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• Research article
• Open access
• Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

• Israel Júnior Borges do Nascimento 1 , 2 ,
• Dónal P. O’Mathúna 3 , 4 ,
• Thilo Caspar von Groote 5 ,
• Hebatullah Mohamed Abdulazeem 6 ,
• Ishanka Weerasekara 7 , 8 ,
• Ana Marusic 9 ,
• Livia Puljak   ORCID: orcid.org/0000-0002-8467-6061 10 ,
• Vinicius Tassoni Civile 11 ,
• Irena Zakarija-Grkovic 9 ,
• Tina Poklepovic Pericic 9 ,
• Alvaro Nagib Atallah 11 ,
• Santino Filoso 12 ,
• Nicola Luigi Bragazzi 13 &
• Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume  21 , Article number:  525 ( 2021 ) Cite this article

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Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento & Milena Soriano Marcolino

Medical College of Wisconsin, Milwaukee, WI, USA

Israel Júnior Borges do Nascimento

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA

Dónal P. O’Mathúna

School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany

Thilo Caspar von Groote

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Livia Puljak

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IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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Chronic Disease Mapping, an Important Strategy and Tool for Health Promotion

GUEST EDITORIAL — Volume 21 — April 25, 2024

Karen Hacker, MD, MPH 1 ; Rachel Kaufmann, PhD, MPH 1 ( View author affiliations )

Suggested citation for this article: Hacker K, Kaufmann R. Chronic Disease Mapping, an Important Strategy and Tool for Health Promotion. Prev Chronic Dis 2024;21:240110. DOI: http://dx.doi.org/10.5888/pcd21.240110 .

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Loss of life from the COVID-19 pandemic has been tremendous over the past several years (1); however, chronic diseases like heart disease and cancer still account for the largest numbers of deaths in the US. Stroke and Alzheimer disease are also among the leading causes of death (2). Chronic disease overall continues to drive national mortality and morbidity (2). Its annual national medical cost exceeds $1 trillion, which doesn’t include the cost to the economy of workdays lost to illness and disability (3). Having a chronic disease like diabetes or cancer is a risk factor for severe morbidity and mortality from COVID-19 (4). We know that many chronic diseases can be prevented (5) and that risk behaviors such as tobacco use, alcohol consumption, poor nutrition, and lack of physical activity are the leading contributors to preventable chronic disease (6). As we move forward, our country’s ability to remain resilient is dependent on chronic disease prevention and management (7).

The Centers for Disease Control and Prevention’s (CDC’s) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is dedicated to preventing chronic disease and promoting health and wellness for all. Our 9 divisions work in major areas related to both risk factors such as smoking and physical inactivity and diseases such as cancer, diabetes, and cardiovascular disorders (7). Strategies fall into 4 domains: epidemiology and surveillance to understand the prevalence and incidence of conditions and behaviors over time, environmental approaches aimed at shifting behaviors and offering opportunities for healthy living to all, health care interventions that identify disease early and help manage chronic conditions, and connecting people to the clinical care and resources they need to thrive (8). NCCDPHP relies on various types of public health surveillance data, such as individual interviews about health behaviors, clinical and laboratory data, tracking cancer survivors’ medical journeys, sales data documenting Americans’ use of tobacco and food, and vital statistics from birth and death certificates (9). These are used to understand the population’s health status and trends, identify emerging issues, and evaluate whether interventions aimed at improving health have been successful.

Helping communities, state and local partners, and all interested parties understand the prevalence of chronic disease is always a challenge. Over the last few decades, visualization has become enormously helpful (10). Mapping information that helps people literally see where conditions disproportionately affect specific areas and groups has proved enlightening. Maps created by using geographic information systems — GIS — provide the public with clear, easy-to-understand information on patterns, relationships, and levels of disease or behavior within specific geographic areas (11). For example, a study of life expectancy at birth showed disparities as large as 20.1 years across US counties, with the lowest life expectancies clustered in the Southeast and Appalachia and the highest clustered in Colorado and the California coast (12).

Animated maps can also depict changes over time. Take for example maps of the obesity epidemic, which provided a stark understanding of the epidemic’s expansion (13). Or maps of opioid overdoses, which demonstrated the severe loss of life that occurred from 2011 through 2017 (14). More recently, maps of COVID-19 morbidity linked with maps of chronic disease helped local communities direct vaccination and other mitigation efforts (15). The value of the “Aha!” moment that occurs when you see the public health surveillance data in a GIS visualization cannot be overestimated. For example, in 1995, a map of blood lead testing results for young children attending WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) clinics in Salt Lake County, Utah, showed that 76% of children with elevated blood lead levels resided in a contiguous area comprising 10% of the county (16). Consequently, the Salt Lake city and county health departments reached out to parents and physicians to encourage screening of young children living in that area. Screenings increased significantly, and additional children with elevated levels were identified. This early mapping application was uncomplicated yet revealing, providing the exact information local health departments needed to take appropriate action.

Although mapping for public health action may have begun with John Snow’s famous demonstration in 1854 of a cholera-contaminated water source (17), use of GIS in public health has proliferated over the past several decades. Today’s digital maps can involve multiple layers integrating disparate types and sources of information. GIS allows users to create maps that can examine health-related factors by location, elevation, and time. Users can integrate relevant information about population density, air quality, neighborhood wealth index, transportation routes, and food availability, as just a few examples. These “geospatial determinants of health” (18) need to be identified and shared with the people who set policy, plan interventions, treat patients, and organize communities.

In recent years, NCCDPHP has used GIS extensively to identify areas of high and low disease prevalence, and environments that dispose populations to high and low risk of chronic disease. These locations might benefit from directed interventions, producing changes over time. NCCDPHP has also sponsored efforts to increase the use of GIS by health departments. From 2018 through 2020, NCCDPHP’s Division of Heart Disease and Stroke Prevention published GIS Express for Chronic Disease , a newsletter for public health professionals to share GIS-related information (19). NCCDPHP has also supported the National Association of Chronic Disease Directors’ GIS Capacity Building Project, which provides GIS training for state and local health departments and established the Chronic Disease GIS Network to connect, support, and highlight public health professionals using GIS to address chronic disease priorities (20,21).

