2021 Special Populations

Question 1

List the 5 most common health conditions identified in incoming inmates?

Answer 1

• head injuries (34% of incoming inmates),
• mental illness,
• back pain
• asthma
• HCV
• TB
• HIV

Question 2

What is the Healthy Immigrant Effect?

Answer 2

• immigrants initially have better health than their native-born counterparts in the settlement society,
• is lost as their residence lengthens
• worse for adults than children

Question 3

List 4 Mandatory age-specific laboratory and radiologic tests in the Immigration Medical Exam?

Answer 3

Mandatory age-specific laboratory and radiologic tests include:

• Urinalysis – clients ≥ 5 years
• Chest x-ray (postero-anterior view) – clients ≥ 11 years
• Syphilis – clients ≥ 15 years
• HIV – clients ≥ 15 years

Question 4

List 5 tests that asymptomatic refugees would be screened for?

Answer 4

• CBC
• Hepatitis B
• Hepatitis C
• Syphilis
• HIV
• Varicella serology (over 13 years old)
• Stool for enteric parasites
• Serology for schistosomiasis and strongyloides
• Urinalysis
• Lead levels in children (<7 years old)
• Mantoux tests
• Immunizations
• Cancer screening including PAP testing

Question 5

What are the top four most common disability types?

Answer 5

1. Pain related (15%)
2. Flexibility (10%)
3. Mobility (10%)
4. Mental Health (7%)

Question 6

Which age group is most affected by disability?

Answer 6

Question 7

List 5 examples of how we could accomodate disabilities within public health programs to enhance accessibility

Answer 7

• Providing telephone teletype lines for individuals who are Deaf or hard-of-hearing
• Ensuring space is physically accessible (e.g., ramps, snow removal, curb cuts)
• Waiving fees for support persons
• Following web accessibility guidelines
• Posting disruptions to elevator service as far in advance as possible

Question 8

List 5 specific health outcomes associated with
homelessness

Answer 8

• increased risk of tuberculosis (due to alcoholism, poor nutritional status and AIDS, crowding in shelters, inadequate ventilation, large transient population)
• Injuries
• Poor mental health including substance use disorders; cognitive impairments
• Poor Oral and dental health
• Inadequate control of hypertension and diabetes (Many homeless people do not have a health card, are unable to keep/make appointments, or lack continuity of care due to transience)

Question 9

List 5 Public Health interventions that could be targeted to address homelessness

Answer 9

• Monitoring and surveillance of health outcomes of individuals experiencing homelessness
• Case management (for psychiatric patients, assertive community treatment)
• Housing first: Strategy for addressing homelessness that provides housing without requiring individuals to engage with services or find a job first; improves health outcomes and reduces involvement with justice and healthcare system
• Poverty reduction / income support
• Affordable housing
• Eviction prevention
• Institutional transition support (housing on discharge)
• Employment opportunities for low-skilled workers
• Primary prevention: Anti-violence interventions, early childhood interventions

Question 10

Name three significant determinants of positive mental health and wellbeing in the LGBTQ-TS group

Answer 10

1. social inclusion
2. freedom from discrimination and violence
3. access to economic resources

Question 11

List 3 LGBTQIA2 behaviours that could lead to poor health outcomes?

Answer 11

• Stress (isolation, alienation due to discrimination from a homophobic society)
• Substance abuse (use of alcohol, tobacco and other substances may be 2 to 4 times higher among LGBTQIA2 people than heterosexual people)
• Smoking (higher rates of smoking among LGBTQIA2 adults (36%) than other adults (17%))

Question 12

List 3 Lesbian health outcomes

Answer 12

• prevalence of asthma is 16% among lesbian and bisexual women, compared with 9% among heterosexual women.
• Bisexual and lesbian individuals are more likely to suffer from arthritis than their heterosexual counterparts.
• Lesbian women are more likely to be overweight/obese
• Lesbian women use preventive healthcare services less than heterosexual women
  
  • Higher risk:
  • DM II
  • coronary heart disease
  • Stroke
  • Osteoarthritis
  • Breast cancer
  • colon cancer

Question 13

List 3 health outcomes for MSM (Men who have sex with men)

Answer 13

• HIV rates are higher (MSM represent 2% of the population, yet 61% of all new HIV infections in 2009 were among MSM)
• HPV and HPV-related anal cancers are higher
• Other STIs
  • Syphilis
  • Chlamydia
  • Gonorrhea

HIV/long-term antiretroviral therapy risk factor for:

• Cardiovascular disease
• Stroke
• Myocardial infarction
• Peripheral artery disease
• Chronic heart failure

Question 14

List 5 barriers Transgender patients experience when accessing health care

Answer 14

• Discrimination by healthcare providers major deterrent to accessing healthcare
• denied care
• Primary care providers often lack knowledge on how to care for this population
• financial barriers (lack of insurance, lack of income),
• lack of cultural competence by health care providers,
• health systems barriers (inappropriate electronic records, forms, lab references, clinic facilities)
• socioeconomic barriers (transportation, housing, mental health)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/#:~:text=The%20biggest%20barrier%20to%20health,systems%20barriers%20and%20socioeconomic%20barriers.

