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Healthy People 2010 identified overweight and obesity as 1 of 10 leading health indicators and called for a reduction in the proportion of children and adolescents who are overweight or obese, but the United States has made little progress toward the target goal.
Results from the 2007-2008 NHANES, using measured heights and weights, indicate that an estimated 16.9% of children and adolescents aged 2-19 years are obese.
NHANES used stratified, multistage, probability samples of the civilian noninstitutionalized U.S.
2 Data for 1963-1965 are for children aged 6-11; data for 1966-1970 are for adolescents aged 12-17, not 12-19 years. NOTE: Obesity defined as body mass index (BMI) greater than or equal to sex- and age-specific 95th percentile from the 2000 CDC Growth Charts.
Une escarre (parfois appelee plaie de lit ou ulceres de decubitus) est une lesion cutanee d’origine ischemique liee a une compression des tissus mous entre un plan dur et les saillies osseuses[1]. L’escarre est decrite selon quatre stades, comme une plaie de dedans en dehors de forme conique (une partie des lesions n’est pas visible), a base profonde, ce qui la differencie des abrasions cutanees.
Son origine est multifactorielle, cependant le role de la compression tissulaire associee a une perte de mobilite et a la denutrition est predominant. Le traitement de l’escarre peut etre chirurgical, bien qu’il soit le plus souvent medical et preventif. La survenue d’une escarre est favorisee chez les personnes longuement alitees, notamment chez les personnes en fin de vie, dans le coma ou encore paraplegiques. La prevention de la part du personnel soignant est determinante dans ce processus qui affecte environ 5 % des personnes hospitalisees.
Preferer les sieges en position semi-inclinee (le dossier et l’assise forment un angle de 90° mais l’assise fait un angle de 30° avec le sol). A chaque changement de position, appliquer des Acide Gras Hyperoxygenes sur les zones d’appui (recommandation de faible niveau de preuve). Le traitement est difficile et necessite un personnel forme a la prise en charge des escarres.
L’objectif des soins locaux est d’obtenir une re-epidermisation de l’escarre en laissant la plaie en milieu humide et propre tout en favorisant l’activite de cicatrisation naturelle. Application d’un pansement humide (plaques hydrocellulaires par exemple) ou d’un pansement gras (type tulle gras), entre autres.
When the time came and my husband, Gary, and I felt ready to have a baby, I had nothing left to do except pick up a new ovulation kit.
When I read the positive result on my pregnancy test, I was in such shock that I sat on my couch and didn’t speak for hours. Next I called my mom, but she didn’t pick up, so I sat with my news and started daydreaming. In case you’re sitting on the edge of your seat, wondering if pregnancy cured my type 1 diabetes, the answer is no. Since I wasn’t cured, my biggest priority when I found out I was pregnant was keeping my blood sugar in excellent control. But diabetes is unpredictable, especially with pregnancy hormones swirling around and even if I tested every hour it wouldn’t guarantee perfection.
I got through the first trimester and I’m sorry to report that aside from the knowledge that I was pregnant, which kept me going, I was fairly miserable. For the second time in my young pregnancy someone was telling me I might have to be hospitalized.
She graciously sat with me for two and a half hours and we drastically changed my insulin to carb ratios and cut my basal rates by almost half. Artist and school teacher Jen Jacobs grew up in Long Island, New York and was diagnosed with type 1 diabetes at the age of 12.
It’s nice to hear your story and I know it’ll be a long and difficult journey for me as well but I hope everything works out! Jen, I blame the hormones for the tears that flowed down my face as I read your post, but I must say it was so encouraging to me! The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes. If insulin resistance is such a dominant risk factor in the progression to type II diabetes, it might be useful to have an effective tool for diagnosing it.  In this section I will discuss the various options available for measuring insulin resistance and their efficacy in predicting progression to type II diabetes. Too bad only highly sophisticated metabolic research labs our outfitted with these contraptions.  So unless you volunteer to be a guinea pig at a research facility, it is unlikely that you will have the opportunity to test your insulin resistance with this degree of accuracy.  Your doctor – in case you’re wondering –  probably doesn’t have one stuffed in his clinic closet! Okay, I know, this is just an epidemiological study and, as such, by no means proves that having high A1C causes people to die earlier.  It is entirely possible that some unknown variable is causing both the high A1C and the mortality. As you can see, A1C has a number of issues which make it a less than ideal tool for reliably measuring insulin resistance or predicting progression to diabetes.  Having said that, I do believe that, in general, an A1C  below 5 sustained over time is predictive of good health and indicative of excellent glucose tolerance. The chart below, which I developed from the results of this paper, indicates that, indeed, not all “normal” GTT results are equal. Australia's health 2014Understanding health & illness Australia's health system How healthy are we? Australians have one of the highest life expectancies in the world, but does this mean we are healthy? Death rates continue to drop in Australia, and not only are people living longer, but they are living with more years free of disability.
We have access to increasingly innovative and sophisticated health care, including improved detection, diagnosis and treatments that were not available to past generations. Most deaths in Australia are caused by chronic disease rather than acute illnesses that were the cause of most deaths a hundred years ago. Chronic diseases not only have a profound effect on an individual's health, but they are placing an increasing burden on our national health-care system, including increased pressure on paying for and staffing our health system. Certain population groups, for example people living in lower socioeconomic areas, experience increased health risk factors compared with other Australians. Assessing the health of Australians is a complex task, and involves looking at multiple aspects of health, including both physical health and mental health and wellbeing.