This Preventing Chronic Disease collection features 6 peer-reviewed articles that highlight examples of NCCDPHP’s use of GIS in preventing and addressing chronic diseases. Most were submitted in 2023 in response to a call for papers in the journal’s article category, “GIS Snapshots,” and one essay featuring GIS maps was published before the journal’s call for papers. GIS Snapshots are intended to highlight the public health application of maps in a brief format, demonstrate how GIS informs chronic disease prevention and treatment, and inspire others to use GIS in their work (22). The articles in this collection document how GIS can be used to identify populations at greatest risk, locations for public health interventions, and sometimes-surprising relationships requiring more in-depth research.

The essay by Petersen et al (23) includes maps illustrating how obesity prevalence varies startlingly across the United States — not just by region, but also by race and ethnicity. While the obesity epidemic has affected the entire nation, its burden falls especially on non-Hispanic Black and Hispanic Americans. The Evans et al article (24) also examined national disparities by race and by county, this time for stroke. They found that counties with the highest number of stroke deaths were similar for Black and White Americans, but counties with the highest stroke hospitalization rates had more divergence, a finding that suggests avenues for future study in stroke care.

Geolocating areas where resources are needed can be useful for decision makers as they consider interventions directed at patients, clinicians, and the general public. In the Wittman et al (25), Fujii et al (26), and Richardson et al (27) articles, authors sought information critical for focusing these future interventions. Wittman et al found that in Appalachia, economically distressed counties are less likely to have a diabetes self-management program, even though having to travel a long distance to participate may be an important barrier to program use in these communities. Such analyses can provide decision makers with important information about where new programs are needed to improve access. In a similar vein, Fujii et al examined locations of barber and beauty shops as potential community-based resources in fighting hypertension. Their analysis demonstrates the potential feasibility of bringing the LA Barbershop Model (28), in which blood pressure screenings are offered at community-friendly locations, to other cities. Richardson et al examined state-level improvements in colorectal cancer screening rates to elucidate patterns of use and opportunities for improvement. Although screening prevalence has increased in every state since 2012, 22 states did not meet the national target screening rate for 2020. Lastly, GIS visualizations can also prompt additional unanswered questions. For example, the analysis by Han et al (29) of chronic kidney disease and poverty at the county level showed that outcomes do not always follow predicted patterns. Poverty and chronic kidney disease were not always related as expected, and the pattern seemed to vary by region.

The articles in this collection demonstrate just a few recent uses of GIS at NCCDPHP. Mapping is used extensively by CDC programs and partners to highlight features such as prevalence and geographic distribution of risk factors, disease outcomes, and community characteristics. Geographic visualizations can be important tools during emergency responses but also play a key role in understanding relationships among disorders, risk factors, environmental context, and other factors. In 2019, Preventing Chronic Disease published an article collection, Population Health, Place, and Space: Spatial Perspectives in Chronic Disease Research and Practice . The articles in that collection provided insights on how using GIS mapping advances understanding of connections between community-level characteristics and population health and showed innovative ways of developing and applying new spatial statistical methods and geospatial tools in public health and how maps and geospatial results can be used to guide program and policy decisions (30).

Today, GIS competency is necessary for public health departments across the nation at local, county, and state levels (31). Its use will continue to evolve, and we look forward to applying it to additional chronic disease issues. As artificial intelligence becomes more available, this too will help to drive GIS capacity, such that large datasets can be transformed into clearly visible spatial analyses (32). For further information on the work across NCCDPHP and to download state and local chronic disease data for your own GIS maps, visit the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Open Data Portal (www.cdc.gov/chronicdisease/data/indicators.htm).

Corresponding Author: Karen Hacker, MD, MPH, Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta GA 30341 ( [email protected] ).

