Theme 9: Growth and Development Flashcards
(147 cards)
1
Q
What are the tasks of the GGD?
A
- to protect by offering vaccinations, providing protection against infectious diseases, covering sexual health, and take notice of environmental standards noise, heat, and air pollution
- to monitor epidemiological data at population level and youth health care
- promote health by health policies and interventions (examples?)
2
Q
Which steps does the municipal health cycle entail?
A
step 1: problem identification with focus on (high-risk) subgroups and determinants
step 2: policy analysis by asking what you can do to address the problem and what do you expect from the policy (influence on the health situation, the costs and benefits and feasibility)
step 3: stategy and policy development by translation of the solution to the local situation (what is the context? What is needed? who is needed for this?)
step 4: policy enactment to ensure policies are rolled out by checking what the procedures are and what kind of legislations are necessary or need to be adapted
step 5: implementation by determining the guidelines, coordinate the rollout, determine indicators for monitoring and evaluate policy
3
Q
What is the definition of public health?
A
the science and art of preventing diesease, prolonging life and promoting physical health and efficiency trough organized community efforts
4
Q
When did modern public health practices begin to develop?
A
Modern public health practices began to develop around 1900.
5
Q
How did public health efforts change in terms of scale around 1900?
A
Public health efforts expanded dramatically in terms of scale, moving from small, localized initiatives to large-scale programs that reached entire cities, regions, and countries.
6
Q
What does “integration” in public health refer to around 1900?
A
Integration in public health refers to different public health organizations and sectors working together more effectively, coordinating efforts among various entities, including government agencies, non-governmental organizations (NGOs), and the private sector.
7
Q
Why is the period around 1900 significant in public health history?
A
The period around 1900 is significant in public health history because it marks the beginning of modern public health practices with the establishment of extensive preventative infrastructures and the integration of various organizations into a cohesive system dedicated to improving public health on a broad scale.
8
Q
GGD founded in 1893/1901 functions:
A
- food inspection
- disinfection
- public hygiene (clean water, maintaining public baths and toilets)
- medical care of the poor
9
Q
The Accident Act
A
(1901) provided workers with financial and medical support in the event of workplace accidents to ensure social protection and welfare for citizens
10
Q
Morality Acts
A
(1911) were a set of laws aimed at regulating behaviors and activities deemed immoral or harmful to society. trend of linking public morality with public health. what they entail:
- banning specific activities
- brothels (STD) and trafficking in women
- sale of contraceptives: traditional views on procreation and family structure
- pornography to maintain public decency and morality
- abortion: Abortion was criminalized, aligning with the moral and religious views of the time regarding the sanctity of life.
- sexual contact with minors or the same sex
- ball games on sundays (presevere sabbath)
- public drunkenness
- illegal bars and gambling
- by regulating these activities the government aimed to reduce the spread of diseases, protect vulnerable populations, and promote overall social well-being
11
Q
porter’s statement “the ship of state took health on board”
A
encapsulates the significant shift in the role of the state and the approach to health during the 20th centiry
- state: resources, power, money, logistics of the state used for building the infrastructure of public health.
- This included the establishment of hospitals, clinics, laboratories, sanitation systems, and other facilities aimed at promoting community health and preventing diseases.
- The state played a central role in coordinating and funding these efforts, leveraging its authority and resources to implement public health interventions on a national scale.
- health: shift from combating diseases to optimizing health by preventive measures, helath promotion and addressing the underlying social determinants of health
- also shift to the health of entire populations or social groups and addressing broader, social, economic and environmental factors that influence health
12
Q
late 19th c.: the ‘social issue’
A
downsides of industrialisation (poor living conditions, overcrowding, pollution and inadequate access to healthcare)
13
Q
late 19th/early 20th c.: the eugenics movement
A
which believed that high fertility among the unfit and low fertility among the fit were leading to the degeneration of the nation
14
Q
first world wars as catalyst:
A
fighting fit population: for military readiness. this led to initiatives to improve public health, nutrition, and fitness levels among citizens
15
Q
crisis 1930s/producer and consumer economy:
A
highlighted the importance of the productivity of the opulation for economic stability and growth. Governments recognized that investing in public health and social welfare could improve the productivity and resilience of their populations, leading to the expansion of public health programs and social policies.
