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https://www.youtube.com/watch?v=nAqTKctKV8c

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https://www.nhs.uk/conditions/nhs-screening/

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Screening is a way of finding out if people have a higher chance of having a health problem, so that early treatment can be offered or information given to help them make informed decisions.
This page gives an overview of screening, with links to the different types of screening offered by the NHS in England.

What is screening?

Screening is a way of identifying apparently healthy people who may have an increased risk of a particular condition. The NHS offers a range of screening tests to different sections of the population.

The aim is to offer screening to the people who are most likely to benefit from it. For example, some screening tests are only offered to newborn babies, while others such as breast screening and abdominal aortic aneurysm screening are only offered to older people.

Screening results

If you get a normal result (a screen negative result) after a screening test, this means you are at low risk of having the condition you were screened for. This does not mean you will never develop the condition in the future, just that you are low risk at the moment.

If you have a higher-risk result (a screen positive result), it means you may have the condition that you've been tested for. At this point, you will be offered further tests (called diagnostic tests) to confirm if you have the condition. You can then be offered treatment, advice and support.

Finding out about a problem early can mean that treatment is more effective. However, screening tests are not perfect and they can lead to difficult decisions about having further tests or treatment.

Read on to find out about the benefits, risks and limitations of screening.

What types of screening are offered by the NHS in England?

An independent expert group called the UK National Screening Committee (UK NSC) advises the NHS, in all 4 UK countries, on which screening programmes to offer.

The NHS screening programmes currently offered in England are listed below. For more detailed information on each type of screening, follow the links.

You can view screening timelines.

You can also watch animations about NHS screening:

Screening in pregnancy

The screening tests offered in pregnancy are:

Screening for newborn babies

Newborn babies are offered:

Diabetic eye screening

From the age of 12, all people with diabetes are offered an annual diabetic eye test to check for early signs of diabetic retinopathy.

Cervical screening

Cervical screening is offered to all women and people with a cervix aged 25 to 64 to check the health of cells in the cervix. It is offered every 3 years for those aged 25 to 49, and every 5 years from the ages of 50 to 64.

Breast screening

Breast screening is offered to women aged 50 to 70 to detect early signs of breast cancer. Women over 70 can self-refer.

Bowel cancer screening

Everyone aged 60 to 74 is offered a bowel cancer screening home test kit every 2 years.

If you're 75 or over, you can ask for a kit every 2 years by phoning the free bowel cancer screening helpline on 0800 707 60 60.

Abdominal aortic aneurysm (AAA) screening

AAA screening is offered to men during the screening year (1 April to 31 March) that they turn 65 to detect abdominal aortic aneurysms (a dangerous swelling in the aorta). Men over 65 can self-refer.

Benefits, risks and limitations of screening

Making an informed choice

Before having any screening test, it's worth finding out about the test itself and what would happen next if you found out you have a higher risk of a particular condition.

Deciding whether or not to have a screening test is a personal choice and one which only you can make. When you are invited for screening, you will receive an information leaflet about the screening test.

You can discuss any aspect of the screening test with your health professional and decide whether or not it's right for you.

Different types of screening have different benefits and risks. Some of these are listed below.

The benefits of having a screening test include:

Screening can detect a problem early, before you have any symptoms.

Finding out about a problem early can mean that treatment is more effective.

Finding out you have a health problem or an increased chance of a health problem can help people make better informed decisions about their health.

Screening can reduce the chance of developing a condition or its complications.

Some deaths from abdominal aortic aneurysms, bowel cancer, breast cancer and cervical cancer can be prevented.

The risks and limitations of screening include:

Screening tests are not 100% accurate. You could be told you have a problem when you do not - this is called a "false positive" and may lead to some people having unnecessary further tests or treatment as a result of screening. A screening test could also miss a problem - this is called a "false negative" and could lead to people ignoring symptoms in the future.

Some screening tests can lead to difficult decisions. For example, if a pregnancy screening test tells you your baby has a higher chance of having a particular condition, you may then be faced with a decision about having further diagnostic tests that involve a risk to your pregnancy. If the diagnostic test is positive, you may then need to decide whether to continue with your pregnancy.

Finding out you may have a health problem can cause considerable anxiety.

Even if your screening test result is normal or negative (meaning you are not at high risk), you could still go on to develop the condition.

How does the NHS decide which types of screening to offer?

An expert group called the UK National Screening Committee ( UK NSC) advises the NHS on which screening programmes to offer.

When considering who to screen and which conditions to screen for, the benefits of offering a screening programme are weighed up against the harms. The UK NSC only recommends screening when it believes the benefits to the group offered screening outweigh the harms.

The UK NSC regularly reviews its recommendations on screening for different conditions as new research becomes available. This is usually done every 3 years.

Find out how the UK NSC reviews evidence and monitors the quality of screening programmes.

Private screening

All screening tests provided by the NHS are free. Private companies offer a range of screening tests that you have to pay for. Some of the tests on offer are not recommended by the UK NSC because it is not clear that the benefits outweigh the harms.

The UK NSC has produced a downloadable leaflet on private screening.

Confidentiality and use of data

By law, everyone working in, or on behalf of, the NHS must respect your privacy and keep all information about you safe. The NHS Constitution sets out how the NHS should handle your records to protect your privacy. There are also laws in place to ensure that confidentiality is maintained.

Screening records are only shared with staff who need to see them, such as technicians carrying out screening, your GP and any clinicians involved in follow-up tests and treatment. They are also shared with the Government who uses them to check that local screening services are safe and effective. Screening records are sometimes also shared with researchers looking at how to improve the screening programmes.

Read more about screening data and confidentiality.

Further information about screening

Questions about screening results

For pregnancy or baby screening results, contact your midwife or health visitor.

For abdominal aortic aneurism or diabetic eye screening, contact a GP or your local screening programme.

For breast screening, cervical screening or bowel cancer screening, contact a GP, who should receive a copy of your results. You can also contact your local breast screening unit, or call the bowel cancer screening helpline on 0800 707 6060.

Questions about symptoms

Speak to a GP if you have any concerns about your health or need to ask about a family history of cancer.

Questions about screening practice and policy (England only)

Contact the national screening helpdesk using the online enquiry form, or email PHE.screeninghelpdesk@nhs.net

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Screening is a way of finding out if people have a higher chance of having a health problem, so that early treatment can be offered or information given to help them make informed decisions. This page gives an overview of screening, with links to the different types of screening offered by the NHS in England.

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https://www.youtube.com/watch?v=ZQwOvNe9-Yo

Great video on dengue fever

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Dengue Fever | Pathophysiology, Symptoms, Diagnosis & Treatment

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https://www.who.int/images/default-source/health-and-climate-change/risk-pathways-climate-health.jpg?Status=Master&sfvrsn=3ba050b0_5

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A 35 year old woman is worried about her health risks due to her family member being recently diagnosed with a disease, which screening programs would she be invited to be apart of?
-bowel cancer screen
-cervical cancer screen every 3 years
cervical cancer screen every 5 years
-breast cancer screen

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Four surprising ways climate change is affecting people’s health in England and Wales - Climate To

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10 ways climate change is affecting your health | LSHTM

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LSHTM scientists are researching solutions for a healthy future in the face of a changing climate.

For years, researchers have been warning that as well as a threat to the environment, climate change is also a very real threat to human health. Soaring temperatures, rising sea levels and an increase in the number and intensity of extreme weather events such as storms and floods will have a huge impact on the health of everyone around the world.

Some of the poorest parts of the planet and those who have done least to contribute to the climate crisis have been feeling the force of this for some years now. But the richest are also starting to wake up, says Sir Andy Haines, professor in environmental change and public health at the London School of Hygiene and Tropical Medicine (LSHTM).