Author Affiliations: 1 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

• Centers for Disease Control and Prevention. COVID data tracker. Accessed March 6, 2024. https://covid.cdc.gov/covid-data-tracker/#datatracker-home
• Centers for Disease Control and Prevention. Leading causes of death. Accessed March 4, 2024. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
• Waters H, Graf M. The costs of chronic disease in the U.S. Milken Institute, Santa Monica; 2018. Accessed March 4, 2024. https://milkeninstitute.org/report/costs-chronic-disease-us
• Centers for Disease Control and Prevention. People with certain medical conditions. Updated February 10, 2023. Accessed April 12, 2023. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
• Centers for Disease Control and Prevention. How you can prevent chronic diseases. Accessed March 6, 2024. https://www.cdc.gov/chronicdisease/about/prevent/index.htm
• Centers for Disease Control and Prevention. About chronic diseases. Accessed March 4, 2024. https://www.cdc.gov/chronicdisease/about/index.htm
• Hacker K. The burden of chronic disease. Mayo Clin Proc Innov Qual Outcomes . 2024;8(1):112–119. PubMed doi:10.1016/j.mayocpiqo.2023.08.005
• Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion: about the center. Accessed March 6, 2024. https://www.cdc.gov/chronicdisease/center/index.htm
• Centers for Disease Control and Prevention. Chronic disease data. Accessed March 6, 2024. https://www.cdc.gov/chronicdisease/data/index.htm
• Casper M, Kramer MR, Peacock JM, Vaughan AS. Population health, place, and space: spatial perspectives in chronic disease research and practice. Prev Chronic Dis . 2019;16:E123. PubMed doi:10.5888/pcd16.190237
• US Geological Survey. What is a geographic information system (GIS)? Accessed March 4, 2024. https://www.usgs.gov/faqs/what-geographic-information-system-gis
• Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, et al. . Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Intern Med . 2017;177(7):1003–1011. PubMed doi:10.1001/jamainternmed.2017.0918
• Centers for Disease Control and Prevention. Adult obesity prevalence maps. Accessed March 4, 2024. https://www.cdc.gov/obesity/data/prevalence-maps.html
• Rich S, Kornfield M, Mayes BR, Williams A. How the opioid epidemic evolved. The Washington Post, Dec. 23, 2019. Accessed March 4, 2024. https://www.washingtonpost.com/graphics/2019/investigations/opioid-pills-overdose-analysis/
• DuClos C, Folsom J, Joiner J, Jordan M, Reid K, Bailey M, et al. . Mapping chronic disease risk factors with ArcGIS online in support of COVID-19 response in Florida. Prev Chronic Dis . 2021;18:E38. PubMed doi:10.5888/pcd18.200647
• Centers for Disease Control and Prevention (CDC). Targeted screening for childhood lead exposure in a low prevalence area — Salt Lake County, Utah, 1995-1996. MMWR Morb Mortal Wkly Rep . 1997;46(10):213–217. PubMed
• Tulchinsky TH. John Snow, cholera, the broad street pump; waterborne diseases then and now. Case studies in public health. 2018:77–99. Accessed March 28, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150208/
• Agency for Toxic Substances and Disease Registry. Getting to know GRASP. Accessed March 4, 2024. https://www.atsdr.cdc.gov/placeandhealth/getting_to_know_grasp.html
• Centers for Disease Control and Prevention. GIS express for chronic disease. Accessed March 3, 2024. https://stacks.cdc.gov/view/cdc/107843
• National Association of Chronic Disease Directors. Geographic information systems. Accessed March 3, 2024. https://chronicdisease.org/GIS/
• Miranda ML, Casper M, Tootoo J, Schieb L. Putting chronic disease on the map: building GIS capacity in state and local health departments. Prev Chronic Dis . 2013;10:E100. PubMed doi:10.5888/pcd10.120321
• Centers for Disease Control and Prevention. Preventing Chronic Disease, author’s corner. Accessed March 5, 2024. https://www.cdc.gov/pcd/for_authors/index.htm
• Petersen R, Pan L, Blanck HM. Racial and ethnic disparities in adult obesity in the United States: CDC’s Tracking to inform state and local action. Prev Chronic Dis . 2019;16:E46. PubMed doi:10.5888/pcd16.180579
• Evans K, Casper M, Schieb L, DeLara MS, Vaughan AS. Stroke mortality and stroke hospitalizations: racial differences and similarities in the geographic patterns of high burden communities among older adults. Prev Chronic Dis . 2024;21:E26.
• Wittman JT, Alexander DS, Bing M, Monteirth R, Xie H, Benoit SR, et al. . Identifying priority geographic locations for diabetes self-management education and support services in the Appalachian region. Prev Chronic Dis . 2024;21:E28.
• Fujii Y, Streeter TE, Schieb L, Casper M, Wall HK. Finding optimal locations for implementing innovative hypertension management approaches among African American populations: mapping barbershops, hair salons, and community health centers. Prev Chronic Dis . 2024;21:E10.
• Richardson LC, King JB, Thomas CC, Richards TB, Dowling NF, Coleman King S. Adults who have never been screened for colorectal cancer, Behavioral Risk Factor Surveillance System, 2012 and 2020. Prev Chronic Dis . 2022;19:E21. PubMed doi:10.5888/pcd19.220001
• Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, et al. . A cluster-randomized trial of blood-pressure reduction in Black barbershops. N Engl J Med . 2018;378(14):1291–1301. PubMed doi:10.1056/NEJMoa1717250
• Han Y, Fang X, Morgenstern H, Bragg-Gresham J, Gillespie BW, Steffick D, et al. . Mapping the overlap of poverty level and prevalence of diagnosed chronic kidney disease among Medicare beneficiaries in the United States. Prev Chronic Dis . 2024;21:E23.
• Centers for Disease Control and Prevention. Population health, place, and space: spatial perspectives in chronic disease research and practice. 2023. Accessed March 27, 2024. https://www.cdc.gov/pcd/collections/Spatial_Perspectives_2019.htm
• Brissette I, Casper M, Huston SL, Jordan M, Karns B, Kippes C, et al. . Application of geographic information systems to address chronic disease priorities: experiences in state and local health departments. Prev Chronic Dis . 2019;16:180674. Erratum in: Prev Chronic Dis. 2019 Jun 27;16:E81.
• Song Y, Kalacska M, Gašparović M, Yao J, Najibi N. Advances in geocomputation and geospatial artificial intelligence (GeoAI) for mapping. Int J Appl Earth Obs Geoinf . 2023;120:103300.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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Top 100 Disease Research Topics For Paper Writing

Students have many disease research topics to consider when writing research papers and essays. A disease occurs when the body undergoes some changes. Science philosophy has pointed at pathogens and the causes of illness. Today, medicine focus on biochemical factors, nutrition, immunology levels, and environmental toxins as the causes of diseases. Research papers on disease topics can focus on specific illnesses independently or in groups. You can also write about infectious diseases like COVID-19 and HIV or non-communicable diseases. Non-communicable diseases are also known as chronic illnesses. These are diseases that you can’t get from a sick person. They include heart disease, cancer, stroke, and lung disease. These diseases account for up to 70% of global deaths. Nevertheless, whether you opt to write about advanced topics in Lyme disease or something simple like flu, research will be paramount. You  can also buy research papers cheap, if you don’t have time for it. So, d on’t put your grade at risk and get research paper online help .  

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Top Disease Research Topics

Maybe you want to research and write a research paper on a topic that anybody will find interesting to read. In that case, consider ideas in this list of disease research topics.

• How NSAIDS lead to peptic ulcers
• What are pandemic diseases?
• What is the role of pandemic diseases in the mankind history?
• What are the symptoms of acute lung disease?
• Explain how Attention Deficit Hyperactivity Disorder affects children
• Discuss the AIDS pandemic in third world countries
• Describe the main causes of AIDS
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• Is alcohol addiction a disease?
• Discuss the Alzheimer’s disease scope and how it affects the elderly persons’ brain
• How can you help dementia or Alzheimer’s disease patients and caregivers?
• What are the symptoms of Alzheimer’s disease?
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• Explain how autoimmune thyroiditis begins
• Examine acute protective membrane inflammation in bacterial meningitis
• Compare pathology of AIDS and black death
• Discuss the effects of cancer in today’s society
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These are topics disease experts will recommend researching and writing about. And because students can write about these topics without getting complex, anybody will find them interesting. If you’re searching for research topics on Alzheimer’s disease, this list also has some ideas for you to consider.

Infectious Disease Topics for Research Papers

Are you interested in infectious disease research topics? If yes, you will find this list interesting. This category comprises hot topics in infectious disease fields. Consider some of these ideas for your research paper.

• The virology, epidemiology, and prevention of COVID-19
• The diagnosis of COVID-19
• Prevention vaccines for SARS-CoV-2 infection
• Questions people ask about COVID-19
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• COVID-19 management in a hospital setting
• Infection control for COVID-19 in homes and healthcare settings
• Skin abscess and cellulitis in adults
• Clinical manifestation, diagnosis, and epidemiology of yellow fever
• Transmission and epidemiology of measles
• Role of untreated inflammation of genital tract in HIV transmission
• Racial inequities of COVID-19 and HIV in black communities
• Community-acquired pneumonia overview in adults
• The use of procalcitonin in the infections of lower respiratory tract
• Herpes simplex virus prevention and treatment
• Uncomplicated Neisseria gonorrhea treatment
• Society guidelines for COVID-19
• Why public education is crucial in fighting COVID-19
• Overview of Ebola over the last two decades
• Investigations into the use of monoclonal antibody in treating Ebola

This category also has some of the best infectious disease presentation topics. Nevertheless, learners should prepare to research extensively before writing academic papers on these topics.

