H+S Y4 Flashcards
Epidemiology of Suicide?
Rates are ^.
Peaks in April, May, June
Lowest in December
Men more likely to kill themselves successfully, so rates higher in men.
Peak age 60-75
Greatest incidence in divorcees, widows and widowers. Lowest in married
Highest rates in social classes 1 and 5
Highest rates in unemployed, but rates also high in: university, doctors, lawyers, farmers, policeman
Patients treated for an affective disorder have x30 risk of suicide.
Alcoholism accounts for 15% of suicides
15% of depressives will commit suicide and schizophrenics have lifetime risk of 10%
Risk factors for suicide
Sex - male Age - <19 or >45 years Depression Previous attempt Excess alcohol or substance use Rational thinking loss Social support lacking Organised plan No spouse Sickness
Unemployment
Urban environment
Bereavement
Epidemiology of deliberate self harm
More common in young (contrast to suicide)
Peak age for men 20-24, women 15-19
More common in women
Divorced, single, married young
More common in lower SES
15-20% of those who self harm have psychiatric illness (50% depression, 30% personality D, 15% alcoholism)
Major life events/disruption to relationships
Criminal records
Child abuse
Social isolation
Anxiety of finances/work/housing
Epidemiology of depression?
F>M (2:1) - due to hormonal effect and postnatal depression Greater incidence in lower SES (4+5) Prevalence 2-3% in men, 2-9% in women. Lifetime risk 10% men, 20% women Onset of 50% of cases is <40 Peak age group 25-40 Urban populations More common in separated, widowed, divorced
RF’s for depression
Life events Bereavement PMHx of depression Physical illness Dementia Refugees Afro-Caribbean or Asian ethnicity Social isolation Unemployment
The effect of dementia on carers?
- difficulty accepting there’s no cure
- frustration over lack of effective treatment
- worry about discomfort of patient
- overwhelmed by prospect of having to care
- hurt by personality changes of patient
- embarrassed by odd behaviour of patient
- angry with patient and their irritating behaviour
- guilty about resenting having to care, wanting them to go to permanent care or to die
- sadness over loss of the person they once knew
- cannot cope, go into state of despair
Sources of help for carers
Day care for the patient, carer can have a break
District/community nurses
Social services
Welfare/disability benefits
Voluntary organisations - Age concern, The Alzheimer’s Society, Carers UK, Mind, British Red Cross, Crossroads
Screening for dementia?
Little evidence to support population screening, but targeting high risk groups may be an effective strategy: Elderly >75 years History of falls/fractured hips High attenders of community services Known depression New referrals
Testing for dementia?
MMSE - gold standard, but is lengthy. Score <23/30 = dementia
6-CIT (6 item Cognitive impairment test) - short, easy to complete, easy to translate, highly sensitive, computer based, score >8/28 = significant
AMTS (abbreviated mental test score) = short, widely used, simple, limited validity, culturally specific, score <7/10 = significant
Addenbrooke’s cognitive exam = very lengthy, takes up to 45 mins, highly specific, score <82/100 = significant
Who gets fertility treatment (based on NICE recommendations)?
Women aged <40 who have been unable to conceive after 2 years of regular unprotected intercourse are offered 3 cycles of IVF (with or w/o ICSI)
Women aged 40-42 in the same position are offered 1 cycle, but only is they have NOT has IVF in the past and do NOT have low ovarian reserve
Ovarian stimulation can be given in unexplained infertility, and IUI can be used if there is mild endometriosis, mild male infertility or physical or psychological problems with having sex
Risks of fertility treatment
IVF is associated with increased risk of multiple births if more than 1 embryo is implanted at once, ectopic pregnancy, and OHSS
Risks of multiple pregnancy
Miscarriage, anaemia, C-section, HTN, gestational diabetes, pre-eclampsia
What happens at booking appointment?