He points to the devastating wildfires in California this summer as a sign of how climate change is no longer a "distant threat" to people in richer countries and one which he hopes will galvanise more people into action.

"Climate change has always been framed as an environmental issue and it's always difficult to get traction on that but researchers have been conceptualising it as a health issue and we hope people will start to take notice," he says.

UK researchers are leading the world in coming up with both mitigation strategies - limiting warming - and adaptation, working out how to live with changing weather patterns. By doing both there will be huge benefits to health.

"We need to mitigate - so we need to cut emissions. But we also need to adapt to create more resilient societies," says Prof Haines.

But what can we do to push forward on it? Here are 10 ways that climate change will affect health, and how LSHTM researchers are tackling these monumental challenges.

1. Too hot to handle

Extreme heat is perhaps the most obvious sign of a warming planet - but as well as the environmental effects of droughts and parched land, high temperatures can be extremely harmful to human health.

Quantifying this invisible killer is paramount. Research carried out by Antonio Gasparrini, professor of biostatistics and epidemiology at LSHTM, showed that by the end of this century all regions of the world will see deaths associated with extreme heat, with the poorest regions affected more than others.

The research showed that for every projected 1°C increase in temperature there will be an additional 0.05 per cent risk of mortality. And by 2099, excess deaths related to extreme heat will increase in all countries or regions by 1.4 to 10.3%.

Temperature increases are likely to be greatest in sub Saharan Africa where people will also find it harder to mitigate the effects of extreme heat against existing or growing health challenges. An 11-year study in Burkina Faso found that exposure to moderate or extreme heat significantly increased premature mortality from non communicable diseases. Even the UK will be affected. Research carried out by LSHTM and Public Health England estimated that by 2050 the number of deaths associated with heat will rise by about 250 per cent.

Extreme heat is particularly harmful to older people who are more likely to have other conditions, such as cardiovascular or respiratory disease, that make them vulnerable. Pregnant women are also at risk - a recent analysis by LSHTM and other researchers compared daily temperatures to birth rates in the United States and found there were more births on days of extreme heat and the following day. The researchers estimated that an average of 25,000 infants per year were born earlier as a result of increased exposure to hot weather.

But while limiting temperature rise itself is of course important there are steps we can take to lower temperatures, particularly in cities which generate a 'heat island effect'. From planting more trees to painting roofs and covering roads in heat-reflecting rather than absorbing materials, experts are coming up with innovative ways to turn down the heat. The UK Climacare study, led by a coalition of UK researchers, is looking into how extreme heat affects care facilities and finding ways to mitigate it.

2. Fires, floods, and storms

Thousands of people are killed and injured every year in disasters such as floods, storms and wildfires linked to climate change - with the effects being both short and long term. These events are devastating both in human and economic terms - in 2018, 831 extreme weather events resulted in US$166 billion in economic losses. Some 30 people were killed during the bushfires that swept through Australia in the 2019 to 2020 summer. And a further 445 deaths were linked to smoke inhalation and more than 4,000 people were admitted to hospital.

In Pakistan in 2010 more than 15 million people were affected by flooding, with around six million people needing medical care. And heavy rains have other, longer-term consequences: standing water caused by heavy rainfall or overflow of rivers act as breeding sites for mosquitoes, which carry diseases such dengue, malaria and West Nile fever.

In 2019 Cyclone Idai hit Mozambique just as people were about to harvest their crops, meaning they were left without food and many lost their livelihoods. The land was contaminated by seawater for months, making it harder for many to rebuild their lives.

Building resilience among communities that are vulnerable to climate change is vital.

3. Enough healthy food for all

Climate change and changing weather patterns are affecting the food we grow by reducing both crop yields and quality. A study by researchers at the University of Minnesota found that climate change is reducing global rice yields by 0.3% and wheat yields by 0.9% on average each year, with people in the developing world most vulnerable.

But richer nations are becoming increasingly reliant on exotic fruit and vegetables from climate vulnerable countries. A study led by Dr Pauline Scheelbeek from LSHTM found that domestic production of fruit and vegetables in the UK dropped from 42% in 1987 to 22% in 2013. At the same time the proportion imported from climate-vulnerable countries increased from 20% to 32%. People in the UK may have to revert to more sustainable food sources - like ditching bananas that have been flown halfway round the world to home-grown apples in autumn.

But while eating more sustainably is important researchers are working on developing supercrops that are both resistant to extreme weather and have been fortified with minerals and vitamins. For example, the UK government has funded development into 'scuba rice' which can survive being completely submerged in water, so heavy rains and flooding wouldn't affect output

Food production is also linked to climate change - the global food system is thought to produce about 20 to 30 per cent of all carbon emissions. The Sustainable and Healthy Food Systems research team (SHEFS) at the LSHTM is carrying out essential research to help governments design systems that deliver healthy, nutritious food but in a sustainable and equitable way.

4. Spreading disease

While the number of deaths from malaria has fallen sharply over the last decade, this mosquito-transmitted disease still kills nearly half a million people every year, the majority of whom are children under five in sub Saharan Africa.

Recent research from the World Health Organization shows that changing weather patterns linked to climate change mean there will be at least 60,000 more deaths from malaria between 2030 and 2050 as hotter climates are more favourable environments for mosquitoes. Mosquito-transmitted viruses such as dengue, chikungunya and Zika, are also becoming more common. Dengue virus - which causes excruciating muscle and joint pain - has exploded across the world in recent years. In 1970, just nine countries around the world saw outbreaks of the disease compared to more than 100 today, including southern Europe.

Many of the control efforts used to battle the malaria mosquito such as insecticides, treated bed nets and preventive treatments have been pioneered by UK researchers, particularly at the LSHTM. But as dengue becomes increasingly prevalent and a burden on societies more sophisticated techniques are being developed. LSHTM researchers such as Dr Rachel Lowe are working on an early warning system that uses seasonal climate forecasts to predict dengue outbreaks up to seven months in advance.

5. A lot on our minds

There is growing evidence of the link between mental health and climate change - countries hit by climate-related disasters such as floods or droughts linked to changing weather patterns are likely to see an increase in the number of people suffering mental health conditions such as depression and anxiety.

Researchers are still trying to understand the link between high temperatures and mental health. Work by Antonio Gasparrini shows there may be a temperature range where suicide is more common. Researchers such as Elaine Flores, who recently completed her PhD at LSHTM looking at the mental health outcomes relating and resilience strategies associated with El Niño Southern Oscillation (ENSO) in Peru, are becoming increasingly interested in promoting resilience in communities that are particularly vulnerable to climate change.

Dr Sari Kovats at LSHTM led a study of people whose homes had been flooded in England and found that those who did not have insurance were more likely to report depression or anxiety.

There is also growing recognition of 'eco-anxiety', with younger people thought to be particularly at risk. People describe despair, and guilt associated with the climate crisis and other global environmental issues and a feeling of helplessness. Researchers in the UK are looking into whether climate activism can mitigate eco-anxiety.

6. Water for life

From rising sea levels and temperatures to an increase in frequency of droughts and floods, the water we drink and use to grow our food is likely to be affected both in terms of both quantity and quality. Warmer water temperatures can encourage the growth of harmful algal blooms that poison marine and aquatic life, risking an increase in gastro-intestinal diseases as well as a loss to the livelihoods of those who rely on fishing as a source of income.

Rivers that have burst their banks and overflowing sewage systems can lead to outbreaks of waterborne diseases such as cholera, typhoid and dysentery - a particular risk for those who are displaced, living in crowded conditions or are one of the one in three people globally who do not have access to clean water and sanitation.

The Bill and Melinda Gates Foundation have long been interested in developing an alternative to the standard plumbed-in sanitation system and have challenged designers to come up with innovative solutions. Alternatives have included a toilet that runs on solar energy and another that recycles waste into electricity.