Interesting Disease Topics

Maybe you want to research and write a research paper on a topic that most people find interesting. In that case, consider these disease topics for research paper.

• Discuss bulimia as a common eating disorder
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• Is assisted suicide a way to treat terminal diseases?
• What are the effects of brain injuries?
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• Is autism a norm variant or a disease?
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• How eating disorders affect self-harm behavior
• How feminism affect anorexic women phenomenon

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Cardiovascular Disease Research Topics

Maybe you’re interested in topic ideas on heart disease. Perhaps, you want to write about an illness of the respiratory system. In that case, consider these heart disease research topics.

• An investigation of hypertrophic cardiomyopathy
• A research of the causes of coronary artery disease
• Antithrombotic therapy in surgical valve and prosthetic heart valve repair
• Intervention choice for severe cases of calcific aortic stenosis
• Prognosis and treatment of heart failure using preserved fraction of injection
• Infective endocarditis management in adults
• Risk assessment for cardiovascular disease for primary prevention
• Prognosis and treatment of acute pericarditis
• Treatment of reflex syncope in adolescents and adults
• Anticoagulant therapy for preventing thromboembolism in atrial fibrillation
• Cardiac manifestations of COVID-19 in adults
• Acute decompensated heart failure treatment
• What is hypertriglyceridemia?
• How to manage elevated low-density lipoprotein-cholesterol in cardiovascular disease
• Management and evaluation of cardiac disease
• Conduction system and arrhythmias disease and COVID-19
• Myocardial infarction in COVID-19
• Can somebody inherit a cardiac disease?
• How effective are treatments for irregular heartbeat?
• How to determine the risk for a sudden cardiac death

This list comprises some of the best special disease topics. That’s because most people reading about these topics might not have heard about them before. Nevertheless, this category also has interesting research topics for disease control that may help individuals that want to avoid or manage some illnesses.

Research Topics for Chronic Disease

You probably know somebody living with a chronic illness. Unlike controversial topics in infectious disease, people don’t talk much about chronic illnesses. And for this reason, some people don’t know about these illnesses. When writing about non-communicable illnesses, you can settle for human genetic disease topics or even research topics for sickle cell disease. Here are some of the topics about non-communicable diseases that you can write about.

• The risk of breast cancer after childbirth
• Postpartum PTSD- Effective preventative measures
• Experiences of females suffering from cardiac disease during pregnancy- A systematic review
• Husbands attendance and knowledge of wives’ postpartum care in rural areas
• Postpartum depression screening by perinatal nurses in hospitals
• Gestational diabetes mellitus screening from the rural perspective
• Maternal mortality- How to help cardiac and pregnant patients
• Sex differences in cardio metabolic disorders and major depression- Effect of immune exposures and prenatal stress
• Determinants and prevalence of anxiety and antepartum depressive symptoms in fathers and expectant mothers- Outcomes from perinatal psychiatric morbidity
• Evaluating the effect of community health workers on non-communicable diseases, tuberculosis, malnutrition, antenatal care, and family planning
• History of women with postpartum affective disorder and the risk of future pregnancies recurrence
• New self-care guide package and its effect on neonatal and maternal results in gestational diabetes
• Depressive symptoms and life events in pregnant women- Moderating the resilience role and social support
• Gestational diabetes and ethnic disparities
• Pregnancy and diabetes- Opportunities and risks
• Cardiovascular disease maternal death reduction- A pragmatic investigation
• Meta-analysis and systematic review of gestational diabetes mellitus diagnosis with a two-step or one-step associations and approaches with negative pregnancy outcomes
• Gestational diabetes mellitus treatment in women- A Cochrane systematic overview
• Research in non-communicable diseases in Africa- A strategic investment
• How to finance the national response to non-communicable diseases

Whether you opt to write about research paper topics in Huntington’s disease or non-communicable liver disease topics, you have to engage in extensive research to come up with a brilliant paper. We have more health research topics for you, so don’t hesitate to check them. Therefore, select an idea you will be comfortable researching and writing about. That way, you will avoid enduring a boring process of investing your topic and writing the paper. If you want to hire someone to help you with your assignment, just c ontact us with a “ do my research paper now ” request and we’ll get your papers done. 

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Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

• James Shaw 1 , 13 ,
• Joseph Ali 2 , 3 ,
• Caesar A. Atuire 4 , 5 ,
• Phaik Yeong Cheah 6 ,
• Armando Guio Español 7 ,
• Judy Wawira Gichoya 8 ,
• Adrienne Hunt 9 ,
• Daudi Jjingo 10 ,
• Katherine Littler 9 ,
• Daniela Paolotti 11 &
• Effy Vayena 12  

BMC Medical Ethics volume  25 , Article number:  46 ( 2024 ) Cite this article

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The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

Conclusions

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Peer Review reports

Introduction

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table  1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table  2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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As a nursing practitioner, it is necessary to understand the nuances of antimicrobial therapy, as well as the differences between viral and bacterial infections. In the following, the differing categories of antimicrobial agents will be stated and defined. Furthermore, the vital differences between viral and bacterial infections will be elucidated. Finally, the importance of differentiating between viral and bacterial infections in an antimicrobial agent prescription will be explained. The ability to treat viral and bacterial infections is greatly increased with the help of antimicrobial agents, but it is crucial to properly identify the type of infection before prescribing treatment.