Happens by 10 weeks
Identify women in need of additional care
Calculate BMI, measure BP, dipstick urine, risk factors for pre-eclampsia and gestational diabetes, blood test for group, rhesus, HBopathies, HIV, HepB, syphilis
Offer Down’s screening - combined at 11-14wks or quadruple at 15-20wks
USS for gestational age and anomalies
Ask about mental health, depression, occupation to identify risks
Give info on pregnancy, nutrition, exercises, benefits, planning birth
What happens at 16 weeks antenatal appointment?
Review, discuss and record screening test results
Measure BP and test urine for protein
What happens at 28 weeks antenatal appointment?
Measure BP, test urine for protein
Measure/plot symphysis-fundal heigh
Offer Anti-D prophylaxis to Rhesus D negative women
Offer more screening for anaemia and atypical RBC autoantibodies
What happens at 34 weeks antenatal appointment?
Review, discuss and record screening results from tests at 28 wks
Measure BP, test urine for protein
Measure symphysis-fundal height
What happens at 36 weeks antenatal appointment?
Measure BP, test urine for protein
Measure/plot symphysis-fundal height
Check position of baby, offer ECV for breech
Give info on breastfeeding, care of newborns, vitamin K, postnatal depression
What happens at 38 weeks antenatal appointment?
Measure BP, test urine for protein
Measure/plot symphysis-fundal height
Give info about prolonged pregnancy
What happens at 40 weeks antenatal appointment?
Measure BP, test urine for protein
Measure/plot symphysis-fundal height
Give more info about prolonged pregnancy
What happens at 41 weeks antenatal appointment?
Measure BP, test urine for protein
Measure/plot symphysis-fundal height
Offer membrane sweep, induction of labour
What data is available on the process and outcome of antenatal care?
Maternal morbidity and mortality
Perinatal mortality and stillbirths
Why is cervical screening not performed for patients <25?
Because invasive cancer is rare in this age group and evidence suggests it will do more harm than good
Why is cervical screening not performed in patients >65?
Women in this age group with 3 negative smears are very unlikely to develop the disease
Frequency of cervical screening?
First invitation - 25
3 yearly from 25-49
5 yearly - 50-64
What is the evidence that cervical cancer screening is effective?
Uptake of 80% in the population can prevent up to 95% of cervical cancers
Incidence of cervical cancer fell by 42% from 1988-97
Key groups at risk of STIs
Young Black/minority ethnics Gay/bisexual Injecting drug users HIV infected Sex workers Prison inmates
What are the key messages of sexual health promotion?
Reduce transmission of HIV/STIs
Reduce prevalence of undiagnosed HIV/STIs
Reduce unintended pregnancy rates
Improve health/social care for HIV infected
Reduce stigma associated with HIV and STIs
What is chlamydia screening?
Aims to ensure people <25 are aware of the risk of acquiring chlamydia and its complications, and have access to screening, prevention and treatment
Opportunistic screening the preferred approach, with kits available at frequently visited places (uni, college, GP, pharmacy, contraception clinics) and through postal kits
Epidemiology of STIs
Trends over the last 10 years show risk in the number of new and recurrent STI diagnsoses, and risk in the number of other GUM clinic diagnose (BV and candidiasis)
Syphilis has risen enormously, especially for men
Gonorrhoea was on the rise, but is now decreasing
Chlamydia, herpes and genital warts diagnoses are still rising
Chlamydia is most common STI
The risk in STI diagnoses can be put down to decreased sexual health among the young and MSM, but also greater acceptability and uptake of GUM services
What support is there for newborn infants?
Hospital at birth:
Kept in 4-5 days if C-section
Can be as fast as 6 hours for an uncomplicated birth provided baby has opened bladder / bowels
GP – new babies can be registered with a practice as soon as possible – pink card given at hospital
Health visitor – usually 1st visit or seen at clinic within 10 days
Nurse with specialist neonatal training
Holistic family assessment, check that everyone is managing (not just baby)
Can offer extra support, put you in touch with groups / other mothers etc.