This chapter attempts to paint a summary picture of the ways Australia as a nation is healthy, and areas where we could be doing better. It gives key measures that allow us to assess how healthy we are, including information on leading causes of death and life expectancy. Knowing where we are at in terms of our health helps governments plan and allocate for health care into the future, helps health-care professionals and researchers target research and innovation, and helps individuals and population groups assess their own health. Life expectancy is often expressed as either the number of years a newborn baby is expected to live, or as the expected number of years of life remaining for a person at a given age.
Life expectancy in Australia has risen by more than 30 years since the late 1800s (Figure 3.1). Note: Data points on this graph are based on either a 3- or 10-year period ending in the year shown to reduce the effect of fluctuations in death rates from year to year—for example the 2012 figure refers to babies born in 2010–2012, and the figure for 1890 is for babies born in 1881–1890. Indigenous life expectancy continues to be substantially lower than for the non-Indigenous population (see Chapter 7 'Indigenous life expectancy and death rates').
In 2011, Australia was ranked 6th among OECD countries for life expectancy at birth for males, and 7th for females (Table 3.2).
Over the last 2 decades, Australia has consistently ranked in the top 10 of OECD countries for life expectancy at birth (see Chapter 9 'International comparisons'). There are currently no national data to describe the relationship between life expectancy and long-term health conditions or lifestyle behaviours—for example, life expectancy of smokers compared with non-smokers.
Similarly, no data are available on life expectancy by socioeconomic factors, country of birth, employment, or level of education. Examining leading causes of death can help us to understand health in different populations and population groups. Changes in the pattern of causes of death may also reflect changes in behaviours, exposures, and social and environmental circumstances.
Causes of death are documented on death certificates completed by medical practitioners or coroners, and coded using the World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD) by the Australian Bureau of Statistics. The ICD allows for the categorisation of causes of death into disease groups in a way that is meaningful for public health purposes. The leading underlying cause of death was coronary heart disease, accounting for 11,733 male deaths and 9,780 female deaths (Figure 3.2). For males the next most common causes of death were lung cancer (4,959 deaths) and cerebrovascular diseases (which include stroke) (4,427 deaths). For females the next most common causes of death were cerebrovascular diseases (6,824 deaths), and dementia and Alzheimer disease (6,596 deaths).
For both males and females, the 5 leading causes of death were the same in 2001 and 2011, albeit with different rankings (Figure 3.2).
The leading cause of death in both years was coronary heart disease, accounting for 20% of deaths in 2001 and 15% in 2011.
For males, the largest changes in leading causes of death from 2001 to 2011 were the rise of dementia and Alzheimer disease from 13th to 6th place, and the fall of land transport accidents from 9th to 17th place.
For males, 2 leading external causes of death (land transport accidents and suicides) fell in rank over this period while many cancer causes of death rose in rank (lung, prostate and pancreatic cancers, and cancers with unknown or ill-defined site). For females, many leading cancer causes of death (breast, colorectal, pancreatic and ovarian) fell in rank over this period—for example, breast cancer fell from 3rd in 2001 to 5th in 2011. Rankings are based on number of deaths; a decline in rank does not necessarily indicate a decline in the number of deaths.
Data for 2011 are based on the preliminary version of cause of death data and are subject to further revision by the ABS. Coloured lines point to the cause as ranked in 2011; causes in bold indicate they have moved into the leading 20 causes in 2011 while those in grey have moved out since 2001.
Coronary heart disease was the leading cause of death in all areas, from Major cities to Very remote, in 2009–2011.
Diabetes ranked higher as a cause of death among people living in Remote and Very remote areas compared with regional and city areas. Cerebrovascular diseases, and dementia and Alzheimer disease ranked higher among diseases causing death in Major cities, and Inner regional and Outer regional areas compared with the more remote areas. Land transport accidents ranked more highly with increasing remoteness—they were not in the top 15 in Major cities or Inner regional areas, but ranked 13th in Outer regional areas, 8th in Remote areas and 4th in Very remote areas. Deaths from suicide accounted for a greater proportion of all deaths in Remote and Very remote areas, 4% and 3%, respectively, compared with 2% or less in other areas. Causes of death that ranked in the leading 15 causes of death in Remote and Very remote areas and not in Major cities and regional areas include perinatal and congenital conditions, cirrhosis and other diseases of the liver and unknown and ill-defined causes. Socioeconomic factors such as highest level of education achieved and main occupation are known to be associated with mortality and particular causes of death.
The leading causes of death presented here are based purely on counts of deaths in a particular year; the extra impact of early deaths due to particular causes is not assessed. More information on deaths and leading causes of death in Australia, including by different age groups, is available. Information on variations in leading causes of death by socioeconomic status, remoteness and other socio-demographic variables will be available in a forthcoming AIHW publication Mortality inequalities in Australia. Death statistics are usually analysed and reported using the underlying cause of death only (see Chapter 3 'Leading causes of death in Australia'). Examining multiple causes of death may offer better insights into all the disease processes occurring at the end of life, which can in turn be useful for developing better prevention and treatment policies and practices, refining disease surveillance activities, guiding research investment and enhancing burden of disease estimates (see Chapter 4 'Burden of disease'). The underlying cause of death is the disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury.
