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Even when animals do not die 500 mg metformin free shipping diabetes burnout, general unthriftiness can readily affect income 500 mg metformin with visa rhcp blood sugar, food security and human health 500 mg metformin with amex diabetic diet 2000 calories. Environmental stressors might be the catalyst for a disease to progress from a sub-clinical to a clinical state (e 500 mg metformin for sale diabetes educator jobs. These factors together with potential impacts on trade of livestock can result in significant impacts on livelihoods. They actively engaged in vaccination and other disease control measures for their cattle recognising that childhood disease vaccination programmes were of negligible value if their cattle died, as without protein security the survival of the children was in doubt. Perhaps the most important issue affecting wildlife and livestock health is the ever increasing interface between these sectors. Feeding a burgeoning human population pushes our livestock production into wild places and wildlife moves into human habitation to exploit new habitats and resources. Most (77%) infectious diseases of domestic animals are common to wildlife, so the control of a disease in domestic animals can be impeded by its presence in wildlife. Whilst culling or other disease control measures in infected livestock can reduce levels of disease, if the disease persists in a wildlife reservoir it can spillback to domestic animals at a later point. Local and global movement of domestic animals for trade and farming can help to spread disease and also introduce novel parasites to naïve livestock populations. Production systems are also generators of new diseases, driving the emergence of novel pathogens with potential for affecting livestock, wildlife and human health. Given the need to feed humans into the future it seems certain that livestock production systems will ensure that there are many challenges ahead for pathologists, other diagnosticians, animal and human health services and society as a whole. Wetlands provide an interface for domestic animals and wildlife as well as people allowing transmission of pathogens between these sectors (Sally MacKenzie). Disease Hosts* Impact on livestock Schistosomiasis Cattle, sheep, An estimated 165 million animals are infected in Africa goats. Wild and Asia, most infections are sub-clinical but the mammals and disease can still cause serious morbidity and mortality. Leptospirosis Cattle, sheep, Mortality can be high in calves and young or weak goats, pigs. Brucellosis Cattle, swine, High mortality of unborn animals, the disease can be goats, sheep, other debilitating and causes loss of productivity and welfare ruminants. Duck virus enteritis Ducks and geese In susceptible domestic waterfowl flocks, high percentage mortality and reduced egg production can occur. Epizootic ulcerative Wide range of wild High losses to fish farmers through mortalities, reduced syndrome and farmed fish productivity and market rejection due to presence of lesions affecting consumer confidence. Lead poisoning Mammals, poultry Lead is a common cause of morbidity and mortality in including livestock, particularly for sheep and cattle. Salmonellosis Most commonly in Many infected animals will not show clinical disease. In poultry and pigs mammals, clinical disease is most common in very young, pregnant or lactating animals, and often occurs after a stressful event. Outbreaks in young ruminants, pigs and poultry can result in a high morbidity rate. African animal Cattle, swine, Trypanosomiasis threatens 50 million cattle in Africa trypanosomiasis camels, goats and and can reduce livestock holdings by 10-50%. The mortality rate can reach 50- 100% within months of exposure, particularly if the animal is exposed to poor nutrition and other stresses. Bovine tuberculosis Cattle plus a wide Significant importance to the cattle industry through range of wild and loss of production, control measures and trade domestic restrictions. The majority (60%) of emerging infectious diseases in humans are caused by zoonotic pathogens. Livestock production systems provide opportunities for zoonotic disease transmission and increased human population density living with domestic livestock and pet animals is linked to a rise in the number of zoonotic infections in humans. Additionally, wildlife plays a key role by providing a ‘zoonotic pool’ from which new diseases may emerge. Human encroachment into wildlife habitats and wildlife utilising urban settings, as well as trade and use of wildlife (e. As well as the direct impact of animal diseases on humans, there are numerous indirect impacts mainly caused by the reduced