Question 15

What are 3 health outcomes Transgender people have?

Answer 15

Mental health conditions including Suicide, self harm, depression, anxiety disorders, post-traumatic stress disorder, schizophrenia, and other psychotic disorders

Question 16

List 4 types of homelessness

Answer 16

• Chronic homelessness: Individuals who are currently homeless and have been homeless for > 6 months in the last 12 months (i.e., 180 cumulative nights in a shelter or place not fit for human habitation)
• Episodic homelessness: Individuals who have experienced 3 or more episodes of homelessness in the last 12 months
• Transitional homelessness: Housed in supportive, but temporary, shelter
• Roofless: Homeless and living outside

Question 17

List 3 domains that homelessness is experienced in

Answer 17

1. Physical domain: Lack of a place to live fit for habitation
2. Legal domain: Lack of legal title or security of tenure
3. Social domain: Lack of private, safe space (e.g., social isolation)

Question 18

What are the Risk factors for homelessness?

Answer 18

• Adverse childhood experiences
• Criminal justice system experiences
• Mental illness and substance use
• Marital breakdown / intimate partner violence
• Institutionalization (health care, child protection, jail)
• Housing unaffordability
• Indigenous (28-34% of the shelter pop is Indigenous)

Question 19

What is the Impact of homelessness on health care use?

Answer 19

• Prioritizing seeking food and shelter above medical care
• Difficulty adhering to medication regimens (e.g., due to lack of storage space, unable to regularly take with food, limited access to clean water, limited access to toilets for GI side effects)
• Difficulty obtaining a health card without an address
• Difficulty accessing medical services without a health card
• Difficulty booking appointments (no address or return phone number)
• Difficulty receiving coordinated healthcare (medical records stored in several
• locations)
• Personal appearance and or personal hygiene that may be alarming to some working in or utilizing health care services
• Difficulty paying for prescriptions and items not covered by the province
• Challenges to recuperation following treatment due to a lack of caregivers and space to recuperate

Question 20

List the Health outcomes associated with homelessness

Answer 20

• Health outcomes associated with homelessness:
• Cardiovascular disease
• Mental illness and substance use
• Injuries, including traumatic brain injury (unintentional, intentional, and self-harm)
• Hypothermia / frostbite
• Tuberculosis
• Hepatitis B and C
• HIV
• Scabies
• Body lice
• Bartonella quintana (“urban trench fever”; documented in US and France)

Question 21

List 5 Public Health Roles for Racial Health Equity

Answer 21

1. BUILD CAPACITY to analyze and act on the structural forces that drive racial inequities.
2. CREATE KNOWLEDGE: by assessing and reporting on the impact of racialization and racism including analyzing health outcomes utilizing an anti-racism lens, and measuring racism on both individual and structural levels
3. Modify and re-orient public health and social INTERVENTIONS to ensure that they are designed to reduce and eliminate racialized health inequities.
4. Develop POLICIES with an overt focus on tackling racism including implementing racial equity assessments (e.g. support anti-discrimination policies)
5. Develop PARTNERSHIPS with other sectors and communities that work on racial equity to shift cultural and societal values and norms and create substantive change in the lives of racialized peoples.

Question 22

List 6 pathways in which racism can harm health?

Answer 22

• (1) economic and social deprivation;
• (2) toxic substances and hazardous conditions;
• (3)discrimination and other forms of socially inflicted trauma (mental physical, and sexual, directly experienced or witnessed, from verbal threats to violent acts;
• (4) targeted marketing of harmful commodities (e.g., “junk” food and psychoactive substances such as , tobacco, alcohol and other licit and illicit drugs); and
• (5) inadequate or degrading medical care; and,
• (6) degradation of ecosystems, including as linked to systematic alienation of Indigenous populations from their lands and corresponding traditional economies

Question 23

List 5 ways that culture can affect health outcomes?