Associated causes of death are all causes listed on the death certificate, other than the underlying cause of death. Of the 146,932 deaths in Australia in 2011, 94% (137,809 deaths) were due to natural causes. In 2011, 81% of natural deaths had more than 1 cause and, on average, 3.2 diseases or conditions were recorded on the death certificate. Analysis of multiple causes of death is particularly useful in relation to chronic diseases, which were commonly recorded in combinations of 2 or more. Coronary heart disease was an associated cause of death for 51% of deaths due to diabetes, 28% of deaths due to chronic and unspecified kidney failure and 19% of deaths due to chronic obstructive pulmonary disease (COPD). Hypertensive disease was an associated cause of death for 35% of deaths due to diabetes, 28% of deaths due to cerebrovascular diseases (which include stroke) and 21% of deaths due to coronary heart disease. Influenza and pneumonia was also a common associated cause of death—more specifically, for 31% of deaths due to asthma, 30% of deaths due to COPD and 29% of deaths due to dementia and Alzheimer disease.
Chronic diseases that are more likely to be reported as the underlying cause of death rather than as an associated cause of death include prostate, breast, colorectal (bowel), liver and lung cancers (Figure 3.3). Chronic diseases that are more likely to be reported as associated causes of death include chronic and unspecified kidney failure, diabetes, asthma, COPD, and dementia and Alzheimer disease. When deaths are reported by the underlying cause of death only, the involvement of certain diseases in overall mortality may be underestimated.
Deaths registered in 2011 are based on the preliminary version of cause of death data and are subject to further revision by the ABS. Underlying refers to deaths with the disease recorded as the underlying cause of death, regardless of whether the disease was also recorded as an associated cause of death. Australians have one of the longest life expectancies in the world, but does this mean we are healthier than our parents or grandparents?
The concept of what it is to be 'healthy' encompasses more than just how many years a person lives—for example, it could also include consideration of how many of those years are spent in good health or with disability or chronic illness. While a baby born today can expect to live about 30 more years than a baby born in the late 1800s, he or she will face a set of different health challenges, largely driven by lifestyle factors not encountered by previous generations. The rate of potentially avoidable deaths (deaths among people younger than 75 that are potentially avoidable within the present health-care system) has also been in decline. Potentially avoidable deaths are divided into potentially preventable deaths (those amenable to screening and primary prevention, such as immunisation) and deaths from potentially treatable conditions (those amenable to therapeutic interventions). In 1900, people could mainly expect to die from pneumonia, influenza, tuberculosis, gastrointestinal infections, heart disease and strokes (Jones et al. In 2011, the top 5 causes of death in Australia for males were coronary heart disease, followed by lung cancer, cerebrovascular disease (including stroke), prostate cancer and chronic lower respiratory disease.
Since the 1900s, sanitation and housing have improved and vaccines have been developed to help our fight against infectious diseases. In the early 20th century, people ate fewer processed foods, walked more, did more manual labour, lived with fewer labour-saving appliances and gadgets, and spent less time in front of televisions and other screens. According to the latest ABS Australian Health Survey (AHS), in 2011–12 adults spent an average of just over 30 minutes a day doing physical activity. Children and teenagers aged 5–17 spent 1.5 hours a day doing physical activity and more than 2 hours a day in screen-based activity (watching TV, DVDs or playing electronic games). As we are discovering, lifestyle factors such as this can have a profound effect on our health and increase our likelihood of being ill with chronic disease. As well as not getting enough exercise and carrying too much weight, many of us do not eat sufficient fruit and vegetables and some of us smoke tobacco or consume alcohol at risky levels.
In 2011–12, less than half of Australian adults (48.5%) reported that they usually ate the recommended 2 serves of fruit per day and only 8% that they ate the recommended 5 or more serves of vegetables per day.
These self-reported findings were similar to those from the 2007–08 National Health Survey where 9% of people aged 15 and over did not usually consume sufficient serves of vegetables and about half (49%) did not usually consume sufficient serves of fruit (AIHW 2012).
Older Australians (aged 65 and over) in both surveys were more likely to meet the guidelines than younger Australians.
Smoking rates in Australia are still falling, continuing a long-term downtrend trend over the past 50 years. These behaviours put us at an increased risk for a range of chronic diseases, including heart disease, stroke and cancer (see Table 3.3 and Chapter 4 'Chronic disease—Australia's biggest health challenge').


Note: The relationships shown above relate to the causation (development) of the chronic diseases. Today's generation faces emotional, mental and physical stressors that are fuelled by living in a fast-moving, ever-changing world. Stress has been associated with a range of illnesses, from headaches and sleep disorders to autoimmune diseases and heart problems (mindhealthconnect 2012). While a British review of research into the health benefits of work found that, in general, work improved physical and mental health and wellbeing (Waddell & Burton 2006), work stress has been shown to increase the risk of developing mood and anxiety disorders, coronary heart disease and metabolic syndrome, which can be a precursor to type 2 diabetes, stroke and heart disease (Chandola et al. Indigenous Australians experience poorer health and have worse health outcomes than other Australians. The gap in the health of Indigenous and non-Indigenous Australians is best illustrated by differences in life expectancy.
While mortality rates for chronic diseases were much higher for Indigenous Australians (over 5 times the rate of non-Indigenous Australians for diabetes and twice the rate for circulatory diseases in 2007–11), deaths due to circulatory disease fell by 41% and deaths due to respiratory disease fell by 39% from 1997 to 2010 (AIHW 2013a). Typically, chronic conditions are long-lasting, have persistent effects, and can range from conditions such as short- or long-sightedness to debilitating arthritis and low back pain, to life-threatening heart disease and cancers. And while people who control their asthma with medication and a management plan can lead a normal life (National Asthma Council Australia 2013), most people with asthma do not have a written action plan, and poor asthma control (frequent symptoms and asthma exacerbations) is a common problem in both adults and children (ACAM 2011). The burden of chronic conditions extends far beyond personal costs and results in a significant national economic burden.