7. Lives and livelihoods

In 2018, 133.6 billion hours of labour were lost because of heat alone, 45 billion more than in 2000. Research led by Professor Andy Haines from LSHTM shows that for many people living in the hottest parts of the world - central and west Africa and south and south east Asia - working will be near on impossible during the hottest months of the year. An average temperature increase of around 2.5°C will affect up to one billion people, the research shows, with people living on the lowest incomes the worst affected.

People in the poorest countries will be unlikely to work in an environment where they will be able escape the heat or where there will be any cooling - for example if they work as farmers or labourers - so they will either have to stop working during the hottest months or risk the consequences of extreme heat.

8. Forced migration

An increase in poverty and a fight for scarce resources is likely to see an increase in migration. However, most of this movement is likely to be within countries - a move from the country to the city, for example. In Bangladesh, for example, millions of people have moved to the cities in recent years because of an increase in floods.

There are many ways that changes in climate can force people to leave their homes. An extreme weather event such as a storm or flood may wipe out a family's home and crops, forcing them to start their life elsewhere. A decrease in rainfall over many years may make the land increasingly infertile. And a reduction in crop yield may make farming no longer tenable. Increasing people's resilience to climate-related shocks is paramount - planting drought or flood-proof crops or ensuring people have adequate insurance.

9. Countries in conflict

According to the International Committee of the Red Cross, 20 of the countries which are most vulnerable to climate change are also mired in conflict - Yemen, Mali, Afghanistan, and the Democratic Republic of Congo.

The conflicts are not necessarily linked to changing weather patterns but these countries are among the most vulnerable to the climate crisis and have been the most neglected by any kind of action to mitigate or adapt to changing weather patterns. The ICRC highlights an example from Mali, where social unrest coupled with a lack of grazing land due to floods has led to problems for farmers. Nomadic farmers were worried about travelling with their livestock as they were worried about being attacked by armed groups. So they gathered in areas close to water sources, creating tensions with settled farmers and fishermen.

The ICRC warns that by 2050, 200 million people living in these countries may need humanitarian aid - double the number now.

10. The air we breathe

According to the WHO, air pollution is linked to about 4.2 million deaths a year due to stroke, heart disease, lung cancer and chronic respiratory diseases. A recent estimate suggests that about 3.6 million premature deaths annually can be attributed to outdoor air pollution from burning fossil fuels. Fine particles can get deep into the lungs leading to inflammation, carbon monoxide can reduce the oxygen in the blood and gases such as nitrogen can irritate the respiratory system. LSHTM's Prof Paul Wilkinson has undertaken research showing that the closer homes are to greenspaces, the less air pollution is found indoors.

Tackling indoor and outdoor pollution from transport, heat and power generation and outdated cooking sources such as wood-burning stoves - and transitioning to renewables - is an example of a double duty effect. If this objective is achieved by decarbonising the economy, not only will this lead to a reduction in the greenhouse gas emissions and tackle climate change this will also clean up the air we breathe.

Research by Prof Haines highlighted some triple duty effects - cutting air pollution will improve health as well as cutting down on emissions but will also bring other positives.

An increase in walking and cycling will benefit physical and mental health. And a reduction in the consumption of meat in high income countries will free up land and improve physical health, particularly if accompanied by increases in consumption of fruit, vegetable and nut and seeds.

"Systemic change is what is needed," says Prof Haines, pointing out that tackling problems individually can lead to unintended consequences. For example, insulating houses to make them more energy efficient can also lead to an increase in indoor air pollution.

Prof Haines is neither optimistic nor pessimistic about the task ahead - researchers around the world are working hard to provide evidence of the scale of the threat. Climate change is potentially catastrophic for human health. We must adapt to change where we can, and prevent changes that we can't adapt to. Then we can reap the health benefits of a zero carbon economy as well as reduce the risks from dangerous climate change.

As Prof Haines urgently notes, "We must keep pushing forward as fast as we can against the very big barriers that are in front of us."
This article is part of the Decade of Health campaign from organisations across the UK - including LSHTM - who are working to make the world healthier and safer through innovation and collaboration. Check out decadeofhealth.co.uk and find out more about how research institutes are bringing together the world's greatest scientific minds to develop solutions to health challenges such as climate change, antimicrobial resistance and COVID-19.
Listen to more LSHTM Viral podcasts.

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10 ways climate change is affecting your health | LSHTM

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For years, researchers have been warning that as well as a threat to the environment, climate change is also a very real threat to human health. Soaring temperatures, rising sea levels and an increase in the number and intensity of extreme weather events such as storms and floods will have a huge impact on the health of everyone around the world.

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8 Environmental Factors that Affect Health - Regis College Online

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8 Environmental Factors that Affect Health | Regis College Online

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Environmental factors that affect health include air, water, and chemical pollution; climate change; microbial disease; health care access; and infrastructure.

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I used the sofia textbook and the lecture

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I used the lecture

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https://www.youtube.com/watch?v=lh_vcrQiSm8

https://www.who.int/news-room/fact-sheets/detail/malaria

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https://s3.us-west-2.amazonaws.com/secure.notion-static.com/e9c4e081-1a29-4a7e-b76f-14fbe3b5f908/Climate_change_Infographic.png_.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIAT73L2G45EIPT3X45%2F20220317%2Fus-west-2%2Fs3%2Faws4_request&X-Amz-Date=20220317T170813Z&X-Amz-Expires=86400&X-Amz-Signature=f9759d8a6a1d47db6c3b0ddea3b30a54a18ed1710ed8892006e152ac79a77360&X-Amz-SignedHeaders=host&response-content-disposition=filename%20%3D%22Climate%2520change%2520Infographic.png%2520.pdf%22&x-id=GetObject

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The main determinants of health gaph : https://www.researchgate.net/profile/Jude-Stansfield/publication/267196673/figure/fig1/AS:406846415360000@1474011152406/Social-and-economic-determinants-of-health.png

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https://www.youtube.com/watch?v=7VtRlPFMZ5c

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What Happens When Someone Gets Dengue Fever?

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https://www.cdc.gov/malaria/about/distribution.html

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Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas, where

Temperature is particularly critical. For example, at temperatures below 20°C (68°F), Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in the Anopheles mosquito, and thus cannot be transmitted.

This map shows an approximation of the parts of the world where malaria transmission occurs.

In many malaria-endemic countries, malaria transmission does not occur in all parts of the country. Even within tropical and subtropical areas, transmission will not occur

At very high altitudes;

During colder seasons in some areas;

In deserts (excluding the oases); and

In some countries where transmission has been interrupted through successful control/elimination programs.

Generally, in warmer regions closer to the equator

Transmission will be more intense, and

Malaria is transmitted year-round.

The highest transmission is found in Africa South of the Sahara and in parts of Oceania such as Papua New Guinea.

In cooler regions, transmission will be less intense and more seasonal. There, P. vivax might be more prevalent because it is more tolerant of lower ambient temperatures.

In many temperate areas, such as western Europe and the United States, economic development and public health measures have succeeded in eliminating malaria. However, most of these areas have Anopheles mosquitoes that can transmit malaria, and reintroduction of the disease is a constant risk.

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Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas, where Temperature is particularly critical. For example, at temperatures below 20°C (68°F), Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in the Anopheles mosquito, and thus cannot be transmitted.

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https://www.mmv.org/

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Medicines for Malaria Venture | Developing antimalarials to save lives

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were shipped to countries in West Africa's Sahel region in 2016, by MMV's partner Guilin Pharmaceutical, enough to provide 18 million children with Seasonal Malaria Chemoprevention

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this is one of many different definitions out there, taken from the public health lecture-
'health inequalities are UNJUST and AVOIDABLE differences in people's health across the population and between specific groups'
(I've uploaded it simply for a quick reference)

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Inequality and Health - Inequality.org
I think this website is very comprehensive and covers all topics that link to inequality (as a general topic) it gives some nice visual aid like graphs etc.
this resource can be used as an aid to multiple LOs

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How do inequality and health relate? Increasing evidence from scientists the world over indicates that many health outcomes - everything from life expectancy to infant mortality and obesity - can be linked to the level of economic inequality within a given population. Greater economic inequality appears to lead to worse health outcomes.

