Analysis by socio-demographic characteristics

Three findings are noteworthy. Firstly, one can note that the three items representing
ways of contracting HIV are generally answered in the same way independent of the
respondent’s socio-demographic profile. Only older people, aged 55 and more and
those who finished their full-time education by the age of 15 or less, have slightly
more difficulty in answering correctly.
Secondly sex, age, education level, household size and urbanization are important
variables in the way answers are given to the other statements of the list. The general
tendency is:

- there are no significant gender differences;
- the younger the respondent, the more likely the answer is to be correct;
- the higher the education level, the more likely the answer is to be correct;
- those living in a household of three or more people have a greater tendency to
give the correct answer;
- those who are retired give the correct answer less often;
- citizens living in large towns seem to give the correct answer slightly more
often than those living in rural areas
However several exceptions can be found:
- Women answer ‘no’ less often for “sitting on a toilet seat” (52% compared to
57% for men)
- and slightly less women than men give the correct answer for “drinking from a
glass” and “giving blood”
Finally older people, aged 55 and more and those who finished their full-time education
by the age of 15 or less, have slightly more difficulty in answering this question, as the
non-response rate is systematically higher for these categories of the population.

How can HIV be contracted

The first category represents the ways you can actually contract HIV. It is reassuring
to see that almost all EU citizens know that HIV can be contracted by “being injected
with a needle which has been used by someone with AIDS or who is HIV positive”,
“receiving blood from someone with AIDS or who is HIV positive” and by “having sex
without protection with someone with AIDS or who is HIV positive”.
Opinions are more split for all of the other items which are not ways of contracting
HIV.
The second category that we can distinguish in the results represents the statement
for which less than half of the EU25 population knows the correct answer: 40% of
citizens from the 25 Member States believe that HIV cannot be caught by “kissing on
the mouth of someone with AIDS or who is HIV positive”. However, the population’s
knowledge is quite low since 24% replied ‘yes’ and 30% answered ‘possibly’ to this
statement.
The third category represents the items for which awareness is still low but more
balanced. Although, a majority of the interviewees think that “drinking from a glass
which has just been used by someone with AIDS or who is HIV positive” is not a way
to contract HIV (52%), 15% believe it is and 30% say it is possibly a way of catching
the disease. We also notice a split opinion for “giving blood”: 54% of the EU25 citizens
believe you cannot contract HIV this way. Yet 30% of respondents answer that this is a
way to contract HIV and 13% replied that this action could ‘possibly’ lead to
contracting the disease. A majority of the interviewees says that “sitting on a toilet
seat which has been used by someone with AIDS or who is HIV positive” is not a way
of contracting HIV (55%). However, this item also generates 26% of ‘possibly’ and
13% of ‘yes’ answers.
When it comes to “taking care of someone who has AIDS or who is HIV positive”, the
population’s awareness is higher: almost six in ten respondents say it is not possible to
catch the disease in this way. Nevertheless 25% of the interviewees answer that it is a
possible way and 12% of them clearly state that it is a way of contracting HIV.
The last category represents the final statements for which more than two thirds of
respondents in the EU believe are not ways of contracting HIV. Seven out of ten
European citizens think it is not possible to contract HIV by “eating a meal prepared by
someone with AIDS or who is HIV positive”. Nevertheless, a non-negligible amount
replied the opposite: 17% of them still state that it is possible and 7% of them are
convinced of this. This is equally the case for “handling objects touched by someone
with AIDS or who is HIV positive” and “shaking the hand of someone with AIDS or who
is HIV positive” for which respectively 13% and 9% of interviewees answer ‘possibly’
and 5% answer ‘yes’.

No matter who you are

If you’re a female, you should be familiar with PMT, and the things that it can do to you. Often, we are left an emotional state for over a week and, if you think about it, this is a quarter of our lives. So, here are some tips that should be able to help you to get over your PMT and try to keep a hold on your life.

Exercise can be very helpful in raising your mood. If you’re feeling down and a little bit sluggish, then try exercising for 20 minutes and you should find that your mood is raised for a good part of the day. If it drops later in the afternoon, then you could always try again and maybe go for another run.
Don’t give into your junk food cravings. If you do, then you will soon realise that the “high” that you get from eating the food disappears after a very short time indeed, meaning that you are left feeling lower than you were before. Instead, you should try snacking on things like fruit and nuts, which will give you a much longer lift and are also a lot healthier for you.

Read more in Mental Health

« “Avatar 2″, Cameron Gives The First Clues

For Autist: “Hey Mom, That’s When We Go to School” »

Relaxing is something that you really must do. If, like me, anxiety is a big part of your PMT, then you need to remember that although it is horrible at the time, the anxiety cannot hurt you at all. You should take the time to have a bath or read a magazine which will take your mind away from things that are bothering you. You should find that taking the time to do this means that some of the stresses that you’ve been experiencing can be released, so that you can get rid of your PMT for good.
If there are certain films or songs that make you cry; avoid them. Go for films with happy endings and upbeat songs which will help to lift your spirits until a time that you would be able to lift them for yourself.

Quit Smoking: A Helping Hand

If you’re trying to quit smoking at the moment, then you’ll know just how hard it is. There is no magic trick to give up, but there are little things that you can help yourself with.