Although Australians now face the challenges of rises in non-communicable diseases which have a long latency period and are more frequent with ageing (Hetzel 2001), we also have new answers to those challenges.
Cancer is the second leading cause of death in Australia (after cardiovascular disease) but despite a rise in new cases diagnosed, the mortality rate has fallen and people are living longer after diagnosis. Presenting a broad picture of health status to some extent masks that there are clear inequalities in health for many Australians, particularly Indigenous Australians (as described earlier), people living in rural and remote areas, and the socioeconomically disadvantaged. People living outside Australia's major cities have worse outcomes on leading indicators of health and access to care.
It has been suggested that socioeconomic factors have the largest impact on health, accounting for up to 40% of all influences compared with health behaviours (30%), clinical care (20%) and the physical environment (10%) (The British Academy 2014). The World Health Organization's Commission on Social Determinants of Health concluded that social inequalities in health arise because of inequalities in the conditions of daily life and the fundamental drivers that give rise to them: inequities in power, money and resources (Commission on Social Determinants of Health 2008). The WHO describes a 'social gradient in health' which shows that, in general, the lower an individual's socioeconomic position the worse their health. The change in the patterns and causes of illness and deaths in Australia and many other countries has been described as the 'health transition' from a pattern of high mortality from infectious diseases to one of lower overall mortality from non-communicable disease and injury (Hetzel 2001).
It could be argued that we are both healthier and unhealthier in different ways compared with the past, and that we have, perhaps, more control of our health. Emerging technologies such as telehealth enable people to monitor chronic conditions such as diabetes and hypertension in their own homes, with the support of health professionals (see Chapter 2 'Australia's health system').
In comparison with figures given earlier for all Australians, only 39% of Indigenous Australians rated their health as 'excellent' or 'very good', 36% as 'good', 18% as 'fair' and 7% as 'poor' in 2012–13 (ABS 2013a). Detailed information on Australians' health and wellbeing, including on leading causes of ill health and risk factors, is available at the AIHW website. Some factors associated with an increased risk of atopic dermatitis include small family size, higher socioeconomic and educational levels regardless of ethnicity, movement from rural to urban environment, and increased use of antibiotics (the Western lifestyle). Atopic dermatitis is a type I IgE-mediated hypersensitivity reaction, but the exact etiology is unknown.
Patients with atopic dermatitis often have dry, sensitive skin due to changes in the epidermis, which serves as a barrier to the environment by maintaining the water balance of the skin.
Defects in the epidermal barrier also lead to increased susceptibility to atopens (atopic allergens such as house dust mites, grass, or pollen). Defective cell-mediated immunity leads to increased susceptibility to many bacterial, viral, and fungal infections of the skin. Many factors exacerbate or trigger atopic dermatitis, including colonization with Staphylococcus aureus, stress, anxiety, systemic illness, and xerosis. Staphylococci exacerbate atopic dermatitis by two mechanisms: acting as superantigens by stimulating an augmented T cell response, thereby leading to exacerbation of skin disease, and promoting increased production of IgE. The infantile stage is characterized by very pruritic, red, eczematous plaques on the cheeks and extensor extremities. The childhood stage is primarily a papular dermatitis affecting the flexural areas, especially the antecubital and popliteal fossae, wrists, ankles, and neck. Atopic dermatitis can resemble other types of dermatitis (seborrheic dermatitis, allergic contact dermatitis, irritant contact dermatitis) and dermatophytosis.
Most patients with atopic dermatitis require hydration though the liberal use of bland emollients, which serve to hydrate the stratum corneum and maintain the lipid barrier. Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are effective alternatives to the chronic use of topical corticosteroids. The pruritus associated with atopic dermatitis can be severe and often interferes with school, work, and sleep.
Nonsedating antihistamines such as fexofenadine, cetirizine, loratidine, and desloratidine can help offset daytime itching without somnolence. These should be used very cautiously and with close monitoring and should be reserved for the most severe cases. Allergic contact dermatitis from topical medications, cosmetics, or metals should be considered in patients with recalcitrant disease. Atopic dermatitis is a chronic disease with intermittent flares and spontaneous remissions.
With good skin care, moisturization, and the use of topical corticosteroids or topical calcineurin inhibitors, most patients with atopic dermatitis do well. First-line treatment consists of applying bland emollients, limiting soap, and decreasing bath temperature.
Percutaneous sensitization through barrier-disrupted skin elicits a TH2-dominant cytokine response. Report of the Topical Calcineurin Inhibitor Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology. An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. A 55-year-old man with a past medical history of chronic lymphocytic leukemia (CLL) presented to the hospital with a four-month history of fever, chills, night sweats, and fatigue. Two days after receiving IV fluids he reported significant pain, erythema (approximately 12 cm in length), bullous lesions, induration, and edema at the IV infusion site on his left forearm (Figures 1, 2, and 3) with erythematous lymphatic tracking proximally towards his axilla. Progress toward reducing the national prevalence of overweight and obesity is monitored using data from the National Health and Nutrition Examination Survey (NHANES). In NHANES III (1988-1994) there was no significant difference in prevalence between Mexican-American and non-Hispanic white adolescent boys.
