tag:theconversation.com,2011:/us/topics/school-sores-48852/articlesSchool sores – The Conversation2019-04-18T06:01:54Ztag:theconversation.com,2011:article/1143552019-04-18T06:01:54Z2019-04-18T06:01:54ZAntibiotic shortages are putting Aboriginal kids at risk<p>At any time, almost <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136789">one in two</a> Aboriginal children living in remote areas will have a school sore. That means right now, there are an estimated 15,000 children needing treatment.</p>
<p>School sores can be painful and itchy. But left untreated, they can lead to <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000467">rheumatic fever</a>, bone infections or sepsis.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730933/">most effective and tolerable antibiotic</a> to treat school sores is in short supply, and this is putting Aboriginal kids at risk of life-threatening infections.</p>
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Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
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<h2>What are school sores?</h2>
<p>School sores (or Impetigo) are common in Aboriginal children living in remote areas due to the association with scabies, tinea and head lice, which are <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000554">also very common</a>.</p>
<p>When their skin or scalp is itchy, children may scratch and break the skin, allowing the bacteria that cause school sores to enter. Insect bites and minor trauma can also become a site for a school sore to develop. </p>
<p>School sores are caused by the bacteria <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-014-0727-5"><em>Staphylococcus aureus</em></a> and Group A Streptococcus. These bacteria are highly contagious and spread easily from child to child.</p>
<h2>What are the treatment options?</h2>
<p>School sores are usually treated with an antibiotic cream when only a few kids have them. But because these sores are so common in remote communities, it’s recommended that an oral antibiotic or an injection is used to prevent the development of antibiotic resistance.</p>
<p>Both the oral antibiotic and the injection work well to treat school sores, but we know many kids won’t want the needle. </p>
<p><a href="https://infectiousdiseases.telethonkids.org.au/our-research/skin-guidelines/">Current guidelines</a> recommend treating school sores with the antibiotic trimethoprim-sulfamethoxazole (known by the brand names Bactrim and Septrin).</p>
<p>Most kids under eight years old need to take a liquid antibiotic. The Bactrim brand antibiotic syrup tastes good and is easy to swallow. Naturally, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960841-2/fulltext">kids prefer it</a> to a painful injection.</p>
<p>In September 2018, Bactrim syrup was withdrawn from the market, possibly due to a company merger, leaving the Septrin brand as the only remaining brand of this antibiotic in syrup form.</p>
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<img alt="" src="https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269721/original/file-20190417-139104-1rk6tqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s much easier to get kids to take a flavoured syrup than swallow a crushed up tablet, or have an injection.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>This put a lot of pressure on the company making Septrin to increase the supply needed for kids all over Australia. But they couldn’t keep up with demand. The Septrin syrup has now been <a href="https://apps.tga.gov.au/Prod/msi/Search/Details/sulfamethoxazole">out of stock</a> for eight months, which has affected the treatment of a large number of Aboriginal children with school sores.</p>
<p>The alternative for younger children is to crush the trimethoprim/sulfamethoxazole tablets, which tastes terrible and is not recommended by antibiotic regulators. It’s not very accurate for getting the dose right, particularly in the smallest kids.</p>
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Read more:
<a href="https://theconversation.com/what-are-school-sores-and-how-do-you-get-rid-of-them-86930">What are school sores and how do you get rid of them?</a>
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<p>For example, a two-year-old will weigh about 12kg. The recommended dose of trimethoprim/sulphamethoxazole for a child of this weight is <a href="https://infectiousdiseases.telethonkids.org.au/siteassets/media-docs---wesfarmers-centre/national-healthy-skin-guideline---1st-ed.-2018.pdf">48mg trimethoprim</a>. The tablets only come as 40mg trimethoprim or 80mg trimethoprim, making it tricky to get the required dose for this child. And guidelines have not anticipated this situation, so there is little to inform dosing decisions.</p>
<p>In recent months, we’ve heard the crushable tablets in another brand of the same medicine, known as Resprim, are now also out of stock.</p>
<h2>How can antibiotics that kids need just disappear?</h2>
<p>Drug shortages are a <a href="https://www.shpa.org.au/sites/default/files/uploaded-content/website-content/shpa_medicines_shortages_in_australia_report_june_2017.pdf">huge problem</a> in health care. </p>
<p>Information about these stock outs filters to doctors and pharmacists haphazardly. There’s no coordinated process for this in Australia, and it can take weeks or months for the information to get to the health-care workers. Often they’ll only become aware of the shortfall when they have a patient who needs the antibiotic.</p>
<p>Mandatory reporting of drug stock outs to the Therapeutic Good Administration (TGA) by the manufacturers <a href="http://apps.tga.gov.au/prod/MSI/search/">commenced in 2018</a> to address this. Time will tell whether it helps the flow of information.</p>