16
Q
pathological model disease definition + diagnostics
A
- Based on ‘symptom, sign, pathology’
➢ ‘1st and 2nd person perspectives’
➢ Binary distinction between health/disease
17
Q
pathological model: place
A
- Localisation of disease in ‘3-D’ body
➢ Underlying ‘lesion’ or pathophysiological
process/defect
➢ Within hospital / clinical population
18
Q
pathological model: time
A
- Directed at the ‘here and now’
➢ Acute / static
➢ Patho(physio)logy is already present
19
Q
surveillance model: disease/risk factor definition + diagnostics
A
- Statistical deviations in/from population
➢ ‘3rd person perspective’
➢ Continuum between normal/abnormal
20
Q
surveillance model: place
A
- Increasingly detached from physical body
➢ Wider community / whole population
➢ Or: individual risk factors + statistical
correlations
21
Q
surveillance model: time
A
- Directed at the future
➢ Initially: chronic diseases and linear time
model (latent – early – late stage)
➢ Later: risk factors +‘splintered time’
(e.g. ‘prediabetes’)
22
Q
Preventive youth healthcare (JGZ) tasks
A
- strong focus on local government
- free of cahrge
- 1 euro spend in preventive measures provides 11 euro back
- oterh types of preventive care for children:
- youth care (youth act)
- pediatricians and GPs: rotujen medical checkups and immunizations
- private organizations
- Information on health and dvelopment including nutrition, safety and parenting
- immunization
- screening for developmental delays, growth disorders
- identifying care needs
- providing support
23
Q
basic principles JGZ
A
- biopsychosocialecological model that considers the interplay of biological, psychological, social and environmental factors
- joint assessment: professionals work together with parents
24
Q
basic JGZ
A
- described in public health act (2008)
- Strengthening and preserving the health and
development of children - National Vaccination Programme
- National screening programmes
- Advice on the prevention of accidents in and around the
home - Healthy lifestyle and parenting issues
- Policy advice to municipalities and schools
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special preventive JGZ
- Extra attention to children with increased risk of health
problems
- Evidence-based interventions and health-promoting
programmes aimed at specific groups
- Substantial further support through the deployment of
non-regular interventions to vulnerable groups
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Preventive JGZ funding
- basic via municipalities, receive funding via central government
- special care for vulnerable groups not structurally financed by central government → municipalities free up funding from own resources
27
Cost-effectiveness of CYH/JGZ:
Investing in prevention that leads to important health gains throughout life: preventing mortality, preventing chronic conditions, and promoting healthy functioning.
28
primary prevention
1. to prevent new cases of a disease by eliminating or reducing the causes of a disease
mostly universal prevention
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Secondary prevention
2. focuses on the early detection of disease so that early treatment is possible or worsening of the condition can be prevented, increasing in healthy years of life
- screening
- pregnancy
- after birth: heel prick test and hearing test
- cancer: breast, cervical, colon
- preventive youth healthcare
30
Tertiary prevention
3. is aimed at limiting the consequeces of a disease. reducing the number and/or consequences of complications, minimizing suffering, and maximizing the number of high-quality years of life
- screening of diabetic patients for diabetic retinopathy to prevent blindness
- prevention of infections in HIV patients
- prevention of recurrence or complication of a condition through physical therapy
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universal prevention
entire population (universal prevention): involves large group of people
32
selective prevention
targets groups with an increased risk
33
high-risk approach/indicated prevention
individuals with an increased risk easy to identify (known health problems)
34
care related prevention
prevention in individual with a disease
35
health protection
1. aims to protect the population from exposure to risk factors in the environment, such as physical factos (radiation), chemical factors (harmful pesticides), or biological factors (microorganisms)
- often outside the healthcare sector
- drinking water and sewers
- workplace prevention
- accident prevention by bicycle helmet mandatory
36
Health promotion
1. primary prevention through health promontion is aimed at promoting healthy behavious, such as not smoking. achieved by:
- health education
- environmental intervention to encourage healthy behavior
- legislation and regulations such as a law for smoke-free
- financial such as pricing measures
e.g. earplugs at festivals
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disease prevention
1. focuses on preventing specific diseases or identifying them at an early stage
e.g. prevention of infectious diseases
measures in this regard:
- providing clean, safe drinking water
- information about hygiene, STDs or behaviour during outbreak
- vaccinations
e.g. prevention of mental illness by suicide prevention, prevention of stress at work, anti-bullying school programmes and early identification of child abuse
38
Public health (wet publieke gezondheid):
1. all aimed at prevention
e.g.