Elle est causee par une suppression de l’irrigation sanguine des tissus, entrainant leur necrose (ou mort tissulaire). Les cloques peuvent etre ouvertes ou fermees (l’ouverture se faisant des le moindre traumatisme local). Elle est egalement favorisee par les etats de denutrition et de deshydratation, ainsi que par l’hyperthermie (fievre) et plus generalement pas les etats d’hypovigilance. Quelques heures suffisant a son apparition, les facteurs favorisants doivent etre reduits et regulierement controles[2].
Ces matelas sont formes d’une mousse qui prend la forme du corps pour diminuer la pression en augmentant la surface de contact. Ces matelas sont formes de plusieurs boudins gonfles qui se gonflent et se degonflent pour pouvoir changer les points de pressions et ainsi diminuer le risque d’une hypoxie.
La partie basse doit etre positionnee de cote (les fesses ne doivent pas toucher le lit, l’appui se fait sur la hanche). Il consiste en une mise en decharge locale des points d’appuis, et dans tous les cas des soins locaux attentifs, en prevenant les causes de recidive. Le pansement est choisi selon les caracteristiques de la plaie qui peut etre exsudative, cavitaire ou encore infectee ainsi que le stade de cicatrisation.
Le contenu a ete elabore par des professionnels de la sante du Centre Hospitalier du Nord Mayenne, en collaboration avec des membres du CLIC de Mayenne.
I make lists about things that don’t need to be listed, and every time I leave my apartment, I stock my bag with enough diabetes supplies to manage a small village of people with diabetes. I dread the prospect of getting pregnant with Type 1, and really appreciate your honesty and openness in telling your story. I had a hellish first pregnancy and vowed never to do it again (five years later changed my mind; the second was much easier!) but the nausea of the first pregnancy lasted pretty much the whole time, and it was just awful.
I’m in my second month of being on folic acid and trying to get my blood sugars on track before I start trying. I am 11 weeks, and my morning (all-day) sickness has kicked in so hard I can hardly look at food. But many of these diseases, such as cardiovascular diseases, some cancers, chronic obstructive pulmonary disease and diabetes, are increasing because of changes to our lifestyles. While we're doing better on many fronts, inequalities in health continue to exist for many population groups, including Indigenous Australians where the health gap is narrowing. This information can be derived from a number of sources, including from an individual's perspective via self-reporting, for example, through health surveys, and from health-care providers, for example, via information recorded in health records and on death certificates.
It can be defined as how long, on average, a person can expect to live, based on current death rates at different ages for males and females. Life expectancy changes over a person's lifetime because as a person survives the periods of birth, childhood and adolescence, their chances of reaching older ages increases.
Differences in life expectancy between population groups and geographical regions can indicate underlying health inequalities due to social, environmental or other factors. Exploring changes over time can help us to evaluate the effects of health policies, interventions, and new treatments. Most deaths, however, are the result of more than one contributing disease or condition (see Chapter 3 'Multiple causes of death in Australia'). Causes of death that are likely to be affected by the revisions process are particular external causes of death, such as suicide and land transport accidents. Burden of disease analyses do, however, quantify the effects of diseases and injuries in terms of 'healthy life' lost due to premature death or disability (see Chapter 4 'Burden of disease'). They include the immediate cause, any intervening causes, and conditions which contributed to the death but were not related to the disease or condition causing the death. These are deaths that were not due to external causes such as accidents, injury and poisoning, or due to ill-defined causes. This is particularly evident for chronic and unspecified kidney failure, diabetes, asthma, COPD, and dementia and Alzheimer disease.
Associated refers to deaths with the disease recorded only as an associated cause of death. The report Multiple causes of death in Australia: an analysis of all natural and selected chronic disease causes of death 1997–2007 is also available for free download. Preventable death rates fell by 36% between 1997 and 2010 (from 142 to 91 deaths per 100,000) and rates of deaths from treatable conditions fell by 41% between 1997 and 2010 (from 97 to 57 deaths per 100,000) (see Chapter 9 'Indicators of Australia's health'). For females, the top 5 causes were coronary heart disease, cerebrovascular disease, dementia and Alzheimer disease, lung cancer and breast cancer (see Chapter 3 'Leading causes of death in Australia'). In many parts of the world, diseases that killed our ancestors no longer prove fatal; however, while we have capitalised on medical advances and technological innovations to treat and prevent these diseases, new threats have emerged. When measured against the National Physical Activity Guidelines for adults 'to do at least 30 minutes of moderate intensity physical activity on most days', only 43% met the 'sufficiently active' threshold (ABS 2013c).
There are an estimated 1 million people aged 2 and over with diagnosed diabetes in Australia. Overall, only 5.5% of Australian adults ate the recommended daily intake of both fruit and vegetables (ABS 2013c). In 1964, 43% of Australian adults smoked (OECD 2013), but by 2010 this rate had dropped to 16%.
The rate of people drinking at a level that put them at risk of harm over their lifetime has remained stable since 2001 (see Chapter 5 'Alcohol risk and harm'). They do not to reflect the determinant's role (effect) on management of the chronic disease. Stress can be triggered by a multitude of causes, from running late for an appointment to a life-changing event such as the death of a family member or partner. They have a burden of disease 2–3 times greater than the general Australian population, and are more likely to die at younger ages, experience disability and report their health as fair or poor (see Chapter 7 'How healthy are Indigenous Australians?').
Overall mortality for Indigenous Australians fell by 19% from 1991 to 2011, and Indigenous infant mortality rates fell by 62% from 2001 to 2012 (AIHW 2013a).