Answer 23

• 1. Positive or negative lifestyle behaviours.
• 2. Health beliefs and attitudes. These include what a person views as illness that requires treatment, and which treatments and preventive measures he or she will accept, as with the Jehovah’s Witness prohibition on using whole blood products.
• 3. Reactions to being sick. A person’s adoption of the sick role (and, hence, how he or she or he reacts to being sick) is often guided by his or her cultural roots. For instance, “machismo” may discourage a man from seeking prompt medical attention, and culture may also influence from whom a person will accept advice.
• 4. Communication patterns, including language and modes of thinking. Beyond these, however, culture may constrain some patients from expressing an opinion to the doctor, or may discourage a wife from speaking freely in front of her husband, for example. Such influences can complicate efforts to establish a therapeutic relationship and, thereby, to help the patient.
• 5. Status. The way in which one culture views another may affect the status of entire groups of people, placing them at a disadvantage. The resulting social inequality or even exclusion forms a health determinant. For example, women in some societies have little power to insist on condom use

Question 24

List 5 strategies for clinicians to provide culturally safe care to Indigenous patients during the pandemic

Answer 24

1. Raise awareness for clinicians that past traumatic experiences may overwhelm and challenge individual’s ability to cope
2. Create/advocate for culturally safe community based testing and isolation sites
3. Build trusting relationships with communities, families and patients
4. Clearly explain what information is being collected and why for test results, contact tracing etc. and who it is shared with and if they would like their information shared with anyone else e.g. family member
5. Provide and offer solutions and interventions that take into account local context and access to resources

Question 25

List 6 health-related recommendations from the Truth and Reconciliation Commission

Answer 25

1. Acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools
2. To establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities
3. Recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples
4. To provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools
5. Recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients
6. Increase the number of Aboriginal professionals working in the health-care field.
7. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
8. Provide cultural competency training for all healthcare professionals.
9. To require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools

Question 26

A) List 5 forms of racism

B) List steps in which racism leads to health inequity for Indigenous people

Answer 26

A)

1. Prejudice and overt bias
2. Oppression
3. Racial discrimination
4. Stereotyping
5. Racial profiling

B)

1. Colonial practices - residential schools
2. Racism in healthcare, legal system and education
3. Destruction of natural environment

Leads to:

1. Social and cultural disruption
2. Intergenerational trauma
3. Poverty
4. Poor living conditions

Leads to health disparities

Question 27

List and briefly describe the 4 principles related to data collection and research surrounding Indigenous people

Answer 27

1. Ownership - refers to the relationship of First Nations to their cultural knowledge, data, and information. This principle states that a community or group owns information collectively in the same way that an individual owns his or her personal information.
2. Control - affirms that First Nations, their communities, and representative bodies are within their rights in seeking to control over all aspects of research and information management processes that impact them. First Nations control of research can include all stages of a particular research project — from start to finish. The principle extends to the control of resources and review processes, the planning process, management of the information and so on
3. Access - refers to the fact that First Nations must have access to information and data about themselves and their communities regardless of where it is held. The principle of access also refers to the right of First Nations communities and organizations to manage and make decisions regarding access to their collective information. This may be achieved, in practice, through standardized, formal protocols
4. Possession - While ownership identifies the relationship between a people and their information in principle, possession or stewardship is more concrete: it refers to the physical control of data. Possession is the mechanism by which ownership can be asserted and protected

Question 28

List 6 additional social determinants of health to consider with regards to Indigenous people

Answer 28

1. Connection to land
2. Connection to language, culture and heritage
3. Connection to community and elders
4. Environmental stewardship
5. Self-determination
6. Racism
7. Colonialism
8. Residential schools
9. Intergenerational trauma

Question 30

List and briefly describe 4 levels of cultural safety continuum

Answer 30

1. Cultural awareness
   * acknowledgement of differences
2. Cultural sensitivity
   * recognise need to respect cultural differences
3. Cultural competence

• Skills and behaviours that help a practitioner provide quality care to diverse populations
• Can build upon self-awareness
• Limited by reducing culture into set of skills

4. Cultural safety

• Determined from patient/community’s perspective
• Consider social political and historical contexts
• Requires practitioners to be self-reflective

Question 31

List categories of determinants of health and provide 3 examples under each

Answer 31

1. Biology and genetics

• Age
• Sex
• Genetic make-up
• Family history

2. Individual lifestyle factors

• Physical activity
• Diet/nutrition
• Smoking
• Health seeking

3. Social and community networks

• Social supports
• Community supports

4. Living and working conditions

• Physical environment
• Working conditions
• Housing
• Water + sanitation
• Healthcare services