- setting up and implementing a programme aimed at preventing alcohol abuse
- providing vaccinations
39
social support (wet maatschappelijke ondersteuning):
2. offering support or care that ensures that more serious care can be prevented
- arranging home adaptation
- promoting accessibility to facilities
40
youth act:
prevent problems through the early provision of help and care
- promoting parenting skills of parents
- promoting the safety of young people in the home setting
41
healthcare Insurance act
4. indicated and care-related prevention required for treatment must be reimbursed through the standard package
- preventive dental check-ups for young people
- giving up smoking
42
long-term care act:
prevention within the WLZ focuses on preventing a worsening of the situation
- preventing decubitus ulcers
- preventing falls
43
focuses on individual requests for care three parts:
1. Curative care: is arranged through the Zvw, which obliges every Dutch person to take out basic insurance with a health insurer2;
2. Long-term care: includes 24-hour care that is laid down in the Long-term Care Act (Wlz), such as care for the disabled or care in nursing homes;
3. Supplementary care: individuals can choose to insure themselves for care that is not reimbursed through the Zvw or Wlz, such as dental care for adults.
this is different from the public health care which is to prevent disease in entire population
44
Access to care: the AAAQ model
- availability: sufficient public health and healthcare facilities are available
- accessibility
- non-discrimination
- physically
- economically
- informationally
- acceptability: all medical facilities, goods, and services work on the basis of medical ethics are appropriate for the culture, gender and stage of life
- quality
45
What form of prevention does this screening for cervica cancer involve?
secondary prevention
46
quit-smoking support and cardiovascular risk managment are
high risk approach = indicated prevention
handy in a easily identifiable risk group
47
when is it preferable to use a population approah
slightly increases the relative risk of the disease and affect a large group of people
e.g. too much salt consumption
48
support DM patient in self-management is
tertiary prevention
49
Tobacco policy (including information about health risks), what is the
point of intervention:
health promotion
50
Preventive measure or provision including: ex: infection disease control:
including Qu vaccination, detection of tbc
target group: population (selective and universal) and high risk approach
51
Preventive measure or provision including: example: social support
tertiary prevention
52
How can health protection be achieved
By eliminating exposure to environmental risk factors
53
What is the primary focus of health promotion?
Encouraging healthy behaviors such as hygiene and nutrition.
54
In the Netherlands, what is the greates successes of prevention in the past 50 years ?
improving road safety and tobaco control
55
Preventive measure or provision including: example: social support :
what is the approach?
high risk approach
56
ensuring good air and water quality is part of health protection or
health promotion?
health protection
57
healthy food supply in school cantens is part of health protection or health promotion?
health promotion
58
what doesn't belong to the surveillance model? (concept)
continuum between normal/abnormal
59
Septic arthritis, osteomyelitis, fracture, malignancy, NAI
In all age categories
60
at what age mostly: Transient synovitis of the hip, neuromuscular, DDH, Inflammatory diseases
1-3 years
61
at what age mostly: Transient synovitis of the hip, Perthes disease, LLD, Growing pain
4-10 years
62
11-15 years
at what age mostly: Slipped capital femoral epiphysis, overuse, osteochondritis dissecans, tarsal coalition
63
what to think about with antalgic gait (pain in lower extremity or lower back)?