However, in the same period, there was a large increase (96%) in incidence rates of treated end-stage renal disease among Indigenous Australians (currently 7 times the rate for non-Indigenous Australians) and Indigenous Australians were twice as likely to be hospitalised for mental and behavioural disorders, and injury and poisoning, as non-Indigenous Australians between July 2010 and June 2012 (see Chapter 7 'How healthy are Indigenous Australians?'). And, as outlined earlier, today many of these acute illnesses have been replaced by chronic, non-communicable illnesses that now cause most of the disease burden—in 2011, 90% of all Australian deaths were caused by a chronic disease (see Chapter 4 'Chronic disease—Australia's biggest health challenge').
Once present, chronic conditions often persist throughout life—which means that although Australians are now living longer, many people live with some type of ill health for many years, with a need for long-term management.
For example, people with asthma rate their health as worse than people without the condition, with most of the impact on their physical functioning and social and work life (ACAM 2011). Estimates based on allocated health care expenditure indicate that the 4 most expensive disease groups are chronic—cardiovascular diseases, oral health, mental disorders, and musculoskeletal—incurring direct health-care costs of $32 billion, or 43% of all allocated health expenditure in 2008–09 (see Chapter 4 'Chronic disease—Australia's biggest health challenge'). Today we have access to an increasingly innovative and sophisticated health system providing care and treatment regimens that were not available in the past. They have higher rates of obesity, smoking and risky alcohol consumption, their rates of potentially preventable hospitalisations are also higher and they are less likely to gain timely access to aged care (COAG Reform Council 2013).
Where people are in the social hierarchy affects the conditions in which they grow, learn, live, work and age, their vulnerability to ill health and the consequences of ill health (WHO 2014). Today there are medications and treatments that were not available to our predecessors—medical technologies such as minimally invasive surgery and devices such as pacemakers and hip replacements offer not just more treatment options, but in some cases treatments that were previously not available at all. Avenues such as online health forums and websites provide better access to health information, making it easier to take more personal responsibility for our own health management. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012–13.
Aboriginal and Torres Strait Islander Health Performance Framework 2012: detailed analyses. Contribution of job control and other risk factors to social variations in coronary heart disease. Mental disorders and their association with perceived work stress: an investigation of the 2010 Canadian Community Health Survey. 1) and hereditary eczema are interchangeable terms for an inflammatory condition of the skin characterized by erythema, pruritus, scaling, lichenification, and papulovesicles. This has led to the hygiene hypothesis, which postulates that infections in early childhood (from less-hygienic practices and older siblings) might prevent atopic dermatitis.
The pathogenesis is multifactorial and involves a complex immunologic cascade, including disruption of the epidermal barrier, IgE dysregulation, defects in the cutaneous cell-mediated immune response, and genetic factors. Essential fatty acids (EFAs), such as linoleic and linolenic acid, are important components of the epidermal barrier.
When such allergens contact atopic skin, they stimulate Th2 lymphocytes to produce cytokines such as IL-4, IL-5, and IL-13, which in turn promote an increase in IgE synthesis.4 atopic dermatitis patients often have high levels of IgE antibodies to house dust mites and other allergens. Children with atopic dermatitis are particularly susceptible to severe, widespread herpes simplex virus infection (eczema herpeticum), a systemic and potentially fatal infection affecting primarily areas of active eczema. Three age-related stages exist: the infantile stage (up to 2 years old), the childhood stage (from 2 to 12 years), and the adult stage (puberty onward).


Affected patients may have had only a few outbreaks since infancy, or they may have had a chronic, relapsing course. The goals of therapy should be to reduce the number and severity of flares and to increase the number of disease-free periods. Sufficient emollients applied liberally several times a day may be enough to significantly reduce the disease activity of atopic dermatitis. Patients can use a low-potency topical steroid (hydrocortisone or desonide) for day-to-day control of mild disease and a medium-potency steroid (triamcinolone acetonide, fluticasone, or fluocinolone) for more severe flares.
Topical calcineurin inhibitors bind calcineurin and block the activation of T cells by cytokines, thus halting the inflammatory cascade that leads to atopic dermatitis. Despite a lack of objective data to support their use, antihistamines are commonly used to break the itch-scratch-itch cycle. Sedating antihistamines such as diphenhydramine or hydroxyzine are often helpful for nighttime pruritus.
Evaluation by an environmental dermatologist and an allergist, including patch, pinprick, and serum radioallergosorbent testing (RAST), may be warranted.
During his admission, a bone marrow biopsy revealed that monoclonal lymphocytes accounted for approximately 75% of bone marrow cellularity. Between 1999-2000 and 2007-2008, there was no significant trend in obesity prevalence for any age group.
Based on current recommendations of expert committees, children with BMI values at or above the 95th percentile of the sex-specific BMI growth charts are categorized as obese. A household interview and a physical examination were conducted for each survey participant. La personne ressent une douleur, des demangeaisons ou un echauffement au niveau de la zone d’appui concernee. Ces matelas sont typiquement formes de plusieurs petits plots qui accompagnent les mouvements du corps pour limiter le cisaillement des tissus.
Croute qui resulte de la mortification d une partie, quelle qu en soit d ailleurs la cause.