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Read more:
<a href="https://theconversation.com/why-are-aboriginal-children-still-dying-from-rheumatic-heart-disease-63814">Why are Aboriginal children still dying from rheumatic heart disease?</a>
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<p>These problems are never simple. Old, cheap antibiotics are no longer on patent and not generally profitable for the manufacturers. These antibiotics are usually prescribed for short courses of three to five days, and so are rarely prioritised in comparison to the long-term medications required for the older population (such as diabetes or heart medications).</p>
<p>In a developed country with world-class health care, it’s unacceptable if an antibiotic needed to treat an infection is not available because we don’t have a national system for coordinating and maintaining antibiotic supply.</p>
<h2>Why this drug shortage is a particularly concerning one</h2>
<p>Skin sores are more than a nuisance condition. They make kids feel sick, take weeks to heal and may lead to absences from school. </p>
<p>The long-term problems of rheumatic fever, sepsis and kidney disease result in <a href="https://static.treasury.gov.au/uploads/sites/1/2019/02/360985-END-RHD-Centre-of-Research-Excellence.pdf">lifelong chronic ill health</a> and are a much higher cost to the health system than a simple, cheap course of oral antibiotics to treat the skin sores before they become a bigger problem.</p>
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Read more:
<a href="https://theconversation.com/how-discrimination-and-stressful-events-affect-the-health-of-our-indigenous-kids-67548">How discrimination and stressful events affect the health of our Indigenous kids</a>
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<p>With 15,000 Aboriginal children at any one time needing this antibiotic to treat school sores, the demand is real.</p>
<p><em>Zoy Goff, antimicrobial stewardship pharmacist at the Perth Children’s Hospital, and Hannah Mann, regional pharmacist in the Kimberley and research partner for the Kimberley-based skin health trials, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/114355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Asha Bowen receives funding from the National Health and Medical Research Council of Australia. </span></em></p>Almost half of Aboriginal kids living remotely will have a school sore at any one time. But there aren’t enough of the right antibiotics to treat them.Asha Bowen, Head, Skin Health, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1086982019-01-07T13:23:52Z2019-01-07T13:23:52ZWhy South Africa will find it hard to break free from its vicious teaching cycle<figure><img src="https://images.theconversation.com/files/251491/original/file-20181219-45385-datotw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Academic outcomes can be accomplished by high teaching quality.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Half of all South African pupils who attended school for five years can’t do <a href="https://mg.co.za/article/2018-11-23-00-basic-education-is-failing-the-economy">basic calculations</a>. This is according to a 2015 TIMMS <a href="http://www.timss-sa.org.za/download/TIMSS-2015-Grade-5-National-Report.pdf">report</a> on mathematics achievements among Grade 5 learners in South Africa. </p>
<p>At the same time, it’s calculated that 10% of the country’s teachers are <a href="http://www.702.co.za/articles/271296/report-10-of-teachers-are-absent-daily-at-most-south-african-public-schools#">absent</a> from school each day, while <a href="http://wiredspace.wits.ac.za/handle/10539/17772">research</a> found that 79% of South African Grade 6 mathematics teachers were classified as having content knowledge levels below the level at which they were teaching. </p>
<p>Given that teacher quality is one of the biggest factors determining the learning <a href="https://research.acer.edu.au/research_conference_2003/3/">outcomes</a> of students, what will it take to improve teacher quality and professionalism in the country?</p>
<p>Numerous suggestions have been floated. But one idea has recently generated particular interest among education departments, statutory bodies, and academia – the introduction of <a href="http://www.cde.org.za/wp-content/uploads/2017/08/CDE-Insight-Professional-Standards.pdf">“teacher professional standards”</a>. These can be broadly defined as a set of common standards that include the professional knowledge, skills and conduct that characterise good teaching. </p>
<p>Their development began in the US in the late 1980s. It was stimulated by the view that higher expectations for student learning could be accomplished only by higher expectations of teaching quality. In the South African context, teacher standards are a response to a lack of teacher accountability. This has been <a href="https://www.tandfonline.com/doi/abs/10.1080/09720073.2012.11891280">identified</a> as a cause of the poor quality of South African education. </p>
<p>The basic premise of teacher standards is that if you expect more from teachers, don’t allow them into the classroom until they’ve met a basic set of criteria, and hold them to account if they fall short, then the quality of teachers will improve. </p>
<p>But introducing teacher standards in South Africa also comes with a caveat. <a href="http://www.cde.org.za/wp-content/uploads/2017/08/CDE-Insight-Professional-Standards.pdf">Research</a> into the value of teacher standards for South Africa warns that this approach could serve to de-professionalise the country’s teaching force if not approached carefully. </p>