5. General socioeconomic, cultural and environmental conditions
   * Policies

Question 32

A) List 5 characteristics of trauma-informed providers and organisations

B) List 5 suggestions for practitioners on how they can incorporate trauma-informed care into their practice

Answer 32

A)

1. acknowledge the widespread impacts of trauma and understand potential paths for healing;
2. recognize the signs and symptoms of trauma in clients, staff and other providers;
3. understand the variety of coping mechanisms used to manage trauma;
4. recognize that people follow different pathways to healing; and
5. respond by integrating knowledge about trauma into policies, procedures, practices and settings

B)

1. Ask every patient what can be done to make them more comfortable during the appointment.
2. Prior to physical examination, present a brief summary of what parts of the body will be involved, allow the patient to ask questions
3. Engage with patients in a collaborative, non-judgmental fashion when discussing health behavior change.
4. Engage in interprofessional collaboration to ensure continuity of care for patients who have experienced trauma
5. Provide all staff with communication skills training about how to discuss a positive trauma screening with a patient.

Question 34

List 3 broad categories of Indigenous social determinants of health and provide 4 examples under each category

Answer 34

1. Distal (Political/social/economic contexts)

• Colonialism
• Racism
• Discrimination
• Undermining self-determination
• Social exclusion

2. Intermediate

• Health care system
• Education system
• Community infrastructure
• Cultural continuity

3. Proximal

• Health behaviours
• Employment
• Income
• Housing
• Food security

Question 35

Identify 4 key features of the healthy migrant effect

Answer 35

1. Migrants tend to have a higher level of education
2. Migrants are screened for a number of diseases and tend to be healthier
3. The healthy migrant effect is stronger for adults than children
4. The healthy migrant effect decreases over time as their health status converges with the general population

Question 36

A) What is an adverse childhood experience

B) List 5 types of adverse childhood experiences

C) List 5 adverse health outcomes from adverse childhood experiences

Answer 36

A) Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years)

B)

1. experiencing violence, abuse, or neglect
2. witnessing violence in the home or community
3. having a family member attempt or die by suicide
4. growing up in a household with substance misuse
5. growing up in a household with family members with mental health problems
6. growing up in a household with instability due to parental separation or household members being in jail or prison

C)

1. Mental illness
2. Substance misuse
3. STIs
4. Teenage pregnancy
5. Injuries

Question 37

Homelessness

A) List 5 health risk behaviours that are more prevalent in homeless people

B) List 5 reasons why a homeless person might not access healthcare services

C) List 5 health conditions that are more prevalent among homeless people

D) List 5 general population health interventions to address a particular health problem in homeless people

Answer 37

A)

1. Poor nutrition
2. Smoking
3. Alcohol/substance misuse
4. Overcrowding
5. Physical inactivity
6. Exposure to heat/cold
7. Chronic psychological stressors
8. Poor oral health

B)

1. Lack of a healthcare card
2. Lack of documents required to obtain a healthcare card
3. Previous experience of stigma/discrimination in healthcare system
4. Lack of money for medication co-payments, allied health services
5. Lack of education and awareness of need for preventive healthcare

C)

1. Mental health disorders
2. Substance use disorders
3. Hepatitis C
4. HIV
5. TB
6. Cardiovascular disease

D)

1. Provide social services to assist in obtaining healthcare card and primary care provider
2. Outreach medical services to shelter/convenient location for specific screening, treatment etc.
3. Fully subsidised treatments and mental health/substance abuse counselling
4. Improve shelter conditions and spaces to reduce overcrowding
5. Funding for shelters to improve nutritional quality of meals
6. Back to work programs to assist in gaining employment
7. Campaign at shelter to increase awareness of particular health issue
8. Partner with other organisations who are providing care/health promotion to increase value

Question 38

List 5 reasons why there may be higher rates of active TB among Indigenous communities

Answer 38

1. Poor housing conditions and overcrowding
2. Higher prevalence of smoking
3. Higher prevalence of comorbidities such as T2DM that place individuals at higher risk of developing active TB
4. Poorer nutritition as a result of food insecurity
5. Poorer access to appropriate health services for testing and treatment of TB

https://www.sac-isc.gc.ca/eng/1570132922208/1570132959826

Question 39

List 4 reasons why T2DM prevalence is higher among Indigenous communities

Answer 39

1. Higher rates of smoking
2. Lower levels of physical activity
3. Unhealthy diets due to poor access, affordability, and food insecurity
4. Higher rates of obesity

