From StudyingMed
See Hazel Mitchell's lecture on skin infections.
Contents
Buzzwords with ATSI
- Spirit and integrity
- Respect
- Reciprocicty
- Responsibility
- Survival and protection
- Equality
- Summary of the ecological model
- Scabies: mite, burrows under skin, lays eggs, itch --> scratch --> break skin --> infection; can't wash off scabies (hygiene stigma).
- Risks: overcrowding, heat (sweating, incubation, don't want to put cream on), water supply, humidity, hygiene, poor nutrition
- Scabies: GAS --> 1) RHD 2) APSGN
- Rx: 5% permethrin over whole body
- Wash bedding, sheets
- Treat everyone else
- Easy to miss infections
- Can't get scabies from cat/dog
- Dx usually based on history
- Parasites: lives in/on another organism; don't respond to antibiotics - "one way" gain for parasite e.g. ticks, lice, worms
- Helminths are worm parasites e.g. hookworms, round worms, flukes, tapeworms
- Fungal infections (e.g. ringworm) are another form of parasite
APSGN
- IgA immune complexes get stuck in glomeruli and cause inflammation
- APSGN - acute post strep glomerulonephritis
- Hematuria (often the first sign)
- Oliguria
- Oedema
- Ascites
- Hypertension
- General
- Acute renal necrosis due to injury of capillary or capillary thrombosis
- Hospital admission for a few days - check blood, urine
- Administer diuretics
- Antibiotic treatment doesn't cure APSGN because it's not the strep that's causing it
ARF
- Immune complexes to GAS can cross-react with heart muscle, causing ARF
- Some kinds of GAS are more likely to trigger APSGN (can come in epidemics)
- ARF can't cause epidemics because it's more about a specific cross reaction between the host and the organism
Risk factors in Aboriginal community
- Prevalence of scabies in the aboriginal community is much higher due to risk factors
- Aboriginal communities have much higher levels of overcrowding
- If you don't remove the risk factors, you get reinfection
- See the big diagram that summarises ecological model for Aboriginal renal disease in one of the articles
- PSGN - in populations that have higher levels of PSGN, they have higher risk of end stage renal disease later on
Interventions - Arnhem land
- Active surveillance programme (homes and schools to check for scabies and pyoderma)
- Checkups for children; applying permethrin cream
- Started because the local community wanted to do something about scabies
- They have poor fruit supply etc (despite fish). There was huge interference with bush food
- Housing interventions are difficult to carry out because the houses need to be refreshed often, and you also need to replace the old inappropriate houses
- Unhealthy food not more expensive than city, healthy food much more expensive
- Adherence is poor for this - teenagers and adults don't do the permethrin treatment
- Skin infections become "normal", and adolescents are unadherent.
- Higher threshold before seeking care
- Outcomes: scabies prevalence not decreased BUT pyoderma rates reduced (which causes the complications). Good empowerment: learning from the health care workers
- Communities that had more infection had more improvement
- Remote communities - kids are bored with nothing to do (impacts on energy levels, fun)
- "No school no pool" (but this assumes that they have control over whether they go to school - it might double disadvantage someone)
Interventions - WA
- Arid, dry, hot environment
- Remote communities
- Study looked at indicators for infections (skin, ear, respiratory tract, trauma)
- Post-swimming pools
- Antibiotic scripts, clinic visits
Assessing cost effectiveness study
- Checked cost effectiveness of a whole lot of health interventions
- Used aboriginal definition of health (community health; life-death-life cycle)
- Individual health gain
- DALY
- Individual empowerment (more able to deal with their lives and overcome challenges (don't force treatments onto people)
- Community health gain
- Social and emotional wellbeing; include whole community
- E.g. pool: jobs, exercise
- Cultural security
- Dont compromise their cultural rights, views, values and expectations of Aboriginals
- Equity
- Access to services
- Differentials in population health outcome
- Individual health gain
- equity vs equality
- equity strives for equality
- equity = provide more resources to achieve equality.
- People have the feeling that these interventions won't change anything so they don't participate
Other places with scabies
- Nursing homes