So it’s probably no surprise to you that I started to think about getting pregnant a whole year before I wanted to get pregnant. Even though I had tight blood sugar control and no fertility issues, I assumed I’d have trouble getting pregnant. Of course, I couldn’t contain myself forever; I called Gary at work and shouted through the phone, GUESS WHAT? Gary was thrilled and said we’d celebrate that night. I was twelve years old, sitting in my parents’ den, eating graham crackers with Grandma Miriam.
To learn more about Jen and her work see her interview with Jessica Apple, What Diabetes Looks Like: Talking to Artist Jen Jacobs. I once spoke to a high-risk specialist who said that it was no problem being pregnant with Type 1, as long as your blood sugars were under perfect control. I don’t think the nausea was necessarily related to the diabetes, but dealing with both at the same time is really tough. And can we say, with such a diverse population, that we are doing better or worse across the board? Revised and finalised data may reflect higher counts of both suicide and land transport accidents. This compares with a baby boy born in 1998 who could expect to live 58 years free of disability and 17.9 years with some form of disability.
However, this is likely to be an underestimate—for every 4 adults with diagnosed diabetes, there is estimated to be 1 with undiagnosed diabetes (AIHW 2013d) (see Chapter 4 'Diabetes'). Common everyday stressors include job insecurity, financial worries and relationship difficulties.
Detection and treatment have improved markedly in recent years, and national screening programs have been established for breast, bowel and cervical cancer (see Chapter 4 'Cancer in Australia').
The COAG Reform Council report, Healthcare 2011–12: comparing outcomes by remoteness, also found that people living outside major cities were more likely to defer access to dental services and general practitioners due to cost and were more likely to wait longer than 1 year for access to public dental services. About 35% of people aged 75–84 rated their health as 'excellent' or 'very good', and a further 33% as 'good'. Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Atopic dermatitis is a distinct condition in persons who are genetically predisposed to developing immunoglobulin (Ig) E-mediated hypersensitivity reactions.
The basis of this increase in not well understood; however, environmental factors appear to play an important role in disease prevalence.
This hypothesis is supported by evidence that infections induce type-1 helper T cells (Th1), whereas there is a predominance of type-2 helper T cells (Th2) in atopic dermatitis. In atopic dermatitis, Δ-desaturase activity is deficient,6 which leads to decreased linoleic and linolenic acid metabolites. Elimination of these allergens from the environment, an extremely difficult undertaking, can lead to improvement of atopic dermatitis.
Widespread infections with human papillomavirus (warts) and molluscum contagiosum are also common in children with atopic dermatitis. To date, no specific single gene has been identified as a unique marker for atopic dermatitis or atopy.
The hand dermatitis is common and may be the only manifestation of adult atopic dermatitis, which can lead to significant disability. Helpful diagnostic tests include a serum IgE level, serum protein electrophoresis, fungal scraping for potassium hydroxide preparation and culture, and skin biopsy. The mainstay of treatment for atopic dermatitis is hydrating the skin with the regular use of emollients and suppressing cutaneous inflammation with topical corticosteroids. Parents of infants and toddlers should apply a bland emollient to the entire body with each diaper change.
Low-potency topical steroids are suitable for infants and for intertriginous and sensitive areas (face, genitals); more potent steroids should be avoided on these sites. Topical calcineurin inhibitors are especially suitable for more delicate areas such as the face and genitals because they do not carry the risks of atrophy, telangectasias, and striae associated with the chronic use of steroids. Topical medications that are known sensitizers, such as lidocaine, doxepin cream, and diphenhydramine cream, as well as topical antibiotics such as neomycin, should be strictly avoided.
More than 75% of children with atopic dermatitis also have asthma or allergic rhinitis. He received his first chemotherapy cycle of bendamustine, rituximab, and pegfilgrastim as an inpatient and was discharged home three days later. This is different from previous years where children above this cutoff were labeled overweight.
During the physical examination, conducted in a mobile examination center, height and weight were measured as part of a more comprehensive set of body measurements. Placer un coussin derriere la nuque, derriere le dos, sous les mollets et entre les jambes permet de repartir les pressions. In preparation, I began to use an insulin pump, got my A1C under 6%, and started to take prenatal vitamins.
As Grandma watched me draw my insulin shot, she casually mentioned that pregnancy cured diabetes. So in order to keep my A1C  in the fives, I’ve been testing fifteen times a day because that’s what the combination of pregnancy and type 1 diabetes demands. I could hardly eat or drink, which caused low blood sugar, weight loss, dehydration, and dizziness. I used to be the low carb queen, like, one cup of lettuce equals 6 carbs, and yes, you had better count that. I got gestational diabetes during my first pregnancy and then it turned out to be type 1, and took insulin during both pregnancies.
In 2001, about one-quarter of 18- to 24-year-olds smoked daily—by 2010, this had fallen to 16% (see Chapter 5 'Tobacco smoking'). Babies born to Indigenous mothers are more likely to be of low birthweight than babies born to non-Indigenous mothers and Indigenous children die at more than twice the rate of non-Indigenous children.
So, while more people are being diagnosed with cancer, more people are surviving due to early detection (which is associated with more successful treatment, generally) and better treatment technology and delivery. About 30% of those aged 85 and over rated their health as 'excellent' or 'very good' and 32% as 'good' (ABS 2013c).
It is characterized by the itch-scratch cycle: Affected persons have the sensation of itch, followed by scratching and the subsequent creation of a rash.
Th1 responses antagonize the development of Th2 cells, thereby potentially decreasing the incidence of atopic dermatitis. Loss of EFAs results in increased transepidermal water loss and subsequent xerosis (dryness). Like affected children, adults also commonly have lichenification of the flexures and facial dermatitis.