Categories of Antimicrobial Agents

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INTRODUCTION SLE and Multiple Sclerosis both being autoimmune conditions, still show lot of diversities in their clinical manifestations. SLE is now also termed as Connective Tissue Disease to avoid confusion with other related diseases. Whereas Multiple Sclerosis is more of an inflammatory disease affecting the Central Nervous System. *Prevalence of SLE : 30 in 100000 in Caucasians to 200/100000 in Afro-Carribeans *Prevalence of Multiple Sclerosis: 120 in 100000 (in UK) *Gender Distribution : Both the diseases are commoner in women than in men

ETIOLOGY OF THE DISEASES

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Before the 20th century, diabetic conditions were rare in the human population. In early 1900, the problem was known as “honey urine” identified among the rich gluttons. In the late years, many physicians distinguished and identified insulin dependent and non-insulin dependent. The adoption and classification of the disease as type one and type 2 diabetes took place in 1970. Until 1950, diet change was considered the only remedy for the problem. Type 2 diabetes was first identified and seen common among the wealthy people. Improvement in living standards influenced development of this condition among the people lower social class

Description and explanation of the disease

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The musculoskeletal system is responsible for all body movements. The skeletal component of the muscular system provides a structural framework for the body, which protects the internal organs and provides the shape for the body. It acts as the storage for calcium and phosphorus and plays a part in mineral homeostasis(Davidson, 2002)

Functions of the skeletal system(Haywood, 2008)

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Among individuals aged 13 to 17 years, previously non-vaccinated with BCG, and who are in direct contact with TB, is the combination therapy of INH 900mg + Rifapentine 900mg once a week for 3 months as effective when compared to individuals aged 13 to 17 years who are also previously non-vaccinated with BCG and have completed the gold prophylactic standard of INH 300mg daily for 6 months in preventing active tuberculosis?

ARTICLE CITATION:

Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155–2166.

CATEGORY: Infectious Diseases

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The complexity of managing hyperthyroidism is largely attributable to the multi systemic effects, a diverse range of symptoms and a wide clinical spectrum ranging from subclinical to severe disease. This work briefly touches on the trends in management of hyperthyroidism and key research findings that have guided clinical approaches over the last 2 decades. Literature review highlighted some niche areas that have predominantly been the focus of research. These include, evaluation of diagnostic criteria, interpretation of laboratory results and prognostic implications of subclinical thyroid disease.

Diagnostics

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Volume 30, Number 7—July 2024

Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Domestic Dairy Cattle and Cats, United States, 2024

Suggested citation for this article

We report highly pathogenic avian influenza A(H5N1) virus in dairy cattle and cats in Kansas and Texas, United States, which reflects the continued spread of clade 2.3.4.4b viruses that entered the country in late 2021. Infected cattle experienced nonspecific illness, reduced feed intake and rumination, and an abrupt drop in milk production, but fatal systemic influenza infection developed in domestic cats fed raw (unpasteurized) colostrum and milk from affected cows. Cow-to-cow transmission appears to have occurred because infections were observed in cattle on Michigan, Idaho, and Ohio farms where avian influenza virus–infected cows were transported. Although the US Food and Drug Administration has indicated the commercial milk supply remains safe, the detection of influenza virus in unpasteurized bovine milk is a concern because of potential cross-species transmission. Continued surveillance of highly pathogenic avian influenza viruses in domestic production animals is needed to prevent cross-species and mammal-to-mammal transmission.

Highly pathogenic avian influenza (HPAI) viruses pose a threat to wild birds and poultry globally, and HPAI H5N1 viruses are of even greater concern because of their frequent spillover into mammals. In late 2021, the Eurasian strain of H5N1 (clade 2.3.4.4b) was detected in North America ( 1 , 2 ) and initiated an outbreak that continued into 2024. Spillover detections and deaths from this clade have been reported in both terrestrial and marine mammals in the United States ( 3 , 4 ). The detection of HPAI H5N1 clade 2.3.4.4b virus in severe cases of human disease in Ecuador ( 5 ) and Chile ( 6 ) raises further concerns regarding the pandemic potential of specific HPAI viruses.

In February 2024, veterinarians were alerted to a syndrome occurring in lactating dairy cattle in the panhandle region of northern Texas. Nonspecific illness accompanied by reduced feed intake and rumination and an abrupt drop in milk production developed in affected animals. The milk from most affected cows had a thickened, creamy yellow appearance similar to colostrum. On affected farms, incidence appeared to peak 4–6 days after the first animals were affected and then tapered off within 10–14 days; afterward, most animals were slowly returned to regular milking. Clinical signs were commonly reported in multiparous cows during middle to late lactation; ≈10%–15% illness and minimal death of cattle were observed on affected farms. Initial submissions of blood, urine, feces, milk, and nasal swab samples and postmortem tissues to regional diagnostic laboratories did not reveal a consistent, specific cause for reduced milk production. Milk cultures were often negative, and serum chemistry testing showed mildly increased aspartate aminotransferase, gamma-glutamyl transferase, creatinine kinase, and bilirubin values, whereas complete blood counts showed variable anemia and leukocytopenia.

In early March 2024, similar clinical cases were reported in dairy cattle in southwestern Kansas and northeastern New Mexico; deaths of wild birds and domestic cats were also observed within affected sites in the Texas panhandle. In > 1 dairy farms in Texas, deaths occurred in domestic cats fed raw colostrum and milk from sick cows that were in the hospital parlor. Antemortem clinical signs in affected cats were depressed mental state, stiff body movements, ataxia, blindness, circling, and copious oculonasal discharge. Neurologic exams of affected cats revealed the absence of menace reflexes and pupillary light responses with a weak blink response.

On March 21, 2024, milk, serum, and fresh and fixed tissue samples from cattle located in affected dairies in Texas and 2 deceased cats from an affected Texas dairy farm were received at the Iowa State University Veterinary Diagnostic Laboratory (ISUVDL; Ames, IA, USA). The next day, similar sets of samples were received from cattle located in affected dairies in Kansas. Milk and tissue samples from cattle and tissue samples from the cats tested positive for influenza A virus (IAV) by screening PCR, which was confirmed and characterized as HPAI H5N1 virus by the US Department of Agriculture National Veterinary Services Laboratory. Detection led to an initial press release by the US Department of Agriculture Animal and Plant Health Inspection Service on March 25, 2024, confirming HPAI virus in dairy cattle ( 7 ). We report the characterizations performed at the ISUVDL for HPAI H5N1 viruses infecting cattle and cats in Kansas and Texas.

Materials and Methods

Milk samples (cases 2–5) and fresh and formalin-fixed tissues (cases 1, 3–5) from dairy cattle were received at the ISUVDL from Texas on March 21 and from Kansas on March 22, 2024. The cattle exhibited nonspecific illness and reduced lactation, as described previously. The tissue samples for diagnostic testing came from 3 cows that were euthanized and 3 that died naturally; all postmortem examinations were performed on the premises of affected farms.

The bodies of 2 adult domestic shorthaired cats from a north Texas dairy farm were received at the ISUVDL for a complete postmortem examination on March 21, 2024. The cats were found dead with no apparent signs of injury and were from a resident population of ≈24 domestic cats that had been fed milk from sick cows. Clinical disease in cows on that farm was first noted on March 16; the cats became sick on March 17, and several cats died in a cluster during March 19–20. In total, >50% of the cats at that dairy became ill and died. We collected cerebrum, cerebellum, eye, lung, heart, spleen, liver, lymph node, and kidney tissue samples from the cats and placed them in 10% neutral-buffered formalin for histopathology.