production of livestock in terms of both food security and quality and reduced income linked to production losses and trade restrictions. An increasing range of interfaces between humans and animals allows zoonotic diseases to emerge. There are economic losses to livestock production as disease causes direct mortality and morbidity and reduces production efficiency, e. Production efficiency is also affected if a disease forces farmers to use resources sub-optimally, e. Disease also causes losses of revenue from restrictions on animal movement and trade, costs of control measures (including veterinary treatments) which can be prohibitive, negative impacts on agriculture and aquaculture markets, socio-economic influence on livelihoods, public health concerns especially in the instance of zoonotic disease, and even loss of income to tourism initiatives, e. However, the costs of disease control operations following an outbreak can be even more so: as a general principle, prevention costs provide a sound investment. Although complicated, the economics of disease management need to be seen in the broader context of ecosystem health [►Section 2. Viewing disease management from this perspective which includes ‘all’ the costs of loss of ecosystem function and benefits can help determine appropriate disease control strategies. Although disease may affect income in one sector there may be other compensations. As an example, losses and theoretical losses to livestock production in endemic African animal trypanosome areas allow areas to be left for wildlife from which other direct revenue can flow, e. A cost-benefit analysis, or decision tree, for example, may be useful when comparing the relative merits of different strategies. Diseases of organisms other than animals, such as plant diseases and diseases primarily of humans, such as malaria and dengue fever, are not included. The practicalities and resources available may vary but the principles of disease management remain the same. Written for wetland managers, this Manual aims to bring together what is currently known about animal diseases affecting wetlands and what options are available for managing them. Following an introduction to the issue of diseases in wetlands, we present the general principles of disease and its management in wetlands. We then provide descriptions of a selection of management practices for preventing and controlling disease outbreaks. Thereafter, factsheets present 2 descriptions of a selection of priority diseases affecting wetlands and information to assist in their management. Throughout the Manual key messages for wetland managers and policy makers are highlighted. As seen in Table 1-2, the drivers for disease emergence in wetlands are closely associated with human activity and disease prevention in these habitats lies primarily with land users and managers, together with decision makers. Use of this Manual should provide managers with enhanced understanding that will help assist better informed decision making with respect to preventing and controlling disease in wetlands. This will assist with the task of maintaining the ecological character of wetlands – an essential element of Ramsar’s wise use agenda. It should also materially benefit human communities dependent on wetlands by reducing disease risk either directly, or indirectly, to their livelihoods by impacts on livestock and other agricultural interests. The drivers for disease emergence in wetlands are closely associated with human activity and thus disease prevention in these habitats lies primarily with wetland managers and users. In summary… Aim of this Manual: Well-informed decisions by wetland managers and policy makers with regard to the prevention and control of animal diseases in wetlands so as to ensure wise use. Objectives of this Manual: To explain the principles of disease prevention and control; To provide guidance on practical measures for disease control in wetlands; To provide generic information on a selection of priority diseases; To provide advice on incorporating disease control measures into site management plans; and To provide links to further resources and information. There are many disease types, including: infectious, toxic, nutritional, traumatic, immunological, developmental, congenital/genetic and cancers. Disease is often viewed as a matter of survival or death when, in fact, effects are often far more subtle, instead affecting productivity, development, behaviour, ability to compete for resources or evade predation, or susceptibility to other diseases factors which can consequentially influence population status. Disease is an integral part of ecosystems serving an important role in population dynamics.