Child health clinics – regular GP clinics for vaccinations and development reviews. Also screen maternal health
Sure Start Children’s Centres (local authority) – focus on improving outcomes for young children and families, focus on the most disadvantaged families, aim to reduce inequalities in child development and school readiness
Can offer educational support & full / part time child care
WHO 10 steps to successful breastfeeding
Have a written breastfeeding policy that is routinely communicated to all healthcare staff = visibly posted in all areas serving mothers / children and for staff to refer to
Train all healthcare staff in skills necessary to implement policy = all staff in contact with mothers should know how to implement the policy
Inform all pregnant women about the benefits and management of breastfeeding
Help mothers initiate breastfeeding within 30mins of birth = normal vaginal deliveries should have skin-skin contact for 30mins and help with starting feeding > Earlier start makes it more likely to be successful
Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants = teach positioning and attachment techniques e.g. if separated for medical reason
Give newborn infants no food or drink other than breastmilk unless medically indicated
Practice rooming-in – allow mothers and infants to remain together 24hrs a day = no nurseries! Allows mother to learn feeding cues and helps establish bond / feeding relationship
Encourage breastfeeding on demand = no restrictions on number or length of feeds e.g. ‘greedy baby’
No artificial teats or pacifiers to breastfeeding infants = interferes with suckling and baby’s learning of how to suckle/ feed
Establishment of breastfeeding support groups and refer mothers to them on discharge from hospital
UK uses UNICEF Baby Friendly Initiative = similar to above 🡪 massively increasing breastfeeding levels
Childood to adult transition for care of chronic conditions
Involve young people & carers:
Co-produce strategies, agree goals / outcomes, and feedback about what effect their involvement had
Ensure it’s developmentally appropriate, taking into account: maturity, cognitive ability, social and personal circumstances, communication needs
Treat as equal partner, not as parent
Start discussions about process of transition young when possible
Aim to allow as much independence as possible
Share important clinical details:
Highest quality of care
Cross-over / joint appointments
Allocate named transition worker - someone involved in young person’s care
Develop transition plan
Develop a personal folder - held by young person, describing their preferences, care needs and history
Offer support for a minimum of six months before and after transfer
Transition planning should be developmentally appropriate
Education and employment, community inclusion, health and wellbeing, and independent living should all be assessed
Impact of chronic conditions on child
visible v non visible > non-visible is harder to adjust to
Impact:
Time off school / difficulty completing school work / exams
Have worse academic performance
Feeling different to friends
Needing to plan day around meals / medications etc.
Increased dependence on parents at a time of when independence is normally developing
Impact on employment
Future fertility
Life expectancy
Cognitive:
Over-acceptance > letting illness take-over = level of impairment above what would be expected
Denial > symptoms + advice ignored, treatment poorly adhered to
Emotional:
May be similar to abnormal or normal bereavement
Behavioral:
Maturing
Could cause regression > act younger, including reduced school performance, bed-wetting
May manifest symptoms somatically
Family:
May suppress feelings to try and support child = can create tension / long-term issues
Social :
Rebellion
As children > adolescents = ↑ autonomy + independence
May not understand or think medication is important
Poor disease knowledge may influence this
Peer relationships and self-image – very important, don’t want to seem different to others or become labelled
Their assessment of risk is skewed – risk of being socially disregarded is much higher than the risk of not taking medication
Side-effects of medication may affect appearance – delayed puberty, short stature
Reaction dependent on: Nature of illness + symptoms Stage of illness Age of the child Temperament Family factors Intellectual capacity
RF’s for child abuse?
1/3 UK children vulnerable = most at risk don’t experience!
Risk factors: Toxic trio: Substance Misuse Domestic Violence Mental Health / LDs
Environment:
Poverty, poor housing, overcrowding = increased stress
Groups where children less visible > migrants, ethnic minority, travelers, home-educated
Family:
Mental health problems, substance misuse, Hx of criminal behavior, being in care
Step parents
Domestic abuse
Young parental age / multiple or closely spaced births
Child:
Failure to meet prior parental expectations – e.g. gender, disabled
Born due to forced sex / commercial sex
Previous child abuse of other family members
Young children & adolescents
Learning Disabilities
Definition of child protection?