INFECTION (kingella kingae)
64
seriously ill, fever, pseudoparalysis, bonnets posture. what are these symptoms of?
septic arthritis
65
joint effusion, limping, usually no fever, slightly elevated CRP and ESR. what are these symptoms of?
transient synovitis
66
where could the problem be in toeing-in?
hip (increases anteversion of the hips), tibia (increased internal rotation tibia) or foot (metatarsus adductus)
67
what are congenital causes of LLD?
hemihypertrophy, hemiatrophy, hip dysplasia/dislocation or clubfoot
68
what are vascular causes of LLD?
Perthes disease and ischemia
69
what are neurogenic causes of LLD?
cerebral palsy/hemiplegia, poliomyelitis, peripheral nerve injury
70
what are trauma/acquired causes of LLD?
growth plate injury, malunion, slipped capital epiphysis
71
what are infectious causes of LLD?
Septic arthritis
72
what to do with LLD 0-2.5 cm?
shoe raise
73
74
what to do with LLD 2.5-5 cm?
epiphysiodesis (fusion of the growth plate, leg lengthening, leg shortening
75
what to do with LLD 5-10 cm
combined surgery
76
In which disorder do you have abductor insufficiency (hip dislocation, iatrogenic)
Trendelenburg gait
77
at what age develops the medial arch?
age 5
78
what is a way to distinguish between flexible and rigid flat feet?
by standing on tip toes, flexible will show medial arch (windless phenomenon)
79
what the cause of rigid, structural flat food where 50-60% is bilateral and can be fibrous, cartilaginous or bony?
tarsal coalition
80
what is the difference between primary and secondary variability?
primary variability are movements unadapted to environmental circumstances whereby secondary (adaptive) variability are experience-based movement selections at function specific moments
81
when are the first body movements?
7 weeks 2 days
82
when does the fetus startles and has isolated limb movements?
8-12 weeks
83
when does the fetus start kicking, sucking tumb and grasping umbilical cord?
>12 weeks
84
at what age does the baby:
Fixates eyes
Moves both legs equally much
Moves both arms equally much
Lifts chin
1 month
85
at what age does the baby:
Smiles back
Follows with eyes and head
Hands open now and then
Looks at own hands
Remins positioned when lifted under the armpits
Holds head up 45°in prone position
3 months
86
at what age does the baby:
Hands playing in midline
Grasps toy within reach
No head lag when pulled to sitting position
When lifted vertically, legs bent or trampling
Holds head up 90°in prone position
6 months
87
at what age is the van wiechen schedule used?
0 – 4,5 years of age
88
Picking up a toy
Holding a toy, picking up another
Plays with both feet
Places cube inside box
Plays ‘give and take’, what are these examples of?
fine motor skills
89
rolling over, sitting, crawling, standing, walking loose, what are these examples of?
gross motor skills
90
* Writing
* Hopping on one leg
* Cycling
* Writing
* Playing the piano
* Sports
* Painting
what are these examples of
complex motor sills
91
when is the baecke fasssaert motor test used?
5-6.5 years old
92
what does the BFMT entail?
1. fine motor skills: handwriting, manual dexertiy, finger strength, hand-eye coordination
2. gross motor skills: running, jumping, throwing, climbing
3. balance: static, dynamic and postural
4. coordination: bilateral/crossing midline
93
for who is child rehabilitation
For children who, as a result of a disease, congenital anomaly or accident, have (remaining / threatening) limitations
diagnosis groups:
Cerebral palsy / Neuromuscular diseases / Spina bifida / Hydrocephalus / Down syndrome / Developmental delay / DCD / chronic pain syndromes / Congenital anomalies upper and lower extremities / Juvenile rheumatoid arthritis / Acquired brain injury / Amputation / Spinal cord injury / severe fractures
94
what are the goals of rehabilitation?
optimal autonomy and participation and preventing/treating complications
95
what is cerebral palsy?
a persistent posture and movement disorder caused by non-progressive pathological process that damaged the brain during development (<1 year)
96
what is the prevalence of CP?