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Below are some of the commonest causes of th death in early 19 Century in Australia generic metformin 500mg without a prescription signs of diabetes in labradors. In addition to showing causes of death they also show some of the limited medical understanding of the time: • Trauma (including drowning and burns) – deaths from drowning and burns appear to have occurred with frightening frequency cheap metformin 500mg mastercard diabetes type 1 diet plan. There were also a large number of trauma deaths – both as a consequence of (mostly) farming accidents and violence 500mg metformin overnight delivery diabetes type 2 measurements. While covering a number of different diagnosis for the most part it referred to heart failure and commonly followed episodes of severe chest pain although at the time this wasn’t recognised for what it was – a myocardial infarction • Abdominal distemper – this was a syndrome characterised by severe abdominal pain order metformin 500 mg otc diabetes symptoms 9 year old, abdominal rigidity, fevers, and death. A significant number of cases were probably appendicitis although it is likely that pancreatitis, liver disease (from alcohol abuse), and gallbladder infections accounted for a number of cases. Again, more recently the term referred to typhoid fever, prior to this it referred to any dysentery. They divided them into one of three groups: • those conditions that can be treated • those that can be contended with • those that cannot be treated It is simple but surprisingly useful because in an austere situation it gives a framework to classify what you can do for your patients; those you can treat and cure, those that you can palliate or make comfortable (until they die or get better), and those that you can do nothing for or where your intervention is likely to make things worse. You need to convey a realistic expectation to your patients of what you will be able to achieve and this provides a simple framework. Lifestyle/Public health Lifestyle: Prior to any disaster it is worth considering what you can do to improve your own and your group’s health. Prevention of diseases such as heart disease, strokes, and diabetes is much better than attempting to treat them in an austere survival situation. You should ensure that all members of your group have their vaccinations up to date especially tetanus, measles, diphtheria, and polio. Preventive medicine: A large proportion of the disease burden in the past is related to poor public health and preventive medicine. For the most part it was related to ignorance of the role of bacteria in causing disease. Key elements of preventive medicine and infection control include: • Clean drinking water – uncontaminated by sewage and waste water • Hand washing – soap production is a priority. Incineration is probably the best option, followed by deep burial – away from water sources. Adequate rubbish disposal and trapping are probably the best methods for rodent control. Depending on climate mosquitoes may be a problem; stagnant water and rotting soft wood are foci for the mosquito larvae. Although many illnesses are infectious before symptoms become apparent it is important that any person who becomes unwell, particularly with fever or diarrhoea, is isolated immediately in an attempt to minimise further infections. With diarrhoeal illness – simple hand washing is usually sufficient for the caregiver. With febrile illnesses or those with respiratory symptoms then barrier precautions should be used – gloves, gown, facemask (N95), and goggles should be used. If this level of protection is not possible then some form of face mask is needed when with the patient and hand-washing, changing clothes (hot wash), and showering before contact with the healthy. For strangers arriving particularly during a pandemic consider 10-14 days isolation, followed by clothes burning and a through wash with soap before entering the community. There are no current infectious diseases with longer incubation times than 10-14 days. Provided the newcomer is symptom free at the end of this period you should be safe. However, among the current potential pandemic causes there are not currently carrier states although this needs to be considered. The recent tsunami in southern Asia clearly demonstrates how quickly public health can break down. Despite widespread knowledge even in developing third world countries about the basic principles of public health and hygiene latrines have been dug next to water supplies, water wasn’t being boiled, and in some places no effort was made to burn or dispose of rubbish, and it was just allowed to accumulate. While you can argue that some of this was due to “shell shock” from the disaster itself it just goes to show how the fundamentals can go out the window in a stressful situation. At present there is a heavy reliance on investigations; in a long-term austere situation history and examination will come into their own again. History taking and Examination: With very limited access to investigations the importance of clinical examination will again take on enormous importance. While modern doctors are competent at physical examination there is heavy reliance on special tests, and many of the skills of accurate physical examination have faded. The basics are easily learned from any clinical skills textbook (We recommend Talley and O’Connor, Physical Examination) and with a little practice. It is almost certain that in long-term austere situations that physical examination will come into its own again. The history 95% of the time is all that is required to know exactly what is going on. The examination and investigations may be used to confirm your thoughts, but it’s the history that usually gives you the diagnosis. Investigations: Laboratory tests: Lab tests which are possible in an austere environment are discussed in the Laboratory chapter. These include basic urine analysis, blood typing, and cross matching, and simple cell counts. There are several low-tech ways that are reasonably accurate in diagnosing fractures. Fractures of the long bones (tibia, fibula, femur, humerus, clavicle, ribs, etc), can be diagnosed by either percussion, or