At ISUVDL, we trimmed, embedded in paraffin, and processed formalin-fixed tissues from affected cattle and cats for hematoxylin/eosin staining and histologic evaluation. For immunohistochemistry (IHC), we prepared 4-µm–thick sections from paraffin-embedded tissues, placed them on Superfrost Plus slides (VWR, https://www.vwr.com ), and dried them for 20 minutes at 60°C. We used a Ventana Discovery Ultra IHC/ISH research platform (Roche, https://www.roche.com ) for deparaffinization until and including counterstaining. We obtained all products except the primary antibody from Roche. Automated deparaffination was followed by enzymatic digestion with protease 1 for 8 minutes at 37°C and endogenous peroxidase blocking. We obtained the primary influenza A virus antibody from the hybridoma cell line H16-L10–4R5 (ATCC, https://www.atcc.org ) and diluted at 1:100 in Discovery PSS diluent; we incubated sections with antibody for 32 minutes at room temperature. Next, we incubated the sections with a hapten-labeled conjugate, Discovery anti-mouse HQ, for 16 minutes at 37°C followed by a 16-minute incubation with the horse radish peroxidase conjugate, Discovery anti-HQ HRP. We used a ChromoMap DAB kit for antigen visualization, followed by counterstaining with hematoxylin and then bluing. Positive controls were sections of IAV-positive swine lung. Negative controls were sections of brain, lung, and eyes from cats not infected with IAV.

We diluted milk samples 1:3 vol/vol in phosphate buffered saline, pH 7.4 (Gibco/Thermo Fisher Scientific, https://www.thermofisher.com ) by mixing 1 unit volume of milk and 3 unit volumes of phosphate buffered saline. We prepared 10% homogenates of mammary glands, brains, lungs, spleens, and lymph nodes in Earle’s balanced salt solution (Sigma-Aldrich, https://www.sigmaaldrich.com ). Processing was not necessary for ocular fluid, rumen content, or serum samples. After processing, we extracted samples according to a National Animal Health Laboratory Network (NAHLN) protocol that had 2 NAHLN-approved deviations for ISUVDL consisting of the MagMax Viral RNA Isolation Kit for 100 µL sample volumes and a Kingfisher Flex instrument (both Thermo Fisher Scientific).

We performed real-time reverse transcription PCR (rRT-PCR) by using an NAHLN-approved assay with 1 deviation, which was the VetMAX-Gold SIV Detection kit (Thermo Fisher Scientific), to screen for the presence of IAV RNA. We tested samples along with the VetMAX XENO Internal Positive Control to monitor the possible presence of PCR inhibitors. Each rRT-PCR 96-well plate had 2 positive amplification controls, 2 negative amplification controls, 1 positive extraction control, and 1 negative extraction control. We ran the rRT-PCR on an ABI 7500 Fast thermocycler and analyzed data with Design and Analysis Software 2.7.0 (both Thermo Fisher Scientific). We considered samples with cycle threshold (Ct) values <40.0 to be positive for virus.

After the screening rRT-PCR, we analyzed IAV RNA–positive samples for the H5 subtype and H5 clade 2.3.4.4b by using the same RNA extraction and NAHLN-approved rRT-PCR protocols as described previously, according to standard operating procedures. We performed PCR on the ABI 7500 Fast thermocycler by using appropriate controls to detect H5-specific IAV. We considered samples with Ct values <40.0 to be positive for the IAV H5 subtype.

We conducted genomic sequencing of 2 milk samples from infected dairy cattle from Texas and 2 tissue samples (lung and brain) from cats that died at a different Texas dairy. We subjected the whole-genome sequencing data to bioinformatics analysis to assemble the 8 different IAV segment sequences according to previously described methods ( 8 ). We used the hemagglutinin (HA) and neuraminidase (NA) sequences for phylogenetic analysis. We obtained reference sequences for the HA and NA segments of IAV H5 clade 2.3.4.4 from publicly available databases, including GISAID ( https://www.gisaid.org ) and GenBank. We aligned the sequences by using MAFFT version 7.520 software ( https://mafft.cbrc.jp/alignment/server/index.html ) to create multiple sequence alignments for subsequent phylogenetic analysis. We used IQTree2 ( https://github.com/iqtree/iqtree2 ) to construct the phylogenetic tree from the aligned sequences. The software was configured to automatically identify the optimal substitution model by using the ModelFinder Plus option, ensuring the selection of the most suitable model for the dataset and, thereby, improving the accuracy of the reconstructed tree. We visualized the resulting phylogenetic tree by using iTOL ( https://itol.embl.de ), a web-based platform for interactive tree exploration and annotation.

Gross Lesions in Cows and Cats

All cows were in good body condition with adequate rumen fill and no external indications of disease. Postmortem examinations of the affected dairy cows revealed firm mammary glands typical of mastitis; however, mammary gland lesions were not consistent. Two cows that were acutely ill before postmortem examination had grossly normal milk and no abnormal mammary gland lesions. The gastrointestinal tract of some cows had small abomasal ulcers and shallow linear erosions of the intestines, but those observations were also not consistent in all animals. The colon contents were brown and sticky, suggesting moderate dehydration. The feces contained feed particles that appeared to have undergone minimal ruminal fermentation. The rumen contents had normal color and appearance but appeared to have undergone minimal fermentation.

The 2 adult cats (1 intact male, 1 intact female) received at the ISUVDL were in adequate body and postmortem condition. External examination was unremarkable. Mild hemorrhages were observed in the subcutaneous tissues over the dorsal skull, and multifocal meningeal hemorrhages were observed in the cerebrums of both cats. The gastrointestinal tracts were empty, and no other gross lesions were observed.

Microscopic Lesions in Cows and Cats

Figure 1 . Mammary gland lesions in cattle in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. A, B) Mammary gland...

The chief microscopic lesion observed in affected cows was moderate acute multifocal neutrophilic mastitis ( Figure 1 ); however, mammary glands were not received from every cow. Three cows had mild neutrophilic or lymphocytic hepatitis. Because they were adult cattle, other observed microscopic lesions (e.g., mild lymphoplasmacytic interstitial nephritis and mild to moderate lymphocytic abomasitis) were presumed to be nonspecific, age-related changes. We did not observe major lesions in the other evaluated tissues. We performed IHC for IAV antigen on all evaluated tissues; the only tissues with positive immunoreactivity were mastitic mammary glands from 2 cows that showed nuclear and cytoplasmic labeling of alveolar epithelial cells and cells within lumina ( Figure 1 ) and multifocal germinal centers within a lymph node from 1 cow ( Table 1 ).