1,5-2,5/1000 live births
97
what are prenatal causes of CP?
low birth weight;
placental insufficiency, maternal bleeding,
Trauma
98
what are perinatal causes of CP?
prolonged and difficult labor,
hypoxia, infarction
99
what are postnatal (<1 year) causes of CP?
CNS infections, seizures,
neonatal hyperbilirubinemia, head trauma
100
muscles are contracted all the time -> difficult to use muscle. what movement disorder is this?
spasticity (86% of CP)
101
involuntary movement which can become more noticeable when a person uses the muscle. what movement disorder is this?
dyskinesia (7%)
102
slow continuous involuntary movements present at rest, worse attempting to move (cerebellum). what movement disorder is this?
ataxic (3%)
103
both arms and legs are affected, what type of CP is this?
quadraplegia
104
both legs are affected, what type of CP is this?
diplegia
105
one side of the body is affected, what type of CP is this?
hemiplegia
106
GMFCS: slight limitation in walking
level 1
107
GMFCS: walking is possible with an orthosis + problems with uneven surface/crowds
level 2
108
GMFCS: walking is possible with a walker
level 3
109
GMFCS: self mobility with a wheelchair
level 4
110
GMFCS: wheelchair dependent
level 5
111
what are examples of associated problems of CP?
Cognitive impairments, mental retardation
Sensory deficits (visual and hearing problems)
Communication disorders
Behavioral and emotional problems
Feeding problems
Sleep disturbances
Drooling
Seizures
Bladder and bowel dysfunction
112
secondary complication weight problem, why?
feeding problems/immobility
113
scoliosis as secondary complication CP, why?
trunk hypotonia/muscle disbalance
114
contractures, hip luxation and foot deformity as secondary complication CP, why?
muscle disbalans/spasticity and immobility
115
what are stretching treatment options of CP?
Stretching: In therapy / orthosis / (sitting/standing) positions / adaptive equipment/ plaster casting
116
what is spasticity treatment in CP?
Spasticity treatment
medication (baclofen)
Btx-a injections
Shockwave
Operations (SDR/ITB)
Physical health: activity / diet / sleeping
117
treatment of secondary complications by surgery in orthopaedics, how?
Muscle
- Lengthening
Tenotomie
Transfer
Bone
Osteotomie: valgus / derotation
Growth plate
118
pain, loss of function, contracture and LLD, what are these symptoms of?
hipluxation/dislocation
119
intramembranous or endochondral ossification?
connective tissue to bone from mesoderm/ectoderm. some skull bones, madible and diaphysis of clavicle
intramembranous ossification
120
mesenchyme to hyaline cartilage to bone. Intramembranous or endochondral ossification?
endochondral ossification
121
which disease has these characteristics?
- COL2A1 mutation
- short stature: trunk >limbs
- abnormal epiphysis
- flat vertebrae
- hearing loss
- ~140 cm adult
spondylo epiphyseal dysplasia
122
which disease has these characteristics?
- RUNX2 gene mutation
- proportionate short sature
- delayed closure anterior fontanelle
- shoulder hypermobility
- delayed pubis ossification
- dental anomalies
cleido cranial dysplasia (CCD)
123
what do you measure with the galeazzi test?
knee height to see if there is luxation
124
what do you measure with the ortolani test?
if femur pops back into socket
125
what do you measure with the barlow test?
if femur pops out of socket
126
what can you measure with the perkin line?
lateralisation of the head of the femur
127
of which anomaly are these the characteristics?
fixed deformity
* cavus: downwards slope of the first metatarsal
* adduction: foot is turned inwards
* varus hindfoot: hindfoot is turned inwards
* equinus: foot is turned downward from the tibia
club foot
128
which disease has these characteristics?
mutation in the EXT1 and EXT2 genes (loss of function) → abnormalities in the growth plate cartilage → formation of osteochondromas (exostoses)
signs/symptoms
- palpable masses near joints (knees, shoulders, ankles and wrists)
- joint deformities like genu valgum (knock knees) and coxa valga (hip deformity)
- aesthetic issues
- limb length discrepancy
- loss of motion of joints
- pinched nerves
multiple osteochondromas
129
which disease these characteristics?