1) Relax. One of the things that happens when you quit smoking is that you get stressed as your body is suffering symptoms of addiction. If you feel as though you’re stressed, then there are several ways that you can calm yourself down, some of which are listed below:
- Exercise. Jogging or even walking can be great; or why not join a dance class?
- Have a bath. A warm bath can be very relaxing and might help you to calm down a little bit.
- Meditate. This can help a lot, and if you sit quietly and take some deep breaths it might help you.
2) Use motivational photos. Think about why you’re quitting. It is for your children? Your partner? Did a loved one die from a smoking related disease? Did your skin look so much better before you started smoking? Whatever your motivation might be, you should place some motivational photographs around your house to help you through the day. You could put one on your front door so that if you’re tempted to go to buy some cigarettes from the shop you will think twice when you see that photo. The other amazing place is your purse/wallet. That way, if you do have a lapse of judgement, you will have to look at the photo before you pay for them, meaning that it might remind you just why you’re giving up before it’s too late.

The Five Most Dangerous Diseases to Humans

.

Maybe the most dangerous diseases to humans.

The survival of mankind has historically seen as a key part in the development of the species.There have been many dangers that threaten human beings, including the 5 most dangerous diseases to humans.

- AIDS.Scientifically known as Syndrome Immune Deficiency Syndrome, is one of the most STDs dangerous and common. In Addition AIDS can be infected by drug use, especially by sharing needles. This disease is wiping out your defenses.
     
- Alzheimer’s. It’s a terrible disease. I do not know if it will be the most dangerous, but I think it’s one that we most fear humans.Think that gradually we will lose the memory stick to almost like a vegetable … it is a fact that may distress to more than one. Moreover, we can consider it as a mysterious disease because they are not very well known source.

- Hepatitis B. Is a liver disease that causes the liver to gradually stop working. We understand it as a chronic disease, which is precisely to be chronic, is difficult to bear. That is, you will damage your liver slowly.

- Cancer. We can say that stress and diabetes are epidemics of the twenty-first century.  Well, cancer does not stay behind, and I daresay that even the disease of greatest concern to humans.

- Osteoporosis. In general, any bone disease is dangerous and that bones are the structure that holds us upright.

The World's Most Deadly Disease

.

According to the World Health Organization (WHO), almost two billion people-one third of the world's population-are infected with tuberculosis (TB) bacteria.

It is an epidemic of unprecedented proportions. It kills more adults worldwide than all other infectious diseases combined, and nearly half of the world's refugees may be infected with it. It is the leading killer of people with human immunodeficiency virus (HIV) and orphans more children than any other infectious disease. It's not AIDS, nor hepatitis, nor malaria, but an ancient disease that was nearly eradicated a generation ago: tuberculosis.

According to the World Health Organization (WHO), almost two billion people-one third of the world's population-are infected with tuberculosis (TB) bacteria.

Each year eight million new cases of TB appear, along with three million TB-related deaths. At current rates the WHO estimates that as many as 500 million people will become ill from TB during the next 50 years.

TB is not a disease limited to the developing world. In the United States alone it is estimated that 10 million to 15 million people are infected with the TB bacterium, and 22,000 new cases of TB occur each year.

Yet, only 15 to 20 years ago, health authorities were about ready to declare that TB, like smallpox and polio, had been wiped off the face of the earth. In the United States during the early 1900s, TB was the No. 1 killer. Then, in the 1940s, the introduction of antibiotic drugs that could kill TB bacteria meant that the disease could be cured. For three decades, from the 1950s to the mid-1980s, TB cases steadily declined.

But in the 1980s the battle against tuberculosis took a turn for the worse. The disease reemerged and spread in industrialized countries and underdeveloped nations. Between 1985 and 1992 the number of TB cases increased by nearly 20 percent in the United States. Worldwide, the modern TB epidemic led the WHO in 1993 to declare its first "global emergency." At the time, TB was killing more adults each year than AIDS, malaria and tropical diseases combined.

TB is caused by a bacillus, Mycobacterium tuberculosis. A person can become infected with the tuberculosis bacterium when microscopic airborne particles of infected sputum are inhaled. The bacteria get into the air when someone who has tuberculosis infection of the lung coughs, sneezes, shouts or even laughs. People who are nearby can breathe the bacteria into their lungs.

For most people who inhale TB bacteria and become infected, the body is able to fight the bacteria to stop them from spreading. The bacteria become inactive, but they remain alive in the body and can become active later. This is called TB infection. People with TB infection do not feel ill, have no symptoms and do not spread TB to others. The infection can remain dormant in a person's body for decades, then flare into active disease when the body's immune system is weakened for any reason. About 10 percent of infected people develop TB at some point.

TB can attack any part of the body but usually targets the lungs. When a person breathes in TB bacteria, they can settle in the lungs and begin to grow, then move through the blood to other parts of the body, such as the kidney, spine and brain. Although TB in the lungs or throat can be contagious, TB in other parts of the body is usually not contagious. Usual symptoms of the disease are a general fatigue or weakness, extreme weight loss, fever and night sweats. If the infection in the lung worsens, then further symptoms can develop, including persistent coughing, chest pain, coughing up of blood and shortness of breath.

Because TB is spread through airborne bacteria, anyone can become infected. Groups with the highest risk are the poor and homeless, as well as those with undeveloped or suppressed immune systems: young children, the elderly, HIV-positive people and patients with certain types of cancer.

New and deadly strains

Health-care officials are increasingly concerned about emerging new forms of drug-resistant TB. According to the WHO, outbreaks of drug-resistant tuberculosis are showing up all over the world and threaten to touch off a worldwide epidemic of virtually incurable tuberculosis.