“Action to promote the welfare of children and protect them from harm”
Protect from maltreatment
Prevent impairment of health and development
Ensure that children grow up in circumstances consistent with provision of safe and effective care
Take action to enable all children to have good outcomes
Role of HCP in child protection & safeguarding?
f a child discloses abuse to you then you have a STATUTORY OBLIGATION to tell an appropriate agency > often discuss with senior / child protection doctor, then inform:
Social services, Police, NSPCC = Child at Risk will have case conference
Social Services, School, Police, relevant Doctors (Paediatrician or GP) and Family members
MDT share concerns & identify risk > identify what to do to protect child = draw up Child Protection Plan
5 Outcomes of Every Child Matters Initiative?
SHEEP
Safe Healthy Enjoy / Achieve Economic Well-being Positive Contribution
What is Children’s Act 1989?
Allocates duties to local authorities, courts, parents and other agencies in the United Kingdom, to ensure children are safeguarded and their welfare is promoted = it is a basic human right of children
Encourages negotiation to try and enable child to remain within their own family
Parental responsibility can be awarded to others – see Safeguarding
Practitioners who suspect child abuse should refer to social services, confirmed in writing within 24 hours
What is Children’s Act 2004?
Amended the Children’s Act 1989, largely in consequence of the Victoria Climbié inquiry – basically to make sure everyone works together / shares information
Girl tortured and killed by guardian (aunt) in 2000 who thought she was possessed by the devil – led to Every Child Matters initiative in 2003 which led to this a year later
Obligation to share information and an obligation to co-operate to safeguard and promote the welfare of children
If have concerns about sharing information with others, they should obtain advice from named or designated professionals for safeguarding children = should be undertaken as soon as possible to ensure little delay to the safety of the child or young person
If concerns are based on information given by a child, healthcare professionals should explain to the child why they are unable to maintain confidentiality = child protection outweighs confidentiality
What is Working Together to Safeguard Children 2018?
Key statutory guidance for anyone working with children in England
Sets out how organisations and individuals should work together and how practitioners should conduct the assessment of children
Updated regularly
Most common cause of death in children > 1yo?
Injury
M>F
Aetiology of childhood accidents in different age groups?
Babies = burns, scalds and being dropped
Toddlers = falls, burns, scalds, POISONING
Older children = falls
Causes of falls in children?
still achieving motor milestones
growth constantly changing center of gravity
at age where explore a lot but with poor cognitive understanding (e.g. consequence)
Prevention of falls in children?
Stair gates up to 2, preferably not at top of steep stairs as if do get over serious consequence = bedroom
Don’t leave babies unattended
Don’t change nappies on raised surface
Causes of poisoning in children?
Infants like to explore through putting things in their mouths
Attracted to bright things, like medicine bottles / pills = look like sweets
Less developed gustatory sense = cant discriminate toxic
Prevention of poisoning in children?
Child resistant containers
Keep things out of reach
Child resistant packaging
Causes of scalds in children?
Peak age for injury with this mechanism is 1yr = lots of admission, rarely deaths
Age of exploration & just achieved ability to grab things, but no cognitive development to know not to do it
Prevention of scalds in children?
Hot drinks out of reach / don’t hold baby whilst drinking hot drink
Teach child not to climb on things
Keeping saucepan handles turned away from hob or on back burners out of reach
Thermostatic mixing valves fixed to taps to prevent water being too hot
Most common causes of accidental deaths in children?
Transport (34.9%)
Asphyxia (29.1%)
Drowning (12.8%)
Smoke, fire and flames (5.8%)
Poisoning (4.1%)
Falls
Struck by object
Electrocution
Other
Signs of NAI
Explanation for injury absent or unsuitable
Child is not independently mobile
Injury on an area that wouldn’t come into contact with hot surface e.g. soles of feet, back, buttocks
Injury in the shape of an object e.g. iron, belt etc.
Delayed presentation
Evasive or changing history
Inconsistency between age of injury and examination findings
Signs of restraint on limbs
Risk factors for falls?
