Q

What is the risk of levels of vitamin D >225?

A

associated with hypercalcemia and calcium deposition in the tissues

70
Q

What happens to calcium in the gut with vitamin d deficiency?

A

decreased calcium absorption from the gut and a tendency toward hypocalcemia

71
Q

What are the recommendations for children

A
72
Q

What is the biggest risk factor for vitamin d deficiency in an infant?

A

maternal vitamin d deficiency

73
Q

Why are premature infants at particular risk for vitamin d deficiency?

A

lower fetal stores

consumption of low volumes of milk

74
Q

What are the recommendations for vitamin d supplementation for infants?

A

All exclusively breastfed infants should receive 400 IU per day, in latitudes >55 during winter months should get 800 IU per day, infants from 40-55th parallel with risk factors should also get 800 IU during the winter months (oct-april)

75
Q

Is there vitamin d in breastmilk?

A

Yes. Except usually mum’s are deficient so there are insuffificient amounts in the breastmilk.

76
Q

What are vitamin d rich foods?

A
  • canned salmon and tuna
  • fatty fish
  • seal
  • polar bear
  • milk, infant formula, fortified rice and soy beverages all have vitamin d
77
Q

How much vitamin d is in formula or milk?

A

400 IU/L

78
Q

How much vitamin d should pregnant and lactating mum’s take?

A

1000 IU/day

79
Q

What are 2 strategies to increase vitamin d for infants?

A
  • supplement infants with vitamin d
  • give mum relatively large doses of vitamin d (2000 IU) during pregnancy and lactation (if mum has adequate stores than her breastmilk should too)
80
Q

How much sunlight should a child be exposed to for vitamin d?

A

short periods

81
Q

What is early childhood caries?

A

presence of tooth decay involving any primary tooth in a child younger than 6 years of age. Is an infectious disease with Streptococcus mutants as the most dominant causative organism.

82
Q

What is the main causative organism in early childhood caries?

A

Strep mutans

83
Q

What is the triad of early childhood caries?

A

presence of cariogenic bacteria
diet (exposure to fermentable carbohydrate)
host susceptibility (integrity of tooth enamel)

84
Q

What are poor outcomes associated with early childhood caries?

A
  • can cause pain and altered chewing
  • potential growth restriction
  • malalignment
  • crowding of permanent teeth (poor bite)
  • need for general anesthesia for repair
85
Q

What is the greatest risk factor for early childhood caries?

A

-poverty

86
Q

What are the components of prevention strategies for early childhood caries?

A
  • oral health promotion
  • regular dental visits - should establish dental home within 6 months of their first tooth or before age 12 months
  • involve pregnant women in screening and dental hygiene
  • water fluoridation
  • topical fluoride varnish
  • fluoridated toothpaste
87
Q

When should fluoridated tooth paste start to be used?

A
  • in aboriginal kids should have supervised use of fluoridated toothpaste starting at the first tooth eruption
  • kids
88
Q

Is there a role for sealants in early childhood caries?

A

We should advocate for these to be used on primary teeth, not just secondary teeth in high risk populations.

89
Q

What is the role for fluoride varnish for early childhood caries in aboriginal kids?

A

all indigenous kids should have access to it twice a year

90
Q

Why are inhalants abused?

A
  • legal
  • inexpensive
  • easy to obtain
  • get a quick high
91
Q

Which youth are at risk for inhalant abuse?

A
  • school dropouts
  • hx of physical or sexual abuse
  • neglected
  • incarcerated
  • homeless
  • aboriginal
92
Q

What are the 3 main categories of inhalants and given an example of each?

A

aliphatic/aromatic/halogenated hydrocarbons: hair spray, polish remover, paint thinners
nitrous oxide: whipping cream aerosols
Volatile alkyl nitrites: angina medications, room odourizers

93
Q

What are the intoxication effects of inhalants?

A
  • stimulation, disinhibition and euphoria
  • get hallucinations, general depression including slurred speech, abnormal giant, dizziness, drowsiness or sleep

-some can cause warmth/flushing and syncope/hypotension

94
Q

What is sudden sniffing death syndrome?

A

-likely due to cardiac arrhythmia (inhalants cause heart to be sensitized to adrenaline)

95
Q

What are the long term effects of chronic inhalant abuse?

A
  • cortical atrophy
  • brainstem dysfucntion
  • motor, cognitive and sensory deficits
  • cardiomyopathy
  • emphysema-like abnormalieietes
  • distal RTA
  • hepatitis
  • teratogenic effects to fetus
  • poor school performance
  • suicidality
96
Q

Can lab test pick up inhalants?

A

usually no but some urinary metabolites can be detected

97
Q

What is the best approach for inhalant treatment?

A

prevention! including advocating for replacement of the inhalant/abuse products with other substances without abuse potential
-inhalant specific treatment programs are required

CPS Statements (14 decks)

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