Drug-resistant strains have appeared in New York City prisons, a hospital in Milan, Italy, and many places in between. "Everyone who breathes air, from Wall Street to the Great Wall of China, needs to worry about this risk," says Dr. Arata Kochi, director of the WHO Global TB program.

An October 1997 survey by the WHO, the U.S. Centers for Disease Control and Prevention and the International Union Against Tuberculosis and Lung Disease estimates that 50 million people are infected with a strain of TB that is drug-resistant. Many of those are said to carry multi-drug-resistant tuberculosis-incurable by two or more of the standard drugs. In underdeveloped countries, where the vast majority of multi-drug-resistant TB cases have occurred, it is usually fatal.

"The world is becoming smaller and the TB bugs are becoming stronger," Dr. Kochi says. "While international travel has increased dramatically, the world has been slow to realize the implications for public health. Only recently have wealthy governments begun to recognize that the poor TB treatment practices of other countries are a threat to their own citizens."

The WHO study identifies hot zones of untreatable tuberculosis that threaten a worldwide crisis. These zones are home to nearly 75 percent of the world's TB cases and include Russia, Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, Pakistan, the Philippines, South Africa, Thailand and Zaire.

Many of the hot zones are regional centers for travel, immigration and international economic activity. WHO officials admit that little can be done to prevent people infected with drug-resistant TB from traveling and spreading the bacilli to other countries.

According to the WHO, one third of the world's nations have a strain of TB resistant to multiple drugs. Untreatable cases account for 2 to 14 percent of the world's total. That number is low, but the WHO said lethal tuberculosis could spread rapidly because only one in 10 patients gets medical care that could overcome drug resistance.

Drug-resistant strains of TB develop when patients do not complete the course of treatment, fail to take their medicine or don't use medication properly. Tuberculosis often can be cured with a combination of four drugs taken for six to nine months. But some patients may begin to feel better after just two to four weeks of treatment, so they stop their medication. But not enough of the medication has been taken to kill all the TB bacteria in the patient. The remaining bacteria survive and mutate, becoming a tenacious, more deadly form of the disease.

TB can be diagnosed in several ways. Chest X rays can reveal evidence of active tuberculosis pneumonia, or they may show scarring, suggesting contained inactive TB. Examination of sputum under the microscope can show the presence of tuberculosis bacteria. A sample of the sputum can also be grown in special incubators, and tuberculosis bacteria can subsequently be identified.

Several types of skin tests are used to screen for TB. Tuberculin skin tests include the Mantoux test, the Tine test and the PPD. In each of these tests, a small amount of dead tuberculosis bacteria is injected under the skin. If a person is not infected with TB, no reaction at the site of the injection will become apparent. However, if a person has become infected with tuberculosis, an area around the site of the test injection will redden and swell. This reaction occurs 48 to 72 hours after the injection.

Treatments can work

Health-care authorities believe one of the best ways to treat TB is something known as "DOTS" (directly observed treatment, short course). Health workers make sure that TB patients take their medicine by watching them swallow every dose they take. Patients take all their medicine, their TB is cured, and the development of drug-resistant tuberculosis is prevented.

According to the WHO, only 10 percent of the world's TB patients are being treated using DOTS. If DOTS were used, WHO officials maintain that nearly three fourths of TB cases could be cured.

"DOTS cures sick patients and prevents drug resistance," says Dr. Kochi. "Alarmingly, only about one in 10 TB patients today has access to DOTS. We have to quickly put more DOTS programs in place to stop multi-drug-resistant TB from increasing."

"The TB epidemic must be fought globally to protect people locally," Dr. Kochi warns. "It is in the interest of the wealthy countries to help less-developed countries fight tuberculosis, before their own countries become the battleground."

What is the most dangerous disease in the world today and why?

.
Mesothelioma is one of the deadliest diseases known to man; the average life span of an inflicted person from the time of diagnosis until death is less than 24 months.
It's a disease that strikes approximately 3,000 United States citizens each and every year; hard working people who have labored for a lifetime to provide for their families, doing the work that keeps this country running and a great place to live. They worked in factories, at shipyards, in mines, for the US military, as engineers, as pipefitters, as steel workers, as auto mechanics, and in so many other professions.
They came home to their loved ones exhausted and covered in dirt and dust; tired, but content that they had a job and were providing for their family. Content that they were putting food on the table and a house over their loved one's heads. Content that they were working to make a better life for their families in this generation and the next...

But what they didn't know was that while they were working so hard, they were not only slowly killing themselves, but those that they were working so hard to help; their family, their loved ones.