By greater inequality, epidemiologists - the scientists who study the health of populations - don't just mean poverty. Poor health and poverty do go hand-in-hand. But high levels of inequality, the epidemiological research shows, negatively affect the health of even the affluent, mainly because, researchers contend, inequality reduces social cohesion, a dynamic that leads to more stress, fear, and insecurity for everyone.

Covid-19 and Health Inequalities

The vaccine rollout around the globe has been rife with inequality. In late November, the number of vaccine doses administered per 100 people was more than 18 times higher in high-income than low-income countries, according to data from the WHO and the World Bank. The costs of this greed-driven global vaccine gap became painfully clear when the Omicron variant discovered in South Africa quickly spread across borders.

According to the APM Research Lab, Black Americans have mortality rates that are significantly higher than all other race and ethnic groups except for Indigenous people. For each 100,000 Americans (of their respective group), about 256 Indigenous people and 179 Black people, 176 Pacific Islanders and 147 Latinx people have died from the coronavirus, compared to 150 Whites and 96 Asians, as of March 2, 2021.

People of color are more likely to suffer severe illness if they are infected with Covid-19. As of November 20, 2021, Center for Disease Control and Prevention data shows that hospitalization rates for Indigenous, Black, and Hispanic and Latinx people are significantly higher than for Whites and Asians, regardless of their age. Per 100,000 people, around 1500 Indigenous people, 1106 Black people, and 891 Latinx people have had Covid-19 symptoms serious enough to require hospitalization, compared to 368 Asian people and 577 Whites.

The racial disparities in Covid-related health indicators have contributed to a larger decline in U.S. life expectancy for people of color, according to data from the National Center for Health Statistics. In 2020, life expectancy dropped for all races, but most sharply for Latinx and Black people. It dropped by 1.2 years to 77.6 for Whites, by 3.0 years to 78.8 for Latinx, and by 2.9 to 71.8 for Black people.

Transgender people are always in a precarious position, but the Covid-19 pandemic has made them particularly vulnerable. According to research from the Williams Institute at UCLA, transgender Americans are at a higher risk for Covid-19 for several reasons. They are more likely to be low-income, with 47.7 percent of transgender people living below 200 percent of the official U.S. poverty line, compared to 28.9 percent of the general U.S. population. They are also significantly more likely to suffer from asthma and HIV, conditions that put people at higher risk of mortality if they contract Covid-19. And they experience high barriers to receiving health care.

Cross-National Comparisons

Economists and health experts have known for years that people who live in poorer societies live shorter lives. But research also points to an additional factor in explaining life expectancy: a society's level of inequality. People live longer, according to World Health Organization and World Bank data, in nations with lower levels of inequality. The Gini coefficient, a standard global benchmark, is used here to measure inequality. In the United States, average life expectancy is four years shorter than in some of the most equitable countries.

A study published in the Journal of the American College of Cardiology in 2019 found that the higher the level of income inequality, the higher the rate of cardiovascular-related deaths and hospitalizations. Based on surveys from 2009 to 2015, participating countries with the lowest levels of income inequality (Central Europe and Scandinavian countries), had the lowest heart failure rate, at 10.9 per 100 person-years. Countries with intermediate income inequality levels (North America, Australia, and India) had a rate of 11.7 per 100 person-years, while those with the highest level of inequality had the highest rates of heart failure, at 13.7 per 100 person-years.

In 2017, nations with the smallest income gaps between households at the 90th and 10th percentiles as calculated by the OECD had significantly fewer infant deaths, according to WHO data, than other nations. A household at the 90th percentile has more income than 90 percent of households. The United States is at the extreme end among other industrialized countries, with the largest gap between the rich and the rest of the population and by far the worst infant mortality rate, at 5.7 per 1,000 live births, compared to just 1.6 per 1,000 in Iceland.

Extreme inequality appears to affect how people perceive their well-being. In nations where the top 1 percent hold a greater share of national income, people tend to have a lower sense of personal well-being, according to University of Oxford Saïd Business School research. Researchers are also finding links between inequality and mental health. Countries with larger rich-poor gaps have a higher risk of schizophrenia incidences. In general, a 0.2 point increase in a country's Gini coefficient results in eight additional incidences of schizophrenia per 100,000 people. Researchers believe that higher inequality undercuts social cohesion and capital and increases chronic stress.

Inequality and Health in the United States

The same association between high economic inequality and poor health can be observed within the United States.

Advocates for raising the retirement age for collecting Social Security benefits often base their argument on rising U.S. life expectancy. But a landmark study published in 2016 by the Journal of the American Medical Association found that low-income Americans - those who depend most on Social Security - have not been part of this positive trend. The divergence is most stark among men. In 2014, those in the top 5 percent of household income could expect to celebrate their 88th birthday, an increase of three years since 2001. For those in the bottom 5 percent, life expectancy has essentially flatlined at around 76 years.

The life expectancy divide is widest among the very richest and poorest in U.S. society, according to that same JAMA study. Men in the top 1 percent of the income distribution can now expect to live 15 years longer than those in the bottom 1 percent. For women, the difference is about 10 years - an effect equivalent to that of a lifetime of smoking.

Within the United States, people live longer in the more equal states, as calculated by the Journal of the American Medical Association. In Hawaii, which has relatively equitable income distribution according to Census Bureau Gini coefficients, people can expect to live nearly seven years longer than in highly unequal Mississippi.

In the 1970s, death rates from all cancer types were similar in rich and poor U.S. counties. As inequality has increased across the nation, this has changed. Today, as American Cancer Society data shows, rich counties have significantly lower levels of cancer deaths than poor counties. Lung cancer deaths in low-income counties have actually increased, from 41.2 per 100,000 per year to 47.7, while dropping slightly in the higher-income counties.

The American Psychological Association published a report which shows that U.S. households with annual incomes below $50,000 report higher levels of stress than other families. Average stress levels gradually declined after the 2007-2008 financial crisis, but the stress gap between rich and poor households has been increasing. Blue collar and low-income jobs are often more stressful and physically demanding than white collar jobs. This contributes to a variety of other health problems, such as high blood pressure, back problems, and diabetes. Societal forces, such as discrimination based on race, gender, and sexual orientation, add to the stress level of certain population groups.

On average, according to CDC research, women in the United States have lower rates of obesity as their income rises. Those with household incomes above 350 percent of the federal poverty line have obesity rates of 29.7 percent, compared to 45.2 percent for incomes less than 130 percent of the federal poverty line. In addition to higher stress levels, factors such as food deserts and lack of recreational facilities in poor communities contribute to higher obesity rates among low-income women. Among men, obesity rates are similar across income groups, while male college graduates have a significantly lower rate than those with less education.

U.S. smoking rates vary widely by income group, from 12.1 percent in households earning more than $100,000 per year to 32.2 percent in households earning less than $20,000 per year, as shown in CDC research. In addition to higher stress levels, low-income communities face heavier targeting by tobacco corporations, both through advertising and high concentrations of stores that sell cigarettes.

The lower American workers rank on the national economic ladder, the more likely their jobs will be physically demanding. Such jobs can lead to more stress, both physical and mental - and higher medical bills. Center for Economic and Policy Research data shows that workers in physically demanding jobs such as janitorial, maintenance, and housekeeping positions, also typically retire earlier, before they can claim full Social Security benefits.