DAME
Drugs
Ageing = age-related changes – e.g. sarcopenia, decreased vestibular function, decreased visual acuity
Medical = neurological, CV, GU 🡪 incontinence, urgency / MSK = myopathy, arthritis, reduced cognitive function
Environment = poor footwear, pets, poor lighting, slippery floor, rugs
What congenital abnormalities are screened for antenatally?
Foetal anomalies and Down’s
> Anencephaly, Spina Bifida, Cleft Palate/Lip, Diaphragm Hernia, Gastroschisis, Exomphalos, Cardiac, Renal agenesis, Edwards & Patau syndromes
o Sickle cell and thalassaemia
o Infectious disease in Pregnancy
> Hep. B, HIV, syphilis, Rubella
What is newborn blood spot test?
day 5-8, but can be up to 1 year if decline (except CF!)
o CF (needs to be done before 8 weeks) o Congenital hypothyroidism o Sickle cell disease o Phenylketonuria (PKU) o Medium chain acyl-CoA dehydrogenase deficiency (MCADD) o Maple-syrup urine disease (MSUD) o Isovaleric acidaemia (IVA) o Glutaric aciduria type 1 (GA1)
Sick Children Get Chubby Ingesting Pizza, McDonalds, and Maple syrup
When is hearing screening done in children?
before 5 weeks – automated otoacoustic emission (AOAE) and automated auditory brainstem response (AABR)
What is Wilson’s Criteria for Screening?
o Well defined disorder o Known incidence o Significant morbidity or mortality o Effective treatment o Sub-clinical period where treatment improves outcomes o Ethical, safe, simple, accurate o Cost-effective
Calendar of routine UK childhood immunisations
Birth – BCG and Hep B (if at risk)
2 months – 5 in 1 (dipheria, tetanus, pertussis, polio, HiB), Rotavirus, Men. B
3 months – 5 in 1 (DTPPH), PCV (Pneumococcus conjugate vaccine), Rotavirus
4 months – 5 in 1 (DTPPH), Men. B
12-13 months – HiB/MenC (combined), MMR, PCV, Men. B
2-7 years – nasal flu spray annually – at school or GP
3 years 4 months to 5 years – preschool booster of 4 in 1 (DTPP), MMR
12-13 years (boys and girls) - HPV subtypes 16 and 18
14 years (year 9) – diphtheria, tetanus, polio booster, Men. ACWY
Adults – influenza and PCV (over 65 or at risk), 4 in 1 (DTPP) (pregnancy women 28-38w gestation), shingles (aged 70-79)
Contraindications to vaccines
For all vaccines:
o Previous analphylaxis to vaccine with same antigen
o Acute febrile illness
o Egg anaphylaxis – no INFLUENZA or YELLOW FEVER (may receive under controlled conditions)
- Live vaccines (BCG, oral polio, MMR) contraindicated if – primary immunodeficiency (IgA deficiency, transient hypogammaglobulinaemia of infancy, Bruton X-linked agammaglobulinaemia), on high dose of steroids, bone marrow transplant in last 6 months, taking immunosuppressive drugs, receiving treatment for cancer (chemo/radio) or have finished treatment in the last 6 months. Some LAVs can be given to HIV +ve (except BCG in low TB prevalence countries)
- Live vaccines timing – any time before or after each other, except for:
o Yellow fever + MMR – at least 4 weeks apart
o VZV and MMR same time, but if not on same day then need > 4 weeks between them
o Mantoux (Tuberculin skin test) + MMR – MMR should be delayed until skin test read, and >4 weeks before Mantoux if MMR is done
Ethical issues with childhood vaccinations
dependent on other making decisions in their best interests
under-developed decision making capacity or value systems
limited power (physical, emotional + legal) with regards to defending their rights
difficulty accessing services
Parental autonomy + child welfare - assumption that parents know their child’s best interest and that the close parental bond motivates them to do their best for their children
Purpose of MDTs for child safety?