Quality Adjusted Life Years

Outcomes in cost-effectiveness analysis (CEA) are usually measured in terms of number of
life years saved as a result of implementation of a new intervention. For interventions with
multiple health endpoints (e.g., hospitalization, treatment, death, etc) an outcome measure
needs to combine information on both morbidity (a measure of clinical illness) and
mortality (the number of deaths in the population under consideration). The best known of
these is the quality-adjusted life year or QALY. In principle, QALYs are based on the
preferences or “utilities” of respondents reflecting tradeoffs among different health states
(e.g., total cure, partial cure, disability, death). A preference or utility weight or score of 1.0
represents perfect health and 0 represents death. The number of QALYs is calculated as the
sum of the duration spent in each health state times the utility weight for that health state.
For example, if the utility weight for a chronic condition is 0.6, and an individual remains
in that health state for 1 year and then dies, the number of QALYs is 0.6. QALYs provide a
common currency that permits comparisons among different people and across different
kinds of conditions. QALYs permit comparisons of diseases that are rapidly fatal with those
that do not produce death but instead produce years of severe disability.
The results of a CEA may be interpreted to determine whether an intervention yields good
value for the investment. An intervention can be considered more or less cost-effective
relative to either another intervention or to a benchmark value. Cost-effectiveness (CE)
ratios are usually expressed in dollars per QALY. The lower the number, the more costeffective
the intervention.
It is commonly said that an intervention that costs more than $50,000 or $100,000 per
QALY is not cost-effective, but a substantial number of healthcare interventions generally
accepted in the United States have higher CE ratios.18 The use of a fixed cost-effectiveness
threshold to define cost effectiveness ignores other determinants of social value such as
perceptions of risk. Further, the Partnership for Prevention has estimated ranges of CE ratios
using standardized methods for 25 clinical preventive services recommended for the general
population by the U.S. Preventive Services Task Force (USPSTF).19 The investigators used a
utility weight of 0.7 for chronic conditions, along with other simplifying assumptions that
make the results difficult to compare with the published CE ratios from studies that are
reported in the Purchaser’s Guide. The investigators found that one-fifth of all recommended
clinical preventive services had CE ratios between $165,000 and $450,000 per QALY in
year 2000 dollars.

preventive services and prioritizing services

Cost-Saving Clinical Preventive Services
A health intervention is cost-saving when the
intervention is 1) effective and 2) costs less in the
long run than the cost of not intervening. For
example, the cost of vaccinating all children in a
given population against measles is less than the cost of treating the children who would
contract measles without the population-wide protection of immunization.
Cost-Effective Clinical Preventive Services
A medical intervention is considered cost-effective when the intervention provides a health
benefit at an acceptable cost. The term “acceptable cost” is not precisely defined and
involves important ethical considerations such as the value of a life. The answer to this
question boils down to a concept called “willingness-to-pay”: for example, how much is an
individual, an employer, or a society willing to pay to extend the life of one individual for
one year? Some conditions produce life- and work-altering disability, but not premature
death. Economists can use willingness-to-pay methods to assess the cost-effectiveness of
methods to prevent or modify disabilities as well. In the United States, there is no
universally accepted answer to the “willingness-to-pay” question and, thus, no universally
accepted threshold that distinguishes a cost-effective health intervention from an
intervention that is not cost-effective.
In order to compare and rank various preventive interventions, economists use costeffectiveness
(CE) ratios. A CE ratio is calculated as the ratio of differences in costs and
outcomes of the status quo and the proposed intervention according to the following
formula:
A CE ratio can be interpreted as the “price” of accepting a new intervention. The lower the
price, the more cost-effective the new intervention.
For more information on defining
the value of preventive services and
prioritizing services for inclusion in a
medical benefit plan, please refer to
Part IV: The Prioritization and
Strategic Implementation of Clinical
Preventive Service Benefits.
29
Cost-effectiveness ratio =
(Outcome with intervention – Outcome without intervention)
(Cost with intervention – Cost without intervention)

Examples of Avoided Costs

.The average dollar spent on:
• Alcohol misuse screening and brief counseling interventions saves $4 in healthcare costs.15-16
• The Hib vaccine (to prevent invasive bacterial infections) saves $1.40 in direct medical
costs and $2.00 in indirect costs.17
• The hepatitis B vaccine saves 50 cents in direct medical costs and $3.10 in indirect costs.17
• The varicella vaccine (to prevent chickenpox) saves 90 cents in direct medical costs and
$5.40 in indirect costs.17
• Chlamydia testing and treatment saves $12 in complications arising from chlamydia.17

The Value of Prevention

.Purchasers can avoid or reduce the costs associated with preventable conditions by offering
coverage for — and promoting the use of — clinical preventive services.
• Clinical preventive services can help individuals avoid disease altogether (e.g., tobacco
use treatment).
• Clinical preventive services can also catch disease it in its earliest stages (e.g., cervical
cancer screening). Identifying patients with early stage disease allows clinicians to
begin treatment sooner, when interventions are generally more effective and less
expensive. Early detection and treatment of some important infectious diseases can
also prevent spread of infection to others (e.g., influenza).
• Disease avoidance and early identification have financial benefits for employers
including:
> Averted medical costs; and
> Reductions in absenteeism, lost productivity, turnover, and disability.
Like any investment aimed at keeping a workforce
healthy and productive, clinical preventive services
offer value. The value of a preventive service is
determined by its ability to prevent a significant
amount of morbidity and mortality in relation to
the cost of offering the service. Because offering a
clinical preventive service has a real (monetary)
cost and an opportunity cost (there is a finite amount of services that can be delivered and
received in a given period of time), it is important for purchasers to quantify the value of
clinical preventive services in relation to one another when making coverage decisions.
The effectiveness of most clinical preventive services, particularly those considered evidencebased,
is well-documented. The effectiveness of clinical preventive services recommended in
the Purchaser’s Guide is detailed in Part III: Evidence-Statements for Recommended Clinical
Preventive Service Benefits. The cost-effectiveness (or economic value) of clinical preventive
services is described below. More information on the economic value of preventive
intervention can be found in each evidence-statement.