Question 40

A) List 4 communicable diseases that are more prevalent among the prisoner population

B) List 4 non-communicable diseases that are more prevalent among the prisoner population

C) List 4 social determinants of health that are most likely to be contributing factors to the poorer health status of prisoners

D) Identify 4 preventive health needs you would recommend for a prisoner health program

Answer 40

A) Communicable

1. Hepatitis C
2. HIV
3. TB
4. Syphilis
5. Chlamydia
6. Gonorrhea

B) Non-communicable

1. Mental health disorders
2. Substance use disorders
3. History of unintentional injury
4. Cardiovascular disease
5. T2DM

C) Social determinants

1. Low income
2. Low educational attainment
3. Adverse childhood experiences
4. Lack of employment/job security
5. Lack of secure housing

D)

1. Ascertain vaccination status and update as needed
2. Identify cancer screening requirements
3. T2DM and hypertension assessment
4. Smoking cessation medication/NRT
5. Provision of mental health counselling/treatment
6. Screening and appropriate treatment for BBV and STI

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4984599/

Question 41

You are an MOH working for First Nations Health Authority in your province. A recent report has highlighted much lower cancer screening rates (breast, colorectal, cervical) for Indigenous peoples within your province. You have been nominated to be on a committee to develop a strategy to increase screening rates.

A) List 5 potential reasons as to why cancer screening rates might be lower among the Indigenous population (assume the differences in rates are true i.e. not artefactual)

B) List 5 key steps in your approach to identifying suitable strategies to include in the plan

B) List 5 potential strategies you might recommend to increase cancer screening rates among Indigenous peoples

Answer 41

A)

1. Differing cultural beliefs and understanding of health and disease prevention
2. Poor accessibility to health care services to undertake cancer screening
3. Previous experiences of racism among Indigenous people in healthcare settings resulting in avoidance of health services in general
4. Concerns regarding screening and subsequently being removed from communities for further tests
5. Lack of appropriate resources and materials about screening that are tailored to Indigenous populations

B)

1. Define the scope of the problem and goals and objectives of the strategy
2. Review data in the report and other literature regarding screening rates in Indigenous communities including most common reasons identified and distinct needs of First Nations, Inuit and Metis people
3. Identify possible strategies used elsewhere that are evidence based and resulted in increased screening rates
4. Engage with communities including elders and Aboriginal health workers to collect further information on reasons why screening rates are lower and desired level of involvement of the community
5. Assess, prioritise and select strategies based on evidence and community engagement

C)

1. Develop information materials and resources regarding cancer screening tailored to Indigenous communities
2. Community awareness and education campaign regarding cancer screening
3. Cultural competency training for healthcare workers who are most commonly providing cancer screening services to Indigenous people
4. Engage with communities and elders to identify champions to promote cancer screening locally
5. Increased accessibility and capacity building in communities for cancer screening activities including training of Indigenous health workers and outreach services

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687663/

Question 42

A) List 5 communicable diseases to consider screening for in refugees

B) List 5 non-communicable diseases to consider screening or being alert to signs and symptoms of in refugees

C) List 3 preventive healthcare needs of refugees

Answer 42

A)

1. TB
2. HIV
3. Hepatitis B
4. Hepatitis C
5. Strongyloides
6. Schistosomiasis

B)

1. Iron deficiency anemia
2. Mental health conditions
3. Type 2 diabetes mellitus
4. Dental pain, dental caries
5. Be alert (but do not screen) for: PTSD, intimate partner violence, child maltreatment

C)

1. Vaccination against vaccine preventable diseases
2. Cancer screening
3. Contraceptive needs

https://www.cmaj.ca/content/183/12/E824.full

Question 43

List 4 specific health screening or interventions to consider providing to women refugees

Answer 43

1. Iron deficiency anemia
2. Cervical cancer screening
3. Contraceptive needs
4. HPV vaccination
5. Breast cancer screening
6. Be alert to signs of (but don’t screen for) intimate partner violence

https://www.cmaj.ca/content/183/12/E824.full

Question 44

List 5 potential barriers for culturally and linguistically diverse populations from accessing health services

Answer 44

1. Language and Communication Barriers
2. Previous experience of racisim and cultural insensitivity in healthcare settings
3. Issues related to seeking care and discussing gender-specific issues
4. Financial and logistical constraints related to transport, childcare, purchasing medicines
5. Personal and cultural factors related to alternative medicines

https://link.springer.com/article/10.1007/s10903-016-0402-6