Figure 2 . Lesions in cat tissues in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Tissue sections were stained with...

Both cats had microscopic lesions consistent with severe systemic virus infection, including severe subacute multifocal necrotizing and lymphocytic meningoencephalitis with vasculitis and neuronal necrosis, moderate subacute multifocal necrotizing and lymphocytic interstitial pneumonia, moderate to severe subacute multifocal necrotizing and lymphohistiocytic myocarditis, and moderate subacute multifocal lymphoplasmacytic chorioretinitis with ganglion cell necrosis and attenuation of the internal plexiform and nuclear layers ( Table 2 ; Figure 2 ). We performed IHC for IAV antigen on multiple tissues (brain, eye, lung, heart, spleen, liver, and kidney). We detected positive IAV immunoreactivity in brain (intracytoplasmic, intranuclear, and axonal immunolabeling of neurons), lung, and heart, and multifocal and segmental immunoreactivity within all layers of the retina ( Figure 2 ).

PCR Data from Cows and Cats

We tested various samples from 8 clinically affected mature dairy cows by IAV screening and H5 subtype-specific PCR ( Table 3 ). Milk and mammary gland homogenates consistently showed low Ct values: 12.3–16.9 by IAV screening PCR, 17.6–23.1 by H5 subtype PCR, and 14.7–20.0 by H5 2.3.4.4 clade PCR (case 1, cow 1; case 2, cows 1 and 2; case 3, cow 1; and case 4, cow 1). We forwarded the samples to the National Veterinary Services Laboratory, which confirmed the virus was an HPAI H5N1 virus strain.

When available, we also tested tissue homogenates (e.g., lung, spleen, and lymph nodes), ocular fluid, and rumen contents from 6 cows by IAV and H5 subtype-specific PCR ( Table 3 ). However, the PCR findings were not consistent. For example, the tissue homogenates and ocular fluid tested positive in some but not all cows. In case 5, cow 1, the milk sample tested negative by IAV screening PCR, but the spleen homogenate tested positive by IAV screening, H5 subtype, and H5 2.3.4.4 PCR. For 2 cows (case 3, cow 1; and case 4, cow 1) that had both milk and rumen contents available, both samples tested positive for IAV. Nevertheless, all IAV-positive nonmammary gland tissue homogenates, ocular fluid, and rumen contents had markedly elevated Ct values in contrast to the low Ct values for milk and mammary gland homogenate samples.

We tested brain and lung samples from the 2 cats (case 6, cats 1 and 2) by IAV screening and H5 subtype-specific PCR ( Table 3 ). Both sample types were positive by IAV screening PCR; Ct values were 9.9–13.5 for brain and 17.4–24.4 for lung samples, indicating high amounts of virus nucleic acid in those samples. The H5 subtype and H5 2.3.4.4 PCR results were also positive for the brain and lung samples; Ct values were consistent with the IAV screening PCR ( Table 3 ).

Phylogenetic Analyses

We assembled the sequences of all 8 segments of the HPAI viruses from both cow milk and cat tissue samples. We used the hemagglutinin (HA) and neuraminidase (NA) sequences specifically for phylogenetic analysis to delineate the clade of the HA gene and subtype of the NA gene.

Figure 3 . Phylogenetic analysis of hemagglutinin gene sequences in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Colors indicate different...

For HA gene analysis, both HA sequences derived from cow milk samples exhibited a high degree of similarity, sharing 99.88% nucleotide identity, whereas the 2 HA sequences from cat tissue samples showed complete identity at 100%. The HA sequences from the milk samples had 99.94% nucleotide identities with HA sequences from the cat tissues, resulting in a distinct subcluster comprising all 4 HA sequences, which clustered together with other H5N1 viruses belonging to clade 2.3.4.4b ( Figure 3 ). The HA sequences were deposited in GenBank (accession nos. PP599465 [case 2, cow 1], PP599473 [case 2, cow 2], PP692142 [case 6, cat 1], and PP692195 [case 6, cat 2]).

Figure 4 . Phylogenetic analysis of neuraminidase gene sequences in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Colors indicate different...

For NA gene analysis, the 2 NA sequences obtained from cow milk samples showed 99.93% nucleotide identity. Moreover, the NA sequences derived from the milk samples exhibited complete nucleotide identities (100%) with those from the cat tissues. The 4 NA sequences were grouped within the N1 subtype of HPAI viruses ( Figure 4 ). The NA sequences were deposited in GenBank (accession nos. PP599467 [case 2, cow 1], PP599475 [case 2, cow 2], PP692144 [case 6, cat 1], and PP692197 [case 6, cat 2]).

This case series differs from most previous reports of IAV infection in bovids, which indicated cattle were inapparently infected or resistant to infection ( 9 ). We describe an H5N1 strain of IAV in dairy cattle that resulted in apparent systemic illness, reduced milk production, and abundant virus shedding in milk. The magnitude of this finding is further emphasized by the high death rate (≈50%) of cats on farm premises that were fed raw colostrum and milk from affected cows; clinical disease and lesions developed that were consistent with previous reports of H5N1 infection in cats presumably derived from consuming infected wild birds ( 10 – 12 ). Although exposure to and consumption of dead wild birds cannot be completely ruled out for the cats described in this report, the known consumption of unpasteurized milk and colostrum from infected cows and the high amount of virus nucleic acid within the milk make milk and colostrum consumption a likely route of exposure. Therefore, our findings suggest cross-species mammal-to-mammal transmission of HPAI H5N1 virus and raise new concerns regarding the potential for virus spread within mammal populations. Horizontal transmission of HPAI H5N1 virus has been previously demonstrated in experimentally infected cats ( 13 ) and ferrets ( 14 ) and is suspected to account for large dieoffs observed during natural outbreaks in mink ( 15 ) and sea lions ( 16 ). Future experimental studies of HPAI H5N1 virus in dairy cattle should seek to confirm cross-species transmission to cats and potentially other mammals.