Table 1.1: Percent of all Deaths in the United States Attributable to Selected Modifiable Health Behaviors, 1990-200013

.HEALTH BEHAVIOR PERCENT OF DEATHS, 1990 PERCENT OF DEATHS, 2000
Tobacco use
Poor diet/physical inactivity
Alcohol use
Infectious agents
Toxic agents
Motor vehicle injuries
Firearms
Sexual behavior
Illicit drug use
TOTAL
19%
14%
5%
4%
3%
1%
2%
1%
<1%
50%
18.1%
15.2%*
3.5%
3.1%
2.3%
1.8%
1.2%
0.8%
0.7%
46.7%
Table 1.1: Percent of all Deaths in the United States Attributable to Selected Modifiable
Health Behaviors, 1990-200013
Figure 1.2: Underlying Causes of Death in the United States, 200013
Tobacco use
Poor diet/lack of exercise
Alcohol use
Infectious agents
Toxic agents
Motor vehicle injuries
Firearms
Sexual behavior
Illicit drug use
435,000
365,000*
85,000
75,000
55,000
43,000
29,000
20,000
17,000
Source: Mokdad A, Marks JS, Stroup DE, Gerberding JL. Actual causes of death in the United States. JAMA
2004; 291(10): 1238-1245. * Correction published: Mokdad A, Marks JS, Stroup DE, Gerberding JL.
Correction: Actual causes of death in the United States 2000. JAMA 2005; 293(3): 293-294.
Source: Mokdad A, Marks JS, Stroup DE, Gerberding JL. Actual causes of death in the United States. JAMA
2004; 291(10): 1238-1245.* Correction published: Mokdad A, Marks JS, Stroup DE, Gerberding JL.
Correction: Actual causes of death in the United States 2000. JAMA 2005; 293(3): 293-294.

The Importance of Preventing Chronic Disease

.Chronic diseases result in a significant amount of
preventable morbidity and mortality in the
United States. In 2000, 46.7% of all deaths in the
United States were caused by modifiable health
behaviors (see Table 1.1).5 The U.S. Department
of Health and Human Services estimates that
approximately 33% of all deaths in the United
States are attributable to just three modifiable health behaviors: smoking, physical inactivity,
and poor eating habits.2
Chronic diseases are the leading cause of direct
healthcare costs. In fact, researchers estimate that
75% of all healthcare costs directly stem from
preventable chronic health conditions such as type 2
diabetes, hypertension, and obesity.7-8 Chronic
diseases are also a major cause of lost productivity
and disability. For example:
• In 2002, the average annual healthcare cost for
a person with diabetes was $13,243 as opposed
to $2,560 for a person without diabetes.9
• It is estimated that the indirect cost of
cardiovascular disease will total over $145 billion in 2006.10
• Each year, an estimated 39 million work days are lost to obesity-related illnesses.11
• In 1999, lost productivity due to smoking, and smoking-related illnesses cost
employers $1,897 per smoking employee.12 Excess medical expenses due to smoking
and smoking related illnesses cost employers $1,850 per smoking employee (both
figures adjusted to year 2002 dollars).12
26
1 The Role of Clinical Preventive Services in Disease Prevention and Early Detection
In 2005, NCQA identified 44.5 million
sick days due to suboptimal care
for hypertension and diabetes, two
preventable chronic diseases. The
lost productivity associated with
these disorders exceeded $7 billion.6
Each individual’s health is shaped by many factors including medical care, social
circumstances, and behavioral choices. Increasingly, there is clear evidence that the major
chronic conditions that account for so much of the morbidity and mortality in the United States,
and the enormous direct and indirect costs associated with them, in large part are preventable
— and that to a considerable degree they stem from, and are exacerbated by, individual
behaviors….. As Americans see healthcare expenditures continue to increase, it is important to
focus on strategies that reduce the prevalence and cost of preventable diseases.5

The Role of Clinical Preventive Services in Disease Prevention and Early Detection

.Prevention Helps Individuals Avoid Disease
Primary prevention is aimed at preventing the onset of disease. One way of doing
this is by controlling risk factors in healthy people that may lead to disease.
Examples of primary prevention include 1) immunizations to prevent communicable
diseases such as influenza or polio, and 2) the promotion of physical activity to
prevent conditions such as obesity that can lead to disease (e.g., type 2 diabetes).
Prevention Modifies Risk
Secondary prevention is aimed at treating a disease after its onset, but before it
causes serious complications. Secondary prevention includes 1) identifying
individuals with established disease, and 2) treating those individuals in a timely way
so as to prevent further problems (e.g., mammography screening to detect and treat
breast cancer in its earliest stages).
Prevention Reduces Disability
Tertiary prevention is aimed at treating the late or final stages of a disease so as to
minimize the degree of disability caused by that disease (e.g., administering a foot
check to a person with diabetes to identify infections that would require amputation
if left untreated).1-2

