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See Hazel Mitchell's lecture on skin infections.

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
  • 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