<p>This is because there are effectively two types of teacher standards, and it’s important not to conflate the two. There are standards that professionalise teaching and standards that simply manage teachers. While standards which professionalise create cultures of collegiality, expertise and pride among teachers, standards that manage can leave them feeling brow-beaten, untrusted, and demotivated.</p>
<p>Yet management standards are often mistaken for professional standards. When this happens, teacher morale drops. This is a common trend in countries like South Africa which have a “vicious” rather than “virtuous” schooling cycle.</p>
<h2>How the schooling cycle works</h2>
<p>The quality of a nation’s teachers cannot be divorced from the quality of its learners exiting schools. This is because successive cohorts of learners progress through school, enter university as student teachers, and graduate as teachers where they nurture the next cohort through the cycle. The end of school is therefore the beginning of higher education. </p>
<p>In a virtuous schooling cycle, such as Finland, education is a desirable career choice for top graduates. This allows for competitive entry requirements for teacher education programmes, which in turn allows for rigorous and challenging courses. This, in turn, produces high quality teachers who improve learner outcomes. The quality and professionalism of the teachers nurtures the next generation of high-quality teacher trainees.</p>
<p>In a virtuous cycle the system can afford to set standards that reflect the best professional knowledge internationally. Initial teacher education is intensive and teachers exit the programmes with high levels of subject and pedagogical knowledge. As a result, their learners perform well and the school system enjoys a high level of public esteem. </p>
<p>Consequently teaching is a prestigious and attractive profession which recruits the brightest and most motivated school graduates, who don’t require continual monitoring and oversight. Teachers instead enjoy professional autonomy; they are trusted in key decisions about their teaching and professional development. </p>
<p>Compare this to South Africa, which has a vicious schooling cycle. Initial teacher education is highly variable but generally insufficient. For example, a <a href="https://www.jet.org.za/resources/taylor-iterp-summary-report-on-component-1-feb15web.pdf">study</a> found that three out of five of the Higher Education Institutions that were sampled provided no English language, literature, or linguistic education for teacher trainees not specialising in this subject, despite poor English language proficiency among teacher trainees being a ubiquitous concern. </p>
<p>Unsurprisingly then, <a href="https://www.jet.org.za/resources/deacon-iterp-final-composite-report.pdf">research</a> on newly qualified teachers indicates that students enter their studies with very poor skills, and leave with little more. Consequently, their learners do very poorly and teaching is perceived as a low status career. Teacher education programmes are therefore in general unable to reliably attract high quality graduates, and so tend to be less demanding. The vicious cycle repeats itself.</p>
<p>In vicious schooling cycles governments take it upon themselves to hold teachers accountable. Standards are used to manage teachers, and to protect students from the worst educators through supervisory surveillance and control. Invariably, the relationship between teacher unions and governments becomes antagonistic and generates feelings of fear and mistrust. This, in turn, alienates the best school graduates who frankly have better career options. </p>
<p>While in-service training programmes attempt to make up the backlog, and some are succeeding in achieving small learning gains, they cannot fully compensate for the lack of teacher skills resulting from poor initial teacher education and generally unskilled matriculants.</p>
<h2>Not all standards professionalise teaching</h2>
<p>Given it’s vicious cycle, management standards may be more likely than professional standards in South Africa. Does this mean that South African teachers are damned to the stick, rather than the carrot? Not necessarily. There are many excellent teachers who are hungry for opportunities to develop in ways that nurture autonomy and collegiality.</p>
<p>South Africa should not shy away from developing and promoting professional best practice, and providing the opportunities for teachers to reach them. </p>
<p>At the same time, management standards must be considered carefully. While they may prevent the worst teaching, they’re unlikely to create the professional culture that promotes the best teaching and attracts the best candidates.</p>
<p><em>Nick Taylor, Senior Research Fellow at JET Education Services, also contributed to this article.</em></p><img src="https://counter.theconversation.com/content/108698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Robinson receives funding from the ESRC.</span></em></p>The introduction of teacher standards may actually reduce teacher professionalism if not handled correctly.Natasha Robinson, PhD Candidate and research consultant, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/869302018-02-01T17:57:00Z2018-02-01T17:57:00ZWhat are school sores and how do you get rid of them?<figure><img src="https://images.theconversation.com/files/203007/original/file-20180123-182965-1180o5w.jpg?ixlib=rb-1.1.0&rect=0%2C1334%2C3538%2C1528&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The usual culprit is the bacterium _Staphylococcus aureus_, better known as “golden staph”.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/698395990?src=5oGzvQ_ZB3yKGJB3Xjhv3g-2-30&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>Impetigo, or “school sores”, is a contagious infection of the very top layer of skin. It’s <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136789">most common</a> in children aged two to six, and ends up spreading from child to child in schools and daycare centres, but can affect children and adults of all ages. </p>