There are several different approaches to providing preventive services:
Clinical preventive services, the focus of this guide, include those services that are typically
performed in a clinical setting and are conducted by a health professional such as a
physician, nurse practitioner, physician assistant, or health educator. Although most clinical
preventive services should be conducted during individual face-to-face office visits, some
services may be conducted in groups, via the telephone, or by email communication.
Community-based preventive services (also known as population-based preventive services)
include any kind of planned activity or group of activities (including programs, policies, and
laws) designed to prevent disease or injury or promote health in a group of people (e.g.,
fluoridation of drinking water, bans on tobacco use in public places).3
Worksite-based preventive services are health promotion programs provided to employees
and their dependents. The expressed purpose of these services is to improve employee health
and prevent disease by providing an opportunity for employees to engage in primary
prevention activities. Examples include:
• Employer-sponsored worksite fitness centers or healthy cafeteria programs that
encourage healthy lifestyles.
• Employer-sponsored health risk appraisals (HRAs) that identify employees at risk for
certain conditions and diseases (e.g., type 2 diabetes, heart disease, or hypertension)
and refer those employees to their health plan for continuing care.
• Employer-sponsored services such as employee assistance programs (EAPs) that can
help employees address health / lifestyle concerns, such as stress or substance use,
before the problems escalate into a clinical disorder (e.g., substance abuse, depression).
• Employer-initiated worksite smoking bans.
• Employer-sponsored worksite influenza immunization clinics.
Preventive Interventions
There are several types of preventive interventions: screening, testing, counseling,
immunization, preventive medication, and preventive treatment.
• Screening is best described as tests that assess the likelihood of the presence of a
disease or condition in an apparently healthy individual. Screening methods include
laboratory, X-ray, and similar technical methods; they also include questions asked by
a clinician. Screening may be targeted to people at increased risk due to age, gender,
family or personal history, or other factors. Each screening tool is different in design
and method, affecting the sensitivity (ability to correctly identify those with the
disease), specificity (ability to correctly identify those without the disease), and
positive and negative predictive values of the tool. Ideally, screening tests are rapid,
simple, and safe. It is important to note that, in most instances, screening is not a
definitive diagnostic test and that a positive result on a screening test merely indicates
that the screened individual has a higher likelihood of having the disease than a peer
with a negative result. Individuals who screen positive on such tests should have
confirmatory diagnostic tests to ensure an accurate diagnosis.4
• Testing refers to any process used to determine whether a condition is present (or not)
or to assess the status of a condition. Testing may involve questioning patients (e.g., a
mental status examination to determine whether thought processes are appropriate),
physical examination (e.g., examining a heart to detect a murmur or performing a
neurologic examination to detect nerve damage), or examining blood, body fluids, or
tissues (e.g., to detect anemia, to monitor levels of blood sugar, or to see if a cancer is
present in a biopsy sample). Testing may also require sophisticated technology, such as
CT or MRI scans and other X-rays, or invasive procedures, such as heart
catheterization to detect blockage of coronary arteries. Tests may be used to:
> Screen individuals who have risk factors, but no indication of having the
condition;
> Diagnose individuals who have symptoms and signs of a condition but where a
test will add certainty about the diagnosis; or
> Monitor the progress of an individual who is being treated or being considered
for treatment, such as monitoring blood pressure over time.
• Counseling refers to a discussion between a clinician and patient about ways that
changes in personal behavior can reduce risk of illness or injury. The goal of
counseling is for clinicians to educate patients about their health risks as well as to
provide them with the skills, motivation, and knowledge they need to address their
risk behaviors (e.g., 5A framework for tobacco cessation: Ask, Advise, Assess, Assist,
Arrange). A special kind of counseling, “informed decision making,” recognizes that
people make different decisions even though their situations may seem to be similar.
Informed decision making is structured to give an individual all the information
needed to choose among different clinical options, such as whether or not to undergo
genetic testing.
• Immunization protects an individual from a specific communicable disease (e.g.,
measles) by exposing the individual to an antigen or a trace amount of inactivated
disease-causing agent, spurring the development of natural immunity.
• Preventive Medications are used to prevent the onset of disease (e.g., aspirin therapy
to prevent cardiovascular events).
• Preventive Treatment involves a procedure intended to prevent the occurrence of a
disease or to prevent the progression of a disease from one stage to another. Preventive
treatments usually refer to the use of prescription or over-the-counter (OTC)
medications, but they may also involve prescriptions for lifestyle changes (e.g.,
exercise, diet change) or other interventions. Some surgical procedures may be
considered “preventive treatment,” such as when polyps in the colon identified during
a screening colonoscopy are removed in order to prevent their progression to cancer
lesions.

The Burden of Kidney Failure

Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes.¹ Kidney failure is the final stage of chronic kidney disease (CKD).

Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases.¹ Even when diabetes is controlled, the disease can lead to CKD and kidney failure. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, ² and nearly 180,000 people are living with kidney failure as a result of diabetes.¹

People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2005, care for patients with kidney failure cost the United States nearly $32 billion.¹

Source: United States Renal Data System. USRDS 2007 Annual Data Report.

African Americans, American Indians, and Hispanics/Latinos develop diabetes, CKD, and kidney failure at rates higher than Caucasians. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to kidney disease of diabetes—factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.

¹United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.

²National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2008.

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The Course of Kidney Disease

Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes.

Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of CKD is called microalbuminuria. The kidney's filtration function usually remains normal during this period.

As the disease progresses, more albumin leaks into the urine. This stage may be called macroalbuminuria or proteinuria. As the amount of albumin in the urine increases, the kidneys' filtering function usually begins to drop. The body retains various wastes as filtration falls. As kidney damage develops, blood pressure often rises as well.

Overall, kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases.

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Diagnosis of CKD

People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.

• eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains about 1 million tiny filters made up of blood vessels. These filters are called glomeruli. Kidney function can be checked by estimating how much blood the glomeruli filter in a minute. The calculation of eGFR is based on the amount of creatinine, a waste product, found in a blood sample. As the level of creatinine goes up, the eGFR goes down.
  Kidney disease is present when eGFR is less than 60 milliliters per minute.
  The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.
• Urine albumin. Urine albumin is measured by comparing the amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amounts of creatinine but almost no albumin. Even a small increase in the ratio of albumin to creatinine is a sign of kidney damage.
  Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.
  The ADA and the NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more.

If kidney disease is detected, it should be addressed as part of a comprehensive approach to the treatment of diabetes.

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Effects of High Blood Pressure

High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it already exists.

Blood pressure is recorded using two numbers. The first number is called the systolic pressure, and it represents the pressure in the arteries as the heart beats. The second number is called the diastolic pressure, and it represents the pressure between heartbeats. In the past, hypertension was defined as blood pressure higher than 140/90, said as "140 over 90."

The ADA and the National Heart, Lung, and Blood Institute recommend that people with diabetes keep their blood pressure below 130/80.

Hypertension can be seen not only as a cause of kidney disease but also as a result of damage created by the disease. As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure, occurs. Early detection and treatment of even mild hypertension are essential for people with diabetes.

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Preventing and Slowing Kidney Disease

Blood Pressure Medicines

Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed.

An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys' glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.

An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events.

Any medicine that helps patients achieve a blood pressure target of 130/80 or lower provides benefits. Patients with even mild hypertension or persistent microalbuminuria should consult a health care provider about the use of antihypertensive medicines.

Moderate-protein Diets

In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease of diabetes consume the recommended dietary allowance for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition.

Intensive Management of Blood Glucose

Antihypertensive drugs and low-protein diets can slow CKD. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with diabetes, especially for those in the early stages of CKD.

The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes.

Intensive management of blood glucose is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes testing blood glucose frequently, administering insulin throughout the day on the basis of food intake and physical activity, following a diet and activity plan, and consulting a health care team regularly. Some people use an insulin pump to supply insulin throughout the day.

A number of studies have pointed to the beneficial effects of intensive management of blood glucose. In the Diabetes Control and Complications Trial supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels. The intensively managed patients had average blood glucose levels of 150 milligrams per deciliter-about 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients. The United Kingdom Prospective Diabetes Study, conducted from 1976 to 1997, showed conclusively that, in people with improved blood glucose control, the risk of early kidney disease was reduced by a third. Additional studies conducted over the past decades have clearly established that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of CKD.

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Dialysis and Transplantation

When people with diabetes experience kidney failure, they must undergo either dialysis or a kidney transplant. As recently as the 1970s, medical experts commonly excluded people with diabetes from dialysis and transplantation, in part because the experts felt damage caused by diabetes would offset benefits of the treatments. Today, because of better control of diabetes and improved rates of survival following treatment, doctors do not hesitate to offer dialysis and kidney transplantation to people with diabetes.

Currently, the survival of kidneys transplanted into people with diabetes is about the same as the survival of transplants in people without diabetes. Dialysis for people with diabetes also works well in the short run. Even so, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of diabetes-such as damage to the heart, eyes, and nerves.

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Good Care Makes a Difference

People with diabetes should

• have their health care provider measure their A1C level at least twice a year. The test provides a weighted average of their blood glucose level for the previous 3 months. They should aim to keep it at less than 7 percent.
• work with their health care provider regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
• have their blood pressure checked several times a year. If blood pressure is high, they should follow their health care provider's plan for keeping it near normal levels. They should aim to keep it at less than 130/80.
• ask their health care provider whether they might benefit from taking an ACE inhibitor or ARB.
• ask their health care provider to measure their eGFR at least once a year to learn how well their kidneys are working.
• ask their health care provider to measure the amount of protein in their urine at least once a year to check for kidney damage.
• ask their health care provider whether they should reduce the amount of protein in their diet and ask for a referral to see a registered dietitian to help with meal planning.

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Points to Remember

• Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure in the United States.
• People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and urine albumin.
• Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease.
• In people with diabetes, excessive consumption of protein may be harmful.
• Intensive management of blood glucose has shown great promise for people with diabetes, especially for those in the early stages of CKD.

Hope through Research

The number of people with diabetes is growing. As a result, the number of people with kidney failure caused by diabetes is also growing. Some experts predict that diabetes soon might account for half the cases of kidney failure. In light of the increasing illness and death related to diabetes and kidney failure, patients, researchers, and health care professionals will continue to benefit by addressing the relationship between the two diseases. The NIDDK is a leader in supporting research in this area.

Several areas of research supported by the NIDDK hold great potential. Discovery of ways to predict who will develop kidney disease may lead to greater prevention, as people with diabetes who learn they are at risk institute strategies such as intensive management of blood glucose and blood pressure control.

Ten most dangerous diseases

One of the worst ways for the human population to be thinned is to die from disease. Millions of people each year have perished as a result of one of any number of seemingly unstoppable diseases. Throughout history mankind has suffered the crippling and mortal effects of a ravaging disease brought on by any number of target factors ranging from animals to one single human host. Here are but ten, in no particular order, that have decimated humankind since the earliest recordings.