The bottom third of U.S. earners tend to retire earlier than other Americans, as calculated by the Brookings Institution, in part because their jobs are often more physically demanding. Because American workers cannot claim full retirement benefits before age 66, this trend exacerbates economic inequality among seniors.

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How do inequality and health relate? Increasing evidence from scientists the world over indicates that many health outcomes - everything from life expectancy to infant mortality and obesity - can be linked to the level of economic inequality within a given population. Greater economic inequality appears to lead to worse health outcomes.

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the website above ^ is also a good resource for this weeks sociology LO as it also talks about health inequalities linked to gender, ethnicity, sexuality and class etc.
the LO being - Define the sociological concepts of gender, ethnicity, sexuality and class

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LC Eco Model 2.2021.pdf - Google Drive

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https://geekymedics.com/dengue-fever/

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Dengue Fever | Infectious Diseases | Geeky Medics

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An overview of dengue fever including aetiology, clinical features, investigations, management and prognosis.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152027/

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Guest Editor (s): Edward T. Ryan, MD, FACP, FIDSA, FASTMH, FAAM

Professor of Medicine, Professor of Immunology and Infectious Diseases, Harvard University

Director, Global Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

Guest Editor (s): David R. Hill, MD, DTM & H, FRCP, FFTM (RCPS Glasg), FASTMH

Professor of Medical Sciences, Director of Global Public Health, Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA

Guest Editor (s): Tom Solomon, BA, BM, BCh, FRCP, DCH, DTM & H, PhD

Professor of Neurological Science, Walton Centre NHS, Foundation Trust, Director, National Institute for Health Research Health, Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK

Guest Editor (s): Naomi E. Aronson, MD

Professor of Medicine, Director, Infectious Diseases Division, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Guest Editor (s): Timothy P. Endy, MD, MPH, FACP, FIDSA, FASTMH

Professor and Chair, Microbiology and Immunology, State University of New York Upstate, Medical University, Syracuse, NY, USA

International travel is associated with a risk of infections not typically seen in high-income settings. Malaria is the most important tropical infection in travelers, but epidemics of dengue, chikungunya, and Zika emphasize that clinicians need to be aware of the rapidly changing distribution of many arboviruses. A detailed travel history and a syndromic approach to the investigation and management of patients is key. Consultation with a specialist is often recommended to ensure that appropriate management and investigations are undertaken in febrile returned travelers.

Keywords: malaria, visiting friends and relatives, travelers, imported infections, arboviruses, fever, skin rash, diarrhea, respiratory tract infection, incubation period, extended spectrum beta-lactamase, incubation period, geographic risk, enteric fever, dengue, salmonella, rickettsia, encephalitis, hepatitis, tuberculosis

* Travel, especially to low-income regions, is associated with an increased risk of infections not typically seen in high-income countries (e.g., malaria, enteric fever, dengue, chikungunya, Zika, and schistosomiasis).

* Although gastroenteritis, respiratory tract infections, and self-limiting viral infections are common, a minority of patients will have a potentially life-threatening tropical infection.

* The evaluation of an ill returned traveler requires a detailed travel history with an understanding of the geographic distribution of infections, risk factors for acquisition, incubation periods, clinical presentations, and appropriate laboratory investigations.

* A syndromic approach to specific investigations, and to presumptive therapy pending laboratory confirmation of the diagnosis, is appropriate.

* Travel is also a risk factor for acquisition of antimicrobial-resistant bacteria, such as those containing extended spectrum β-lactamases, that become part of the traveler's colonizing flora.

* As a rule, malaria should be excluded in all travelers presenting with a fever who have visited the tropics.

TABLE 150.1

Sub-Saharan Africa

HIV-associated infections (including seroconversion)
Malaria
Rickettsiae

Acute schistosomiasis
(Katayama)
Amebic liver abscess
Brucellosis
Dengue
Enteric fever
Meningococcus

North Africa, Middle East, and Mediterranean

Visceral leishmaniasis

Eastern Europe and Scandinavia

Lyme disease

Hantavirus
Tick-borne encephalitis
Tularemia

South Asia

Dengue
Enteric fever
Malaria

Chikungunya
Visceral leishmaniasis

Southeast Asia

Leptospirosis
Melioidosis

Hantavirus
Japanese encephalitis
Other arbovirus
Nipah virus
Paragonimiasis
Penicilliosis
Scrub typhus

North Australia

Barmah Forest
Melioidosis

Latin America and Caribbean

Acute trypanosomiasis (Chagas)
Hanta virus
Yellow fever

North America

Game parks

African tick typhus

Anthrax
Trypanosomiasis

Freshwater exposure

Acute schistosomiasis
Leptospirosis

HIV

Amebiasis
Non-typhoidal salmonella
Tuberculosis

STI (e.g., syphilis)
Visceral leishmaniasis

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

Individual Factors

* Purpose and duration of travel: Individuals visiting friends and relations (VFR) and long-stay travelers (e.g., aid workers) are at greatest risk of acquiring malaria, enteric fever, hepatitis A, tuberculosis, and sexually transmitted infections (STIs), including HIV. This is partly due to longer duration of travel and closer proximity to the local population.

* Immune status: Migrants returning to their home countries may be immune to certain infections, such as hepatitis A and acute schistosomiasis; however, they may incorrectly consider themselves immune to others, such as malaria. Consequently, VFR travelers are less likely to seek pre-travel advice, take malaria prophylaxis, or receive vaccines.4 Travelers with HIV, malignancy, or on immunosuppressant drugs are at increased risk of opportunistic infections, including non-typhoidal Salmonella and penicilliosis.

* Risk activities: Certain activities are an exposure risk (e.g., freshwater swimming and schistosomiasis, unprotected sexual intercourse and HIV).

Pathogen Factors

* Geographic distribution: Risk varies with country and environment (e.g., urban or rural, mountains or coastal plains). Although malaria is the most common infection diagnosed in travelers returned from sub-Saharan Africa, dengue is more prevalent in travelers returning from Southeast Asia and enteric fever from southcentral Asia (see ).

* Incubation period: Most travelers become symptomatic within 21 days of exposure, with the majority presenting within 1 month of return. However, some pathogens have a much longer incubation period (e.g., Plasmodium vivax and tuberculosis); patients can present months or, rarely, years later ( ).

TABLE 150.2

Short (<10 days)

Arboviral infections (e.g., dengue, chikungunya, Zika)
Gastroenteritis, acute (bacterial, viral)
Melioidosis
Meningitis (bacterial, viral)
Relapsing fever ( Borrelia spp.)
Respiratory tract infection (bacterial, viral including H1N1, avian influenza, and MERS)
Rickettsial infection (e.g., tick typhus, scrub typhus)

Medium (10-21 days)

Bacterial

* Brucellosis

* Enteric fever (typhoid and paratyphoid fever)

* Leptospirosis

* Melioidosis

* Q fever (Coxiella burnetii)

Fungal

* Coccidioidomycosis

* Histoplasmosis (can be as short as 3 days)

Protozoal

* Chagas disease, acute

* Malaria (Plasmodium falciparum)

* Trypanosoma rhodesiense

Viral

* CMV, EBV, HIV, viral hemorrhagic fevers

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

Undifferentiated Fever

Malaria

Malaria is a potentially fatal infection in travelers returning from the tropics, particularly from sub-Saharan Africa. 5 It should be excluded in all travelers with a history of fever. The risk of travelers acquiring malaria outside sub-Saharan Africa has decreased substantially in recent years, especially in those from India and South America. 6 Most short-term travelers present within 1 month of return; however, P. falciparum occasionally presents up to 6 months later, and P. vivax, P. ovale, and P. malariae can present a year or more after return. 7 Many travelers do not take chemoprophylaxis, or take it inadequately. 4 When malaria is acquired despite chemoprophylaxis, the onset of symptoms is often delayed, severity of illness reduced, and microbiologic diagnosis may be obscured. 8 Chemoprophylaxis can obscure the diagnosis, so in cases where malaria is thought likely, chemoprophylaxis can be stopped while patients are investigated. 5

Nearly all patients with malaria give a history of fever; however, up to half are afebrile on presentation, although specific fever patterns are uncommon. 9 Headache, myalgia, arthralgia, and malaise are frequently described, and some patients report diarrhea or cough. Complications occur mainly with P. falciparum infection but can also occur after infection with P. vivax and P. knowlesi. In patients with confusion, seizures, or reduced consciousness level, cerebral malaria or hypoglycemia should be considered; hypoxia, tachypnea, and signs of pulmonary edema indicate respiratory involvement.