a tuning fork, and a stethoscope. A bony prominence on one end of the bone in question is tapped, or the base of a vibrating tunning fork is placed against it, and the stethoscope is applied to the other end. If a fracture exists on one side and not the other the gap in the bone at the fracture site will result in less sound being transmitted so the sound will be somewhat muted on the side of the fracture. To diagnose a hip fracture the sound source is applied to the patella (knee cap) and the stethoscope applied over the pubic symphysis. The technique is less effective on the obese as fatty tissue will absorb sound waves. For long bones running near the surface of the body a fracture can be localized by drawing the tuning fork along the bone slowly (>30 sec, but <60 sec) until a very localized source of pain is identified (<3 cm). A cone formed from rolled paper can act as a substitute for a stethoscope but is less than ideal. Once again, the reality will be that the most useful method for diagnosing fractures will be clinical examination. This is also the case for the clinical chest examination in patients who would previously have had a chest x-ray. Treatment The trick to learn for patient care in a truly austere situation is to do what you can do extremely well. You may not have access to many medications or much equipment but do what you are able to do well and you will save lives. The classic survival cliché is a simple scratch could result in you dying from gangrene infection of the leg. While at the extreme end of the spectrum this may be true cleaning the wound with copious amounts of water and keeping it covered will prevent most infections; if there are signs of infection further good basic wound care, resting the limb, and keeping it elevated for 48-72 hours will further the chances of serious infection all without antibiotics. Now obviously sometimes antibiotics will be lifesaving but you can reduce the reliance on high tech treatment by doing low tech treatments well. Medical supplies/Instruments Bandages and Dressings: Any absorbent material may be used as a dressing and any length of material for a bandage. It would be wise to identify what you plan to use in advance and ensure you store it. This book takes a different perspective as it looks at production starting with raw materials and goes through fibre processing, spinning, weaving, bleaching, and finally - 95 - Survival and Austere Medicine: An Introduction sterilizing, and converting into medical textiles.

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Easy to use ultrasound devices for diagnosis of internal discount metformin 500mg otc diabetes mellitus type 2 - an independent risk factor for cancer, especially intra-abdominal cheap metformin 500mg on-line diabetes test on nhs, bleeding would also be a useful development cheap metformin 500mg with amex diabetes insipidus decreased bun. Emergency care generic metformin 500 mg with amex diabetes neuropathy in dogs, including imaging techniques to diagnose bone trauma in health care facilities, is necessary for immediately addressing urgent health issues and to prevent long term disability. Standard radiology remains the major diagnostic tool for trauma and some types of injury. However, health systems in many developing countries are highly segmented and the provision of health services is very fragmented. Experience to date demonstrates that excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs and low user satisfaction with services received [8]. The specialized training needed to diagnose such diseases is a challenge for low and middle income countries. On the other hand, the lack of comprehensive cancer control programmes, including access to treatment services with radiotherapy, represents the major obstacle for reducing cancer mortality in developing countries. Technology and infrastructure Radiation medicine technology is associated with high costs from the acquisition to the functional phase, including maintenance needs and environmental conditions. The costs of these services, considering both the initial investment and operating costs, make careful planning and management of their development necessary, but the latter are not always adequate. Frequently, the costs of procuring and maintaining equipment are much higher than in industrialized countries. All these aspects become more critical with the incorporation of more complex and costly technologies. Almost two thirds of all low income countries do not have a national health technology policy in the national health programmes to guide the planning, assessment, acquisition and management of medical equipment. As a result, inappropriate medical devices that do not meet the priority needs of the population, are not suited to the existing infrastructure and are too costly to maintain are incorporated, draining funds needed for essential health services [9]. Much of the most complex equipment imported from industrialized regions does not work when it reaches low income countries. Maintenance of diagnostic equipment plays a very significant role in the longevity and effectiveness of diagnostic machines, as well as in safety and quality. Better technology policy in countries will lead to an increase in the quality, effectiveness and coverage of health care with regard to medical devices. In some countries, the low demand for medical technology often derives from deep rooted culture and social norms. At the beginning of the symptoms, people tend to solve their problems with traditional medical services or even magic–religious approaches. Many prefer traditional over modern therapies, and it is very common to use a of combination of both. Often, when appropriate results are not produced, the patient then seeks modern medicine. Although the introduction of new technologies and techniques is necessary in some countries, awareness of the traditions and beliefs may be crucial to the success of any project. Some beliefs and culture can affect radiation medicine’s acceptability and accessibility. Human resources Most low income countries face challenges in radiation medicine services because of the lack of skilled human resources. As a consequence, general practitioners