1/15-40.000 births
caused bij FGFR3 gene mutation
signs/symptoms
- short stature, large head
- short limbs, skin folds
- lumbal hyperlordosis (holle rug)
- low nasal bridge, frontal bossing
- short hands with trident fingers
other problems:
- delayed motor development
- sleep apnoe, middle ear infections
- spinal stenosis: L1-L4
- Foramen magnum stenosis
* spinal cord compression
- varus legs
final height
male: 131 cm
female: 124 cm
achondroplasia
130
which disease has these characteristics?
unknown, impaired differentiation of chondrocytes, enchondromas develop in the metaphysis of long tubular bones close to growth plate cartilage
signs/symptoms
- multiple enchondromas, asymmetrically present, very large variation in number, location and extent
- asymmetrical deformities at the lower extremities
- LLD
Ollier's disease
131
of which disease are these the characteristics?
mutation in collagen genes (COL1A1 and COL1A2) affecting type I collagen syntheses
the mutation result in defects:
- quantitative: reduced collagen amount
- qualitative: abnormal collagen structure
⇒ increased bone fragility
- decreased bone density
- blue sclerae
- dentinogenesis imperfecta: teeth less strong and blue grey color
- short stature
- hearing loss in adulthood
- generalized laxity
- hernias
osteogenesis imperfecta
132
what is the definition of chronic diarrhea?
after the age of 6 months
loose stools more than 3 times a day
more than two to four weeks
133
what disease is characacterized by this? Autoimmune disease triggered by gluten protein → T-cell response
increased expression of tissue transglutaminase (TTG) enzyme → forming of TTG IgA antibodies → inflammation and villus atrophy
only in carriers of HLA-DQ2 or DQ8 (40%)
celiac disease
134
of what disease are these the symptoms?: - diarrhea, failure to thrive, weight loss, growth retardation, delayed puberty
- chronic abdominal pain, nausea, vomiting, constipation, distended abdomen
- iron deficiency/anemia
- unexplained fractures
- chronic fatigue
- oral ulceration
- dermatitis Herpetiformis
- Transaminitis
consequences:
- tissue damage
- loss of function (bowel)
- malabsorption
- osteoporosis
- anemia
celiac disease
135
how do you diagnose celiac disease?
TTG IgA >10 and endomysium IgA antibodies positive
136
what is the definition of psychomotor retardation
Significantly subnormal functioning for a child’s developmental stage
Statistically: a motor, verbal, and/or cognitive performance that is two standard deviations below the mean of the general population
IQ measured with a standardized intelligence test <70
137
what is a sign of a upper motor neuron lesion?
increase in tone
138
what is a sign of a lower motor neuron lesion?
decrease in reflexes
139
what are primary causes of microcephaly?
- genetic or chromosomal
- cns malformation
- cns migration disorder
140
what are secondary causes of microcephaly?
- intrauterine: infection, toxin, vascular
- perinatal: meningitis, asphyxia, metabolic
- postnatal
141
what is the definition of child abuse?
“all forms of physical and/or emotional ill-treatment resulting in actual or potential harm to the child in the context of a relationship of responsibility, trust or power.”
142
what are fasciculations?
involuntary rapid muscle twitches that are too weak to move a limb
143
. Brittle bone disease (osteogenesis imperfecta) is most frequently causedby:
(a) type II collagen defects
(b) skeletal mineralization defects
(c) vitamin D deficiency in the diet
(d) impaired type I collagen production
D
144
. Characteristics of achondroplasia are:
normal intelligence, delayed motor development, normal torso and short extremities
145
What is the theory of mind?
the ability to put yourself in another person's situation and to predict anothers person's behaviour (to a certain degree)
146
what is erb's paresis?
Erb's paresis, also known as Erb's palsy, is a form of brachial plexus palsy that primarily affects the upper arm.
Erb's palsy is a type of birth injury that results from damage to the upper brachial plexus, specifically the C5 and C6 nerve roots.
147