o Children get the help they need when they need it
o Professional take timely action to protect children
o Professionals ensure children are listened to & respected
o Agencies and professionals work together to assess needs and risk, and develop effective plans
o Agencies and professionals share information
o Professionals are competent and confident
o Agencies work with members of the community
Prevent spread of general childhood infection
- Isolation on ward for RSV +ve NPA in bronchiolitis, or i.e., until 3 -ve cultures for diphtheria over 48 hours
- Hand washing – in between patients
- PPE – gloves and gowns for infectious patients
- Chemoprophylaxis – i.e., for TB, diphtheria, meningitis
- Vaccination
- Increase public awareness
- Contact tracing
Prevent spread meningococcal disease and bacterial meningitis
o Notify public health team, on basis of clinical suspicion of meningitis
o ^ public awareness of Sx
o Trace contacts in last 7 days prior to onset
> Live together, share rooms, eat together, intimate kissing, HC workers exposed to droplet secretions
> Offer Abx (rifampicin/cipro – NNT 200)
> Consider immunisation – if correct serotype
> The above aims to decrease NP carriage of the strain and decrease risk for others
Definition of outbreak
an epidemic limited to localised increase in disease incidence. Connected in space and time (2+ cases meningitis/legionella), sudden increase within defined area over short period (i.e., salmonellosis), some only one case (smallpox, plague, EVD)
Definition of epidemic
occurrence in a community/region of cases of an illness/health-related behaviour clearly in excess of normally expected
Definition of pandemic
epidemic over a wide area, crossing international borders
Ways to prevent spreading infection
Education/training
disseminate national policies
investigation of outbreaks
screening pt’s (MRSA)
barrier nursing (quarantine infected)
sharps disposal
sterile instruments
Abx prescribing policy
hand washing
Epidemiology of SIDS
- Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old
- 1 per 3,636 is current SIDS rate in UK for live births
- 196 deaths per year, 0.28 deaths per 1000 life births
- 86% of SIDS happen in first 6 months of life
Protective factors of SIDS
sharing a room with baby, sleeping supine, flat firm mattress, breastfeeding, feet to foot position, baby’s head uncovered, not letting baby get too hot or cold
Risk factors of SIDS
male, sleeping on front, sleeping on sofa with baby, low birth weight, young mum, smoking during pregnancy or after baby born, twins, premature
Relevant guidance for parents re: SIDS
- Dial 999 for ambulance if your baby: stops breathing or turns blue, is struggling for breath, is unconscious or seems unaware of what’s going on, will not wake up, has a fit for the first stop, even if they seem to recover
Epidemiology of childhood asthma in the UK
- 1 in 11 children and young people in UK living with asthma
- UK has one of highest prevalence, emergency admission and death rates for childhood asthma in Europe
- Outcomes worse for children living in the most deprived areas
- 1 million children in the UK are receiving treatment for asthma.
- In early childhood, asthma is more common in boys than in girls, but by adulthood, the sex ratio is reversed.
- Asthma accounts for 2-3% of primary care consultations, 60,000 hospital admissions, and 200,000 bed days per year in the UK.
Childhood asthma impact on primary care
- In primary care, asthmatics should be seen at least once a year for their asthma review. Patients most likely attend during an attack o Hx and physical examination o Review asthma control o Review potential triggers o Review treatment/adherence o Review inhaler technique o Education and PAAP - Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden and impact on QoL
Screening for congenital dysplasia of the hip?
- After 1 or both hips. More common in left hip.
- More common in girls and firstborn children.