Enteric Fever (Salmonella Typhi, S. Paratyphi)

Enteric fever is a potentially life-threatening infection that requires early diagnosis and management. It is seen particularly in VFR travelers returning from Asia, 3 although there have been outbreaks in Malawi and Kenya, and this may translate into more imported cases. 10 With an incubation period of 7 to 18 days (range up to 60 days), most patients present within a month of return. A history of vaccination pre-travel has little predictive value; it provides incomplete protection against S. Typhi and no protection against S. Paratyphi.

In addition to fever, symptoms include headache, constipation/diarrhea, and dry cough. Complications, in particular encephalopathy and gastrointestinal bleeding and intestinal perforation, occur infrequently; they are more likely if the duration of illness is >2 weeks.

Rickettsiae

The most common travel-associated rickettsial infections are due to Rickettsia africae (African tick typhus). Endemic throughout sub-Saharan Africa, it is a common diagnosis in those who have visited game parks in southern Africa. R. conorii (Mediterranean spotted fever or tick bite fever) is endemic throughout sub-Saharan Africa, the Mediterranean, Caspian littoral countries, the Indian subcontinent, and the Middle East. Travelers infected with R. typhi (murine typhus) and Orientia tsutsugamushi (scrub typhus) are rarely seen.

Rickettsiae have an incubation period of 5 to 7 days (up to 10 days) and similar presentations. More than 80% of patients infected with R. africae or R. conorii describe fever, headache, and myalgia. The classic signs of inoculation eschar, rash, and lymphadenitis are seen in <50%; however, retrospective cohorts report higher rates ( ). 11 Complications (e.g., reactive arthritis) are rarely encountered in African tick typhus; mortality rates of up to 32% have been reported for Mediterranean tick bite fever, 17% for scrub typhus, and 4% for murine typhus. 12, 13, 14

Arbovirus

There are over 500 arthropod-borne viruses worldwide, although not all cause human disease. The majority are usually restricted to specific geographic locations; for example, Ross River virus in Australia. However, due to a combination of international travel and changes in vector distribution there have been changes in the distribution of many arboviruses. They have short incubation periods (<1 week) and result in self-limiting illnesses. Four clinical presentations predominate:

* Systemic febrile illness (e.g., all arboviruses)

* Hemorrhagic fever (e.g., dengue, yellow fever, Rift Valley fever, Crimean-Congo hemorrhagic fever)

* Acute encephalitis (e.g., Japanese encephalitis, Rift Valley fever, West Nile virus, Eastern and Western equine encephalitis viruses)

* Polyarthralgia or arthritis (e.g., chikungunya, Ross River)

Dengue is the most common arbovirus in travelers. Although widespread, it is a cause of fever mainly in those returning from Asia, the Caribbean, and South America. 15 Most travelers present with a febrile illness associated with headache, retro-orbital pain, myalgia, arthralgia (especially back pain), and rash. 15 The rash, initially erythrodermic, becomes petechial with disease progression ( ). Hepatitis, myocarditis, encephalitis, and neuropathy can occur. Bleeding gums, epistaxis, and gastrointestinal bleeding occur but are not necessarily indicative of dengue hemorrhagic fever, which, like dengue shock syndrome, is rare in travelers.

Chikungunya has a distribution similar to dengue with large epidemics in the Caribbean, South America, India, and Southeast Asia. 16 The clinical presentation is similar to classic dengue fever; however, arthralgia is more prominent. In the majority of cases, the arthralgia settles; 5% to 30% develop chronic arthropathy with pain, stiffness and swelling lasting months to years. 17, 18

Zika virus has caused large outbreaks in the Caribbean, South and Central America, and the Pacific and is increasingly reported in Asia. 19 Acutely, the disease is similar to dengue. However, Guillain-Barré syndrome can be a complication, and during pregnancy Zika can lead to stillbirth and is associated with congenital abnormalities, including fetal microcephaly. Sexual transmission of Zika is well described. 19 No clinical features reliably distinguish dengue, chikungunya, and Zika infection, although thrombocytopenia is normally more pronounced in dengue. 20

Large outbreaks of yellow fever continue to occur in both Africa and South America and may be associated with an increased risk of imported cases among travelers.

Acute Schistosomiasis (Katayama Fever)

This should be considered in febrile travelers returning from Africa. Travelers give a history of freshwater exposure 4 to 6 weeks (up to 9) before symptom onset. Some describe a self-resolving itchy rash immediately after exposure (swimmer's itch). Symptoms and signs include fever, lethargy, myalgia, arthralgia, cough, wheeze, headache, urticarial rash, diarrhea, and hepatosplenomegaly. 21 The eosinophil count is usually elevated with acute schistosomiasis and provides supportive evidence for the diagnosis, but it may only appear a few days after symptom onset. Acute symptoms are self-limiting in most cases.

Leptospirosis

Leptospirosis has a global distribution. Infection occurs after exposure to rodent or dog urine-contaminated freshwater; for example, through recreational water sports, flooding, or occupation. After an incubation period of 7 to 12 days, patients classically present with a biphasic illness: a bacteremic phase with flulike symptoms lasting 4 to 7 days, followed 1 to 3 days later by an immune phase of fever, myalgia, hepatorenal syndrome, and hemorrhage. 22 The severe end of the spectrum, Weil's disease, occurs infrequently but has a case fatality rate of 10% to 15%. Gastrointestinal and respiratory presentations and meningitis, myocarditis, and pancreatitis are occasionally described.

Amebic Liver Abscess

Amebic liver abscess 23 should be considered in all patients with fever and a raised right hemi-diaphragm on chest radiography. It has a higher prevalence in developing countries. Travelers, exposed through fecal-oral transmission, will often present weeks to months after return (incubation period: 8-20 weeks). Most patients report fever, often localized abdominal pain, and hepatomegaly. Only 20% give a history of dysentery, and only 10% have diarrhea at presentation.

Brucellosis

Brucellosis 24 is acquired through ingestion of unpasteurized milk, although transmission can occur after direct contact with animal parts or, in laboratories, through inhalation of aerosolized particles. It has a global distribution, with a higher prevalence in the Middle East, Balkans, former USSR, the Mediterranean, and South America. Symptoms develop 2 to 4 weeks after exposure (up to 6 months) and vary from an acute febrile illness to a chronic low-grade relapsing fever; signs include lymphadenopathy, hepatomegaly, and splenomegaly. Complications of brucellosis are common-in particular, large-joint septic arthritis, sacroiliitis, and, less commonly, spondylitis of the lumbar spine. Other complications include epididymo-orchitis, septic abortion, neurologic involvement (meningitis, encephalitis, and abscess), and endocarditis.

Q Fever (Coxiella burnetii )

Q fever 25 is rarer than brucellosis, although it has a similar clinical history. It has a global distribution, with most cases related to occupational exposure, usually through inhalation of aerosolized particles. Community outbreaks, as reported in the Netherlands in 2008, occur. 26 Most cases are asymptomatic; symptomatic patients present with fever, pneumonia, or hepatitis after exposure to farms or animals. Complications, including chronic infection, are well described, particularly endocarditis.