10. The Black Death 75 million Deaths

The Black Death, or The Black Plague, was one of the most deadly pandemics in human history. It probably began in Central Asia and spread to Europe by the late 1340s. The total number of deaths worldwide from the pandemic is estimated at 75 million people; there were an estimated 20 to 30 million deaths in Europe alone. The Black Death is estimated to have killed between one-third and two-thirds of Europe’s population. [Wikipedia]

9. Polio 10,000 Deaths since 1916

Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route. The term derives from the Greek polio (πολίός), meaning “grey”, myelon (µυελός), “spinal cord”, and -itis, which denotes inflammation. Although roughly 90% of polio infections are asymptomatic, affected individuals can exhibit a range of symptoms if the virus enters the blood stream. In less than 1% of polio cases the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis. [Wikipedia]

8. Smallpox Native Americans suffer a population drop from 12 Mil. to 235,000

Smallpox (also known by the Latin names Variola or Variola vera) is a contagious disease unique to humans. Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 30–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors. Smallpox killed an estimated 60 million Europeans, including five reigning European monarchs, in the 18th century alone. Up to 30% of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors became blind. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature. [Wikipedia]

7. Cholera 12,000 Deaths since 1991

Cholera (or Asiatic cholera or epidemic cholera) is an extreme diarrheal disease caused by the bacterium Vibrio cholerae. Transmission to humans is by ingesting contaminated water or food. The major reservoir for cholera was long assumed to be humans, but some evidence suggests that it is the aquatic environment. In its most severe forms, cholera is one of the most rapidly fatal illnesses known—a healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days without rehydration treatment. [Wikipedia]

6. Ebola 160,000 Deaths since 2000

The Ebola virus first emerged in 1976 in simultaneous outbreaks in Sudan and Zaire. It is known to be a zoonotic virus as it is currently devastating the populations of lowland gorillas in Central Africa. Despite considerable effort by the World Health Organization, no animal reservoir capable of sustaining the virus between outbreaks has been identified. However, it has been hypothesized that the most likely candidate is the fruit bat. Ebola hemorrhagic fever is potentially lethal and encompasses a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding. Mortality rates are generally very high, in the region of 80% – 90%, with the cause of death usually due to hypovolemic shock or organ failure. [Wikipedia]

5. Malaria 2.7 Million Deaths per year-2800 children per day

Malaria is a vector-borne infectious disease caused by protozoan parasites. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. Each year, it causes disease in approximately 515 million people and kills between one and three million, most of them young children in Sub-Saharan Africa. Malaria is commonly associated with poverty, but is also a cause of poverty and a major hindrance to economic development. Malaria is one of the most common infectious diseases and an enormous public-health problem. The disease is caused by protozoan parasites of the genus Plasmodium. The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species can also infect humans. Although some are under development, no vaccine is currently available for malaria; preventative drugs must be taken continuously to reduce the risk of infection. [Wikipedia]

4. Bubonic Plague 250 Million Europeans Dead (1/3 population)

Bubonic plague is mainly a disease in rodents and fleas (Xenopsylla cheopsis). Infection in a human occurs when a person is bitten by a flea that has been infected by biting a rodent that itself has been infected by the bite of a flea carrying the disease. The bacteria multiply inside the flea, sticking together to form a plug that blocks its stomach and causes it to begin to starve. The flea then voraciously bites a host and continues to feed, even though it can not quell its hunger, and consequently the flea vomits blood tainted with the bacteria back into the bite wound. The bubonic plague bacterium then infects a new victim, and the flea eventually dies from starvation. Any serious outbreak of plague is usually started by other disease outbreaks in rodents, or a rise in the rodent population. [Wikipedia]

3. Spanish Flu Between 1918-19: 50-100 Million dead

The 1918 flu pandemic (commonly referred to as the Spanish flu) was a category 5 influenza pandemic caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The Spanish flu pandemic lasted from 1918 to 1919, spreading even to the Arctic and remote Pacific islands. While older estimates put the number of killed at 40–50 million people, current estimates are that 50 million to 100 million people worldwide died, possibly more than that taken by the Black Death. This extraordinary toll resulted from the extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Between 2 and 20% of those infected by Spanish flu died, as opposed to the normal flu epidemic mortality rate of 0.1%. In some remote Inuit villages, mortality rates of nearly 100% were recorded. [Wikipedia]

2. Influenza 36,000 Deaths per year

Influenza, commonly known as flu, is an infectious disease of birds and mammals caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses). In humans, common symptoms of influenza infection are fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort. In more serious cases, influenza causes pneumonia, which can be fatal, particularly in young children and the elderly. Sometimes confused with the common cold, influenza is a much more severe disease and is caused by a different type of virus. Although nausea and vomiting can be produced, especially in children, these symptoms are more characteristic of the unrelated gastroenteritis, which is sometimes called “stomach flu” or “24-hour flu.” Typically, influenza is transmitted from infected mammals through the air by coughs or sneezes, creating aerosols containing the virus, and from infected birds through their droppings. Influenza can also be transmitted by saliva, nasal secretions, feces and blood. Infections also occur through contact with these body fluids or with contaminated surfaces. [Wikipedia]

1. AIDS 25 Million since 1981

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) in humans, and similar viruses in other species (SIV, FIV, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to decelerate the virus’ progression, there is currently no known cure. HIV, et al., are transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can come in the form of anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids. Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century; it is now a pandemic, with an estimated 38.6 million people now living with the disease worldwide. [Wikipedia]

This article is licensed under the GFDL. It uses material from the Wikipedia articles cited above.