often have to interpret the radiological images; nurses or technical personnel, without adequate education and training, carry out the diagnostic examinations or the treatment delivery; and inappropriately trained physicists or engineers assume quality aspects, safety and maintenance responsibilities [10]. On the other hand, there is a lack of mechanisms for the necessary certification or recognition of these professionals [11]. In some countries, these human resources are so scarce that it is not possible to include formal education programmes at the national level; and in those that do have these programmes, they are not of sufficient quality. The possibilities for continuing education for professionals are also very limited in developing countries. Many professionals choose to migrate due to a lack of opportunities for education and training; underfunding of health services; lack of established posts and career opportunities; health service management shortcomings; civil unrest or personal security. Radiation protection and quality assurance Although radiation doses to patients in radiographic examinations are generally considered to be small in comparison with the immense benefits derived from these examinations, it is necessary to optimize the dose to the amount that is necessary to produce the image quality required for a diagnosis. There is also a tremendous amount of waste of resources with regard to the image quality produced in radiographic examinations. On the other hand, an examination that does not help medical management is unjustified, no matter how small the dose is. Many factors influence the effectiveness and safety of radiotherapy treatments, such as accurate diagnosis and the stage of the disease, good therapeutic decisions, the precise location of the tumour, and the planning and delivery of treatment. These procedures should be performed according to previously accepted clinical protocols by adequately trained personnel, with properly selected and functioning equipment, to the satisfaction of patients and referring physicians, in safe conditions and at minimum cost. Many low income countries face an increase in incidence and mortality of many diseases, which are potentially curable if early diagnosis and appropriate treatment are available. Diagnostic imaging and radiotherapy can provide public health programmes with tools to screen, diagnose, treat and palliate many diseases. The incorporation of such technology in developing countries requires a careful study of feasibility that ensures its appropriateness and sustainability. Additionally, it is essential for the human resources working in these services to be trained in the use of the respective technologies. Relevant authorities should be committed to incorporating and maintaining the technology, as well as to ensuring the quality of care and safety. A more widespread and proper use of radiation medicine will lead to a reduction in mortality and help to combat many diseases and conditions of public health concern, as well as to improved quality of life for people in developing countries. Emphasis is placed on the needs of the recipient facility; the provision of tools, accessories, spare parts and manuals; the arrangements for acceptance testing, commissioning and maintenance of the equipment; and the training of staff and service technicians regarding equipment operation and maintenance. Ideally, equipment should be bought new, but to minimize capital costs, developing countries may consider acquiring pre-owned machines, either directly from donors or refurbished from manufacturers. Other costs in addition to capital costs need to be taken into account: installation and siting costs, which involve potential room modifications, equipment transport and custom fees when applicable; operational costs, which include registration and licence fees, utility consumption such as electricity and water, supplies and consumables; and human resources costs that encompass salaries and training of operators, maintenance staff and consultants — if needed. There are also indirect costs, such as facility and equipment depreciation, as well as unexpected fees arising from legal, accounting, clinical, architectural, engineering and medical physics consultations. The procurement issues involved in equipment acquisition should be carefully analysed. The type of radiological equipment that facilities need should depend on the types of services that the facility offers or plans to offer and the staff available or budgeted for to operate and maintain the equipment. The number, characteristics and technical specifications should depend on the population to be served, the availability of resources in the respective health care system, and the volume of procedures to be carried out in a given unit of time [2]. The very first issue the facility should consider is whether the type of equipment to be acquired is really needed and whether it will require additional staff to operate it. Radiation safety requirements The design of radiation emitting equipment and equipment to be used with radioactive materials, such as a gamma camera, should comply with national or international radiation protection and safety standards [3]. Compliance with manufacturer’s specifications Second hand equipment should maintain the original manufacturer’s specifications. If an original feature is no longer functional, but the equipment could still be used, this should be clearly indicated in the documentation provided by the donor/seller. Warranties Refurbished equipment should be sold with warranties, at least for one year of operation. It is important to establish exactly whether it includes parts (X ray tubes are very costly, for example) and when the warranty actually starts. Obsolescence Even in good operating conditions and meeting the manufacturer’s specifications, equipment should not be acquired if deemed to be obsolete; i. For example, a cobalt therapy unit with an adequate radioactive source is not obsolete, but a mammography unit with a tungsten target and an aluminum filter is, because the image quality that is produced is substandard. Acquiring obsolete equipment may have detrimental effects on the health care system.