HIV and Other STIs

Between 5% and 51% of short-term travelers take part in casual sex while abroad, with higher rates reported in long-term travelers. 27 Many STIs present as a febrile illness, including HIV seroconversion, secondary syphilis ( ), and gonorrhea. People living with HIV who travel to the tropics can be at increased risk of opportunistic infections (see ). 28

Respiratory Tract Infections

Respiratory tract infections are diagnosed as the underlying cause of febrile illness in 7% to 24% of returning travelers. 4 These include sinusitis, pharyngitis, tonsillitis, bronchitis, influenza, pneumonia, and pulmonary eosinophilia. Influenza is the most common vaccine-preventable infection acquired by travelers. The following are clinical and epidemiologic associations (see disease-specific chapters for details).

Upper Respiratory Tract Infections

* Diphtheria: Patients with severe pharyngitis on return from the Indian subcontinent, Southeast Asia, Haiti, or South America.

Lower Respiratory Tract Infections

* Middle Eastern Respiratory Syndrome (MERS), caused by a coronavirus, is a severe acute respiratory illness. Nosocomial transmission is well documented, so strict respiratory precautions must be initiated. Camels are known to be the reservoir.29

* Histoplasmosis or coccidioidomycosis: Exposure to damp conditions (e.g., bat-occupied caves) or dusty conditions, respectively. Coccidioidomycosis is restricted to certain areas in the Americas.

* Legionella: Exposure to air conditioning or other aerosolized water sources in cruise ships or hotels.

* Melioidosis (Burkholderia pseudomallei): Febrile patients from Southeast Asia with upper lung zone infiltrates or cavitation on chest radiography or septicemia.

* Q fever: Fever, pneumonia, or hepatitis after exposure to farms or animals.

* Tuberculosis: Travel to areas of high endemicity, particularly among VFRs, long-stay travelers, health care workers, and the immune compromised; symptomatic primary infection is uncommon.30

* Fever, respiratory symptoms, and peripheral eosinophilia: Consider Loeffler's syndrome (Ascaris, hookworm, Strongyloides), acute schistosomiasis, tropical pulmonary eosinophilia (filaria), leaking hydatid cyst, visceral larva migrans, and paragonimiasis.31

Gastrointestinal Infections

Diarrhea

Travelers' diarrhea has a reported incidence of at least 200 cases/1000 ill returned travelers. 3 Fever is self-reported in one third of these patients. Specific pathogens vary according to destination, setting, and season; however, enteric bacteria, including Escherichia coli, Campylobacter, Salmonella, and Shigella, are the most common. In up to 50%, no pathogen is identified. The combination of fever and bloody diarrhea is suggestive of bacterial or amebic dysentery, with the latter (uncommon in the returning traveler) often having a more indolent onset. Empiric antibiotics can be considered (see later). Any systemic febrile infection can have diarrhea at presentation; for example, severe sepsis, malaria, and pneumococcal pneumonia.

Abdominal Pain

Enteric fever, amebic liver abscess, viral hepatitis, and, rarely, leaking or secondarily infected hydatid cysts can cause fever and abdominal pain.

Jaundice

Infections presenting with fever and jaundice are listed in .

TABLE 150.3

Hepatic

EBV, CMV
Enteric fever (typhoid and paratyphoid)
Hepatitis A-E*
Leptospirosis (Weil's disease)
Non-typhoidal Salmonella plus HIV
P. falciparum malaria, severe
Relapsing fevers ( Borrelia spp.)
Septicemia, including pneumococcal sepsis
Typhus
Yellow fever and other viral hemorrhagic fevers

Post-hepatic

Ascending cholangitis (including occasionally helminths)

Hemolytic

Bartonellosis
Hemolytic-uremic syndrome ( Shigella spp., Escherichia coli)
Malaria
Mycoplasma pneumoniae
Sickle cell crisis with infective trigger

Neurologic Infections

Neurologic presentations, including meningitis and encephalitis, are reported in 15/1000 ill returned travelers. 3 Cerebral malaria can present with encephalopathy, meningismus, seizures, or focal signs and should always be excluded.

Meningitis

Typical bacterial and viral causes should be considered. Causes of predominantly lymphocytic meningitis include arboviruses, brucellosis, leptospirosis, Lyme disease, Q fever, relapsing fevers, syphilis, tuberculosis, HIV seroconversion, and HIV-related opportunistic infections (e.g., cryptococcal meningitis). Some infections, such as enteric fever, rarely present with meningismus but the cerebrospinal fluid (CSF) is normal.

Encephalitis

In addition to typical causes of encephalitis, travel-related causes are arboviruses (e.g., West Nile virus, Japanese encephalitis, tick-borne encephalitis), brucellosis, rabies, rickettsial infections, African trypanosomiasis, and tuberculosis. African trypanosomiasis (sleeping sickness) has been described in travelers returning from game parks in East and Central Africa, including Tanzania, Malawi, and Zambia.

TABLE 150.4

Maculopapular

Arboviral infection (e.g., dengue, chikungunya, Zika)
"Childhood viral illness" (e.g., measles, rubella, parvovirus)
Drug hypersensitivity reaction
Fungal infection (papule/nodules) (e.g., histoplasmosis, penicilliosis)
Infectious mononucleosis group, e.g., EBV, CMV, HIV seroconversion
Leprosy (reaction)
Rickettsial infection (e.g., tick typhus)
Syphilis
Viral hemorrhagic fever (e.g., Ebola)

Erythroderma

Dengue
Chikungunya
Zika
Staphylococcal or streptococcal toxin-related syndromes (e.g., toxic shock syndrome, scarlet fever)
Sunburn
Vibrio vulnificus

Purpuric

Dengue hemorrhagic syndrome
Gonococcal infection
Herpes zoster virus, hemorrhagic
Meningococcal infection
Plague
Rickettsial infection, severe
Severe sepsis ± disseminated intravascular coagulation
Viral hemorrhagic fever (e.g., Lassa, Ebola, CCHF, Rift Valley fever)

Pustule

Herpes simplex virus, disseminated
Herpes zoster virus (chickenpox or disseminated zoster)
PVL-associated Staphylococcus aureus

Ulcer

Chancre: Trypanosoma rhodesiense, Yersinia pestis (bubonic plague)
Eschar: African tick typhus, anthrax
Genital ulcer: syphilis, herpes simplex virus
Skin ulcer: anthrax, diphtheria, fungal infection, superinfected bacterial ulcer, tropical ulcer, Buruli ulcer

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

TABLE 150.5

Bacterial

Brucellosis
Enteric fever (typhoid and paratyphoid)
Leptospirosis
Q fever ( Coxiella burnetii)
Relapsing fever (borreliosis)
Rickettsial infection (e.g., tick typhus)

Flukes

Fascioliasis
Schistosomiasis, acute (Katayama syndrome)

Protozoal

Amebic liver abscess
Malaria (acute)*
Trypanosomiasis
Visceral leishmaniasis*

Viral

Dengue
Hepatitis, acute (A, B, E)
HIV, CMV, or EBV seroconversion

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

TABLE 150.6

Bacterial

Brucellosis
Infective endocarditis
Enteric fever (typhoid and paratyphoid)
Pyogenic deep-seated abscess
Q fever ( Coxiella burnetii)
Tuberculosis

Helminth

Schistosomiasis, acute (Katayama syndrome)
Strongyloides hyper-infestation syndrome

Protozoal

Amebic liver abscess
Toxoplasmosis
Visceral leishmaniasis

Viral

HIV plus opportunistic infection

Non-infectious

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

TABLE 150.7

Investigation

Guidance and Interpretation

Malaria film and dipstick antigen test (RDT)