Reports have surfaced suggesting a possible risk of lymphoma associated with high-dose oral pimecrolimus in animal studies,9 prompting the FDA to put out a black box warning advising against the use of topical calcineurin inhibitors in children younger than 2 years. For open wounds, a topical antibiotic such as mupirocin can help to prevent secondary impetiginization (Figs. Allergic contact dermatitis to topical steroids should be considered in any patient who fails to improve or worsens with the use of topical steroids. He followed up with his oncologist as an outpatient and during the next week received pegfilgrastim for chemotherapy-induced neutropenia and IV fluids for dehydration. Treatment was initiated with IV vancomycin and IV piperacillin-tazobactam and blood cultures were drawn. This change in terminology reflects the labels used by organizations such as the Institute of Medicine and the American Academy of Pediatrics. These measurements were taken by trained health technicians, using standardized measuring procedures and equipment. Cliniquement, ce stade se manifeste par un cratere, avec ou sans atteinte des tissus environnants.
There was talk in my doctor’s office of admitting me to the hospital because of dehydration, but my mother assured them that I’d get more fluids.
You’ll have an easy pregnancy and a healthy baby if you somehow manage to not be diabetic. Between 2008 and 2012, 203 out of 100,000 Indigenous children aged 0–4 died compared with 91 out of 100,000 non-Indigenous children.
The EFAs form the substrate of the inflammatory mediators (prostaglandins and leukotrienes), resulting in a secondary deficiency of prostaglandin E1 (PGE1). Treatment with topical or oral antistaphylococcal antibiotics (or both) decreases the colonization of the skin and often leads to improvement of the dermatitis.
Hypopigmentation and hyperpigmentation can occur, which can cause great anxiety in parents.
For severe disease, especially during acute flares, systemic corticosteroids may be necessary. However, there are no data to support an increased risk of lymphoma with topical treatment in humans.9 Topical calcineurin inhibitors should be used for a limited time and only on affected skin. Observations for persons missing a valid height or weight measurement or for pregnant females were not included in the data analysis. Les differentes positions presentees ne dispensent pas de la mobilisation, qui est primordiale.
For the next few weeks, I sipped electrolyte enhanced water, and munched on toddler portions of cheerios that I counted out in a plastic measuring cup.
Instead I prefer to eat things like peanut butter crackers and chocolate covered rice cakes. Indigenous adults of all ages also died at a higher rate than non-Indigenous Australians (AIHW 2013a; SCRGSP forthcoming) (see Chapter 7 'Indigenous life expectancy and death rates'). A wide range of environmental factors, such as contact allergens, stress, food, skin flora, and humidity, play roles in the development and severity of atopic dermatitis. Pityriasis alba, characterized by hypopigmented, scaly patches on the face, is commonly seen. Soap, which dries and irritates the skin, should be avoided, but gentle lipid-free cleansers are beneficial.
The interesting part is that my blood sugars are holding up to the snacky foods I used to avoid.
Keratosis pilaris, or spiny hair follicles, commonly affect the posterior aspects of the upper arms and the anterior thighs.
CT scan and MRI results also were consistent with cellulitis with no evidence of an abscess or osteomyelitis.The patient’s pain, erythema, and edema continued to worsen despite 72 hours of treatment with broad spectrum IV antibiotics. In severe, recalcitrant cases, phototherapy or systemic immunosuppressive medications may be necessary. The possibility of Sweet syndrome or pemphigoid was considered so a punch biopsy of the bullae was obtained and sent to pathology for analysis. I don’t always detect my lows in the 70s or 60s; I feel them when I’m in the 30s or 20s and am about to pass out. The preliminary pathology report revealed a mixed, predominantly neutrophilic, perivascular infiltrate obliterating vessel walls, leukocytoclasis, erythrocyte extravasation, and overlying epidermal necrosis.
Although this cutpoint is not diagnostic, elevated BMI among children indicates increased risk for future adverse health outcomes or development of disease. The histologic findings supported a diagnosis of late stage cutaneous leukocytoclastic vasculitis (LCV). Antibiotics were discontinued and the patient was immediately started on IV methylprednisolone sodium succinate. Within 24 hours a significant decrease in erythema and edema was clearly visible and the patients’ pain was markedly improved. The condition may be secondary to medications, bacterial infection, collagen-vascular disorders, or an underlying malignancy. Approximately half of all cases, however, are idiopathic with no identifiable etiology.2 The incidence of LCV is presumed to be quite low.
It is mostly an acute phase reaction but approximately 10% of patients will have chronic or recurrent disease.
In the absence of internal organ involvement, the prognosis is excellent, with most cases resolving within several weeks.Diagnosis. If exposure to a new drug is the likely etiology then a biopsy may not be necessary, as long as the lesions resolve within a few weeks. Stopping a drug suspected of causing LCV can result in rapid clearing of the inflammatory process.4 Common first-line treatments for cutaneous LCV are colchicine and dapsone.
A combination of these agents can also be utilized when one or the other alone is insufficient. Corticosteroids are strongly recommended, especially with bullous type lesions, in order to prevent cutaneous ulcerations and scarring. A course of an immunosuppressive agent also should be considered for refractory or severe disease (eg, cyclophosphamide, azathioprine, methotrexate, mycophenolate, mofetil, or rituximab).5Take-home Points Cutaneous LCV should be considered as a differential diagnosis when cutaneous manifestations present after a new drug is administered or in the case of an underlying malignancy.



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