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Low hepatitis B knowledge among peri- natal healthcare providers serving county with nation’s highest rate of births to mothers chronically infected with hepatitis B metformin 500 mg diabetic diet compliance. Hepatitis B and liver cancer beliefs among Korean immigrants in western Washington cheap 500mg metformin otc diabetes preventionorg. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www order 500mg metformin mastercard metabolic disease brain. Hepatitis B virus screening practices of Asian-American primary care physicians who treat Asian adults living in the United States 500 mg metformin overnight delivery diabetes in dogs cured. Organizational climate, staffng, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Living with chronic hepatitis C means “you just haven’t got a normal life any more. The next plague: Stigmatization and discrimination re- lated to Hepatitis C virus infection in Australia. Are primary care clinicians knowl- edgeable about screening for chronic hepatitis B infection? The impact of iatrogenically acquired Hepatitis C infec- tion on the well-being and relationships of a group of Irish women. Impact of four urban perinatal hepatitis B prevention programs on screening and vaccination of infants and household members. Hepatitis B surface antigen prevalence among pregnant women in urban areas: Implications for testing, reporting, and preventing perinatal transmission. Family physi- cians’ knowledge and screening of chronic hepatitis and liver cancer. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Focus-on-teens, sexual risk-reduction intervention for high-school adolescents: Impact on knowledge, change of risk-behaviours, and prevalence of sexually transmitted diseases. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: Implications for vaccination programs. Self-reported hepatitis C virus antibody status and risk behavior in young injectors. Creation of a safety culture: Reducing workplace injuries in a rural hospital setting. Reducing liver cancer disparities: A community-based hepatitis-B preven- tion program for Asian-American communities. Knowledge about hepatitis B and predictors of hepatitis B vaccination among Vietnamese American college students. A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Why we should routinely screen Asian Ameri- can adults for hepatitis B: A cross-sectional study of Asians in California. Secondary syringe exchange among users of 23 California syringe exchange programs. Risk perceptions and barriers to hepatitis B screening and vaccination among Vietnamese immigrants. Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans. Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination. Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center. A comparison of trends in the in- cidence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in the United States. The perceptions and aspirations illicit drug users hold toward health care staff and the care they receive. Gender differences in syringeGender differences in syringe exchange program use in Oslo, Norway. Hepatitis B vaccina- tion in adolescents: Knowledge, perceived risk, and compliance. Awareness and utilization of the hepatitis B vaccine among young men in the Ann Arbor area who have sex with men. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The social production of hepatitis C risk among injecting drug users: A qualitative synthesis. Hepatitis C and its risk management among drug injectors in London: Renewing harm reduction in the context of uncertainty. Current prac- tice patterns of primary care physicians in the management of patients with hepatitis C. Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003. Adolescents’ knowledge, beliefs, and behaviors regarding hepatitis B: Insights and implications for programs targeting vaccine-preventable diseases. Hepatitis C disease among injection drug us- ers: Knowledge, perceived risk and willingness to receive treatment. Effectiveness of the hands-free tech- nique in reducing operating theatre injuries. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women. Hepatitis B knowledge and practices among Cambodian American women in Seattle, Washington. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis B knowledge among Vietnamese immigrants: Implications for prevention of hepatocellular carcinoma. Hepatitis B knowledge and practices among Chinese immigrants to the United States. Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Seroepidemiology of hepa- titis B virus infection: Analysis of mass screening in Hawaii. Randomized controlled trial of a brief behavioural intervention for reducing hepatitis C virus risk practices among injecting drug users. Exploring risk perception and behaviour of homeless injecting drug users diagnosed with hepatitis C. Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco bay area, Califor- nia. San Francisco Hep B Free: A proactive approach to promoting hepatitis B immunization in conjunc- tion with screening and care. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The frst Hpart of this chapter reviews current federal vaccination recommenda- tions and state vaccination requirements for hepatitis B. It also summarizes what is known about hepatitis B vaccination rates in specifc populations (for example, infants, children, and adults, including subgroups of at-risk adults, such as incarcerated people and occupationally exposed people). The committee identifed missed opportunities for hepatitis B vaccination and makes recommendations to increase the vaccination rate among vari- ous populations.

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