<p>The good news is that it’s unlikely to cause serious harm. It usually clears up within a few weeks, without any scarring. </p>
<p>The usual culprit is the bacterium <em>Staphylococcus aureus</em>, better known as “golden staph”. <em>S. aureus</em> can cause serious infections, and has a fearsome reputation. But the bacteria <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/staphylococcus-aureus-golden-staph">commonly lives on skin</a>, lurking in the groin and nostrils without causing problems.</p>
<p>A second type of bacteria that causes impetigo is <em>Streptococcus pyogenes</em>, commonly known as “strep”. <em>S. pyogenes</em> can cause other infections such as tonsillitis and pharyngitis. In fact, it is often the “strep” responsible for “strep throat”. </p>
<p>Strep impetigo is more prevalent in rural and remote communities. It is also more common in institutional settings such as aged care facilities, boarding schools, and prisons.</p>
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Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
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<p>Impetigo <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/impetigo-school-sores">appears on the skin</a> one to three days after being infected by staph, or four to ten days after catching strep. It can occur on sores from scratches, insect bites and eczema, or on healthy skin. </p>
<p>The sores begin as red areas, or crops of small blisters, most commonly around the nose and mouth, and on the arms and legs. The sores then burst and begin to weep, before drying with a golden-coloured scab, often referred to as a “honey-crust”.</p>
<h2>Treatment</h2>
<p>While impetigo is unlikely to cause problems in healthy people, it’s important to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">see a GP for an accurate diagnosis</a>.</p>
<p>If only a small crop of sores is present, frequent washing with soap and water might be all that is needed. A prescription antibiotic ointment can also be used. </p>
<p>If the sores are more widespread, or there is evidence of infection spreading into the deeper skin (cellulitis), oral antibiotics are often necessary.</p>
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Read more:
<a href="https://theconversation.com/when-should-you-take-antibiotics-42751">When should you take antibiotics?</a>
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<p>Parents can speed up the healing process by removing the crusts two to three times a day. This is done by soaking the skin in a warm bath, then wiping the scabs away gently with a clean face washer and patting dry with a fresh towel. Sores should be completely covered by waterproof bandages.</p>
<p>To prevent other family members catching the infection, don’t share any towels, face washers, clothes and bed linen, and put them on a hot wash. The infected person should use a fresh towel and washer every time they bathe, and keep their nails short. </p>
<p>Kids are generally ready to go back to school once they’ve had 24 hours of antibiotics and if the sores are covered with dressings. For children not taking antibiotics, public health authorities recommend that <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">children only return to school</a> when the sores are completely healed.</p>
<h2>Complications</h2>
<p>Impetigo can occasionally lead to a further, dangerous infection. If children are feverish or lethargic, sores are spreading despite antibiotics, or you’re concerned your child looks unwell, see a doctor. </p>
<p>Newborns and babies are also at higher risk of serious complications due to their immature immune systems, and so get it checked out at the first sign of infection.</p>
<p>One possible reason for sores not improving on standard antibiotics is infection by an antibiotic-resistant bacteria. Infections due to antibiotic-resistant golden staph, MRSA (methicillin-resistant <em>Staphylococcus aureus</em>), are becoming more widespread, largely due to the widespread use of antibiotics. </p>
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Read more:
<a href="https://theconversation.com/vaccine-for-strep-throat-and-rheumatic-fever-to-be-trialled-in-humans-63390">Vaccine for strep throat and rheumatic fever to be trialled in humans</a>
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<p>An <a href="https://www.mja.com.au/journal/2017/207/9/increasing-importance-community-acquired-methicillin-resistant-staphylococcus">Australian study</a> in the Hunter area of New South Wales looked at all staph infections diagnosed in the region from 2008 to 2014. Nearly 20% were drug-resistant strains. </p>
<p>For most children, though, the infection is mild and fleeting. Keep an eye on the sores, and see your GP for a diagnosis, but try not to worry if it’s a standard case. </p>
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<p><em>Dr Kristen Ochs, a GP registrar at the academic General Practice Unit, Fairfield Hospital and Ingham Institute of Applied Medical Research, co-wrote this article.</em></p><img src="https://counter.theconversation.com/content/86930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Tam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>School sores usually clear up within a few weeks, without any scarring. Here’s what to do if you suspect your child has them.Michael Tam, General Practitioner, and Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.