* Perform in all patients who have visited a tropical country within 1 year of presentation

* The sensitivity of a thick film read by an expert is equivalent to that of an RDT; however, blood films are necessary for speciation and parasite count

* Three thick films/RDTs over 72 hours (as an outpatient if appropriate) should be performed to exclude malaria with confidence

* Positive blood films (thick and thin) should be sent to the reference laboratory for confirmation

* Patients returned from Asia (particularly Malaysia) with a high P. malariae parasite count should have the potentially lethal P. knowlesi excluded by PCR

Complete blood count

* Lymphopenia: common in viral infection (dengue, HIV) and typhoid

* Eosinophilia (>0.45 × 10⁹/L): incidental findings or indicative of infectious (e.g., parasitic, fungal) or non-infectious cause (see )

* Thrombocytopenia: malaria, dengue, acute HIV, typhoid; also seen in severe sepsis

Blood cultures

* Two sets should be taken before any antibiotic therapy

* Sensitivity of up to 80% in typhoid

* Notify the laboratory if the diagnosis of brucellosis is being considered

Serum save †

* HIV testing should be offered to all patients, especially those with pneumonia, aseptic meningitis/encephalitis, diarrhea, viral hepatitis, mononucleosis-like syndrome, unexplained lymphadenopathy, fever, or blood dyscrasia

* Other: consider a "geographic panel" for relevant other infections (e.g., arboviral, brucella, Q fever serology) if indicated

EDTA sample for PCR †

* Consider if other features suggestive of arboviral infection, VHF

Urinalysis

* Proteinuria and hematuria in leptospirosis

* Hemoglobinuria in malaria (rare)

CXR ± liver U/S

Table adapted with permission from British Infection Society. Fever in returned travelers presenting in the United Kingdom: recommendations for investigation and initial management. 5

Malaria

Parasitic confirmation (smears, rapid diagnostic tests [RDTs], or PCR) of suspected malaria is preferred, and empiric treatment is not recommended in clinical settings with good diagnostic facilities. However, diagnostic results must be accurate, timely, and available. Accuracy depends on the skills of the microscopist; RDT and PCR results reflect the performance characteristics of the assay. RDTs have high sensitivity for P. falciparum but can be lower for non-falciparum malaria. Presumptive treatment is not recommended, and facilities managing returning travelers should ensure an accurate diagnostic test result can be obtained within 6 hours.

Amebic Liver Abscess

Metronidazole 750 mg three times daily for 7 to 10 days or tinidazole 2 g daily for 3 days should be started empirically in patients with an appropriate travel history, clinical presentation, imaging, and, where available, serology (can be falsely negative in early disease). Most patients demonstrate clinical improvement and resolution of fever within 48 to 72 hours. The main differential diagnosis is a pyogenic liver abscess; patients with sepsis require broad-spectrum antibiotics until the diagnosis is confirmed. Surgical or percutaneous drainage is rarely required and should only be considered if there is diagnostic uncertainty, symptoms persist after 4 days of treatment, or there is imminent risk of rupture into critical sites (e.g., left-lobe abscess rupturing into the pericardium). 34 After treatment, patients should be given 10 days of a luminal amebicide to prevent relapse: diloxanide furoate (500 mg orally three times daily) or paromomycin (30 mg/kg orally in three divided doses).

Enteric Fever

When there is a strong suspicion, a parenteral third-generation cephalosporin (e.g., ceftriaxone) can be commenced pending blood culture results. Fluoroquinolone-resistant isolates are reported in patients returning from Asia, but so far have been rarely reported in those returning from Africa. 35 Ciprofloxacin 750 mg twice daily remains the treatment of choice for fully sensitive isolates. Azithromycin 1 g followed by 500 mg daily should be used as follow-on therapy where fluoroquinolone resistance is suspected or confirmed. Regardless of which antibiotic is used, fever can take time to resolve; failure to defervesce is not a reason to change antibiotics when the isolate is confirmed as sensitive.

Leptospirosis

Due to the potential severity of the illness, the non-specific nature of initial investigations, and a minimum period of 6 to 10 days before confirmatory serology becomes available, a 5- to 7-day course of penicillin (benzylpenicillin 1.5 million units four times daily) or doxycycline (100 mg twice daily) should be considered in patients with a flulike illness within 7 to 12 days of freshwater exposure.

Rickettsiae

Fever and headache, with or without rash, developing within 10 days of exposure to ticks in southern African game parks should prompt treatment with doxycycline 100 mg twice daily while other infections are excluded. A response is expected within 24 to 48 hours.

Acute Schistosomiasis

Empiric treatment should be offered to travelers presenting with fever, urticarial rash, and eosinophilia (>0.45 × 10 ⁹/L) within 4 to 8 weeks of freshwater exposure. 31 Praziquantel 40 mg/kg in a divided dose 4 hours apart will kill mature, but not immature, schistosomes ( Schistosoma japonicum: 60 mg/kg in three divided doses). Treatment should therefore be given at the time of diagnosis but repeated 6 to 8 weeks later. Corticosteroids can help alleviate acute symptoms.

Bacterial Sepsis

International travel, particularly to India, the Middle East, and Africa, is associated with an increased risk of acquiring extended-spectrum β-lactamase-producing gram-negative pathogens. 36 This should be taken into account when empiric antibiotics are indicated.

30. Cobelens FG, van Deutekom H, Draayer-Jansen IW. Risk of infection with [ Mycobacterium tuberculosis in travellers to areas of high tuberculosis endemicity. Lancet. 2000;356:461-465. [ PubMed] Google Scholar]

33. European Network for Diagnostics of Imported Viral Diseases. http://www.enivd.de/netz.pdf Management and control of viral haemorrhagic fevers. 2nd version. May 2001.

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Guest Editor (s): Edward T. Ryan, MD, FACP, FIDSA, FASTMH, FAAM Professor of Medicine, Professor of Immunology and Infectious Diseases, Harvard University Director, Global Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA Guest Editor (s): David R.

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https://www.cdc.gov/climateandhealth/effects/default.htm

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Climate change, together with other natural and human-made health stressors, influences human health and disease in numerous ways. Some existing health threats will intensify and new health threats will emerge. Not everyone is equally at risk. Important considerations include age, economic resources, and location.

In the U.S., public health can be affected by disruptions of physical, biological, and ecological systems, including disturbances originating here and elsewhere. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

For more information on the health effects of climate change, visit the Third National Climate Assessment's Health Chapterexternal icon , Fourth National Climate Assessment's Health Chapterexternal icon , and the USGCRP Climate and Health Assessmentexternal icon .

For more on the effects of climate change on health in different regions, see "Preparing for the Regional Health Impacts of Climate Change in the United States." pdf icon [PDF - 4 MB]

For more information about how climate change disproportionately affects some communities, visit CDC's webpage on justice, equity, diversity, and inclusion (JEDI) in climate adaptation planning.

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Climate change, together with other natural and human-made health stressors, influences human health and disease in numerous ways. Some existing health threats will intensify and new health threats will emerge.

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Screening tests like the blood spot for newborns is a form of diagnostic test, in regards to the accuracy of these tests which option means sensitivity and which one means specificity?
-% of people with the disease who test positive
-% of people without the disease who test negative

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At what age are diabetic children invited to be apart of the diabetic eye screening program?
-10
-11
-12
-13

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What year are men offered the AAA screening tests?
-the year they turn 50
-the year they turn 55
-the year they turn 60
-the year they turn 65

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In regards to the bowel cancer screening program, how often does the NHS send out a home test kit for peoples ages 60-74?
-annually
-every 2 years
-every 3 years
-every 5 years

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- cervical cancer for 3 years (25-49year olds)
-with disease testing positive= sensitivity, without the disease testing negative= specificity
-12 years old
-65
-every 2 years