- About ½ in every 1000 babies have DDH that needs to be treated
- w/o early treatment, may lead to: problems moving, limp, pain, OA of hip and back
- Hips check as part of NIPE within 72 hours and then 6 weeks. Barlow’s and Ortolani test. If hip feels unstable at NIPE > USS by 2 wks
- Also sent for USS between 4 and 6 weeks if, even with normal clinical examination:
o Childhood hip problems in family (parents, brothers, sisters)
o Breech after 36 wks or in last month of pregnancy
o Baby born in breech after 28 weeks
o If twin sibling has risk factor, other baby should have USS - Screening so important to receive early diagnosis and treatment to allow normal development
o Pavlik harness
o Surgery if diagnosed after 6 months or if harness not helped – reduction surgery
Availability and provision of services for patients with visual impairment and deafness impairment and deafness
For adults and children, parents of children, and carers
- Those with sight problems might need help with:
o Managing sight loss
o Mobility training to get out and about safely
o Managing about the house and preparing food
o Reading and writing (talking books/newspapers)
o Special equipment like talking clocks or lighting - Those with hearing problems might need help with:
o Managing hearing loss
o Lip reading or sign language training
o Communication support (interpreters, voice to text equipment)
o Special equipment like visual doorbells and alarms
o Telephone equipment such as text phones or amplified headsets
services can be accessed by asking GP to make a referral or by contacting local social services. Carers are also entitled to assessment of their needs
o Local blind association - support, clubs, transport help, counselling, grants, talking books, specialist services for children
o Local deaf association - voice to text services, middleman for local lip speakers/interpreters
o Royal national institute for deaf people (RNID) - services similar to local services
o Country libraries - talking books, delivery service
o Worker’s education association (WEA) - classes in lip reading, sign language, deaf awareness
Community management of diabetic eye disease
- Everyone with diabetes who is 12 years old or over is invited for eye screening once a year
- Controlling blood sugar, BP and cholesterol
- Attending all screening appointments
- Stop smoking
- Eat well and move more
- Laser treatment
Potential significance of a squint
- Can lead to further problems:
o Persistent blurred or double vision
o Lazy eye (amblyopia)
o Embarrassment of low self-esteem
Outline the referral pathway for a squint
- If suspected in primary care, direct referral to optometrist or orthoptist to exclude refractive error and strabismus
- Refer to local paediatric eye service
- Urgently if serious underlying condition suspected – limited abduction, diplopia, headaches, nystagmus
- Encourage compliance with Tx, particularly occlusion Tx
- In secondary care, may be offered corrective glasses, occlusion Tx, penalization therapy (blurred normal vision with atropine), eye exercises, surgery (extra-ocular muscles), botox into extraocular muscles
Outline global patterns of visual loss
- Globally, at least 2.2 billion people have a near or distance vision impairment. In at least 1 billion – or almost half – of these cases, vision impairment could have been prevented or has yet to be addressed.
- The leading causes of vision impairment and blindness are uncorrected refractive errors and cataracts.
- Majority of people with vision impairment and blindness are over the age of 50 years
- Low and middle income x4 times higher prevalence than high-income
- Population growth and ageing thought to increase risk of people acquiring vision impairment
- With regards to near vision, rates of unaddressed near vision impairment are estimated to be greater than 80% in western, eastern and central sub-Saharan Africa, while comparative rates in high-income regions of North America, Australasia, Western Europe, and of Asia-Pacific are reported to be lower than 10%
UK rates of blindness ~ 2:1000, whereas rates in Africa + Asia up to 10:1000
- Causes of WORLDWIDE AVOIDABLE blindness: Cataract > glaucoma > ARMD > Corneal opacity > trachoma > childhood (eg Vit A deficiency)
- Causes of BLINDNESS in DEVELOPED COUNTRIES – Congenital causes > Cataract > ARMD >Glaucoma > Diabetic
- AVOIDABLE blindness in LEDCs: Cataract > Glaucoma > Corneal opacities > Trachoma (Chlamydia trachomatis) > Childhood blindness > Onchocerciasis (‘river blindness’ cause by parasitic worm Onchocerca volvulus
o WHO Vision: 2020 – aims to eliminate these 6 causes of avoidable blindness by 2020
Why start immunisations at 2 months?
o Maternal antibodies (transplacental IgG) can prevent the vaccine from working
What is examined for on NIPE?
cataract, retinoblastoma, murmurs, DDH, cryptorchidism
Assess the possibility of neo-natal and childhood deafness
- Hearing check list
o Birth – startles and blinks at sudden noise (i.e., door slam)
o 4 months – quietens or smiles to sound of voice, even if can’t see. May turn towards sound
o 7 months – turns immediately to your voice
o 9 months – listens attentively, babbles
o 12 months – responds to own name and familiar words