Clinical IAV infection in cattle has been infrequently reported in the published literature. The first report occurred in Japan in 1949, where a short course of disease with pyrexia, anorexia, nasal discharge, pneumonia, and decreased lactation developed in cattle ( 17 ). In 1997, a similar condition occurred in dairy cows in southwest England leading to a sporadic drop in milk production ( 18 ), and IAV seroconversion was later associated with reduced milk yield and respiratory disease ( 19 – 21 ). Rising antibody titers against human-origin influenza A viruses (H1N1 and H3N2) were later again reported in dairy cattle in England, which led to an acute fall in milk production during October 2005–March 2006 ( 22 ). Limited reports of IAV isolation from cattle exist; most reports occurred during the 1960s and 1970s in Hungary and in the former Soviet Union, where H3N2 was recovered from cattle experiencing respiratory disease ( 9 , 23 ). Direct detection of IAV in milk and the potential transmission from cattle to cats through feeding of unpasteurized milk has not been previously reported.

An IAV-associated drop in milk production in dairy cattle appears to have occurred during > 4 distinct periods and within 3 widely separated geographic areas: 1949 in Japan ( 17 ), 1997–1998 and 2005–2006 in Europe ( 19 , 21 ), and 2024 in the United States (this report). The sporadic occurrence of clinical disease in dairy cattle worldwide might be the result of changes in subclinical infection rates and the presence or absence of sufficient baseline IAV antibodies in cattle to prevent infection. Milk IgG, lactoferrin, and conglutinin have also been suggested as host factors that might reduce susceptibility of bovids to IAV infection ( 9 ). Contemporary estimates of the seroprevalence of IAV antibodies in US cattle are not well described in the published literature. One retrospective serologic survey in the United States in the late 1990s showed 27% of serum samples had positive antibody titers and 31% had low-positive titers for IAV H1 subtype-specific antigen in cattle with no evidence of clinical infections ( 24 ). Antibody titers for H5 subtype-specific antigen have not been reported in US cattle.

The susceptibility of domestic cats to HPAI H5N1 is well-documented globally ( 10 – 12 , 25 – 28 ), and infection often results in neurologic signs in affected felids and other terrestrial mammals ( 4 ). Most cases in cats result from consuming infected wild birds or contaminated poultry products ( 12 , 27 ). The incubation period in cats is short; clinical disease is often observed 2–3 days after infection ( 28 ). Brain tissue has been suggested as the best diagnostic sample to confirm HPAI virus infection in cats ( 10 ), and our results support that finding. One unique finding in the cats from this report is the presence of blindness and microscopic lesions of chorioretinitis. Those results suggest that further investigation into potential ocular manifestations of HPAI H5N1 virus infection in cats might be warranted.

The genomic sequencing and subsequent analysis of clinical samples from both bovine and feline sources provided considerable insights. The HA and NA sequences derived from both bovine milk and cat tissue samples from different Texas farms had a notable degree of similarity. Those findings strongly suggest a shared origin for the viruses detected in the dairy cattle and cat tissues. Further research, case series investigations, and surveillance data are needed to better understand and inform measures to curtail the clinical effects, shedding, and spread of HPAI viruses among mammals. Although pasteurization of commercial milk mitigates risks for transmission to humans, a 2019 US consumer study showed that 4.4% of adults consumed raw milk > 1 time during the previous year ( 29 ), indicating a need for public awareness of the potential presence of HPAI H5N1 viruses in raw milk.

Ingestion of feed contaminated with feces from wild birds infected with HPAI virus is presumed to be the most likely initial source of infection in the dairy farms. Although the exact source of the virus is unknown, migratory birds (Anseriformes and Charadriiformes) are likely sources because the Texas panhandle region lies in the Central Flyway, and those birds are the main natural reservoir for avian influenza viruses ( 30 ). HPAI H5N1 viruses are well adapted to domestic ducks and geese, and ducks appear to be a major reservoir ( 31 ); however, terns have also emerged as an important source of virus spread ( 32 ). The mode of transmission among infected cattle is also unknown; however, horizontal transmission has been suggested because disease developed in resident cattle herds in Michigan, Idaho, and Ohio farms that received infected cattle from the affected regions, and those cattle tested positive for HPAI H5N1 ( 33 ). Experimental studies are needed to decipher the transmission routes and pathogenesis (e.g., replication sites and movement) of the virus within infected cattle.

In conclusion, we showed that dairy cattle are susceptible to infection with HPAI H5N1 virus and can shed virus in milk and, therefore, might potentially transmit infection to other mammals via unpasteurized milk. A reduction in milk production and vague systemic illness were the most commonly reported clinical signs in affected cows, but neurologic signs and death rapidly developed in affected domestic cats. HPAI virus infection should be considered in dairy cattle when an unexpected and unexplained abrupt drop in feed intake and milk production occurs and for cats when rapid onset of neurologic signs and blindness develop. The recurring nature of global HPAI H5N1 virus outbreaks and detection of spillover events in a broad host range is concerning and suggests increasing virus adaptation in mammals. Surveillance of HPAI viruses in domestic production animals, including cattle, is needed to elucidate influenza virus evolution and ecology and prevent cross-species transmission.

Dr. Burrough is a professor and diagnostic pathologist at the Iowa State University College of Veterinary Medicine and Veterinary Diagnostic Laboratory. His research focuses on infectious diseases of livestock with an emphasis on swine.

Acknowledgment

We thank the faculty and staff at the ISUVDL who contributed to the processing and analysis of clinical samples in this investigation, the veterinarians involved with clinical assessments at affected dairies and various conference calls in the days before diagnostic submissions that ultimately led to the detection of HPAI virus in the cattle, and the US Department of Agriculture National Veterinary Services Laboratory and NAHLN for their roles and assistance in providing their expertise, confirmatory diagnostic support, and communications surrounding the HPAI virus cases impacting lactating dairy cattle.

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• American Veterinary Medical Association . States with HPAI-infected dairy cows grows to six. USDA provides guidance for veterinarians, producers on protecting cattle from the virus. 2024 [ cited 2024 Apr 10 ]. https://www.avma.org/news/states-hpai-infected-dairy-cows-grows-six
• Figure 1 . Mammary gland lesions in cattle in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. A, B) Mammary...
• Figure 2 . Lesions in cat tissues in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Tissue sections were stained...
• Figure 3 . Phylogenetic analysis of hemagglutinin gene sequences in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Colors indicate...
• Figure 4 . Phylogenetic analysis of neuraminidase gene sequences in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Colors indicate...
• Table 1 . Microscopic lesions observed in cattle in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024
• Table 2 . Microscopic lesions observed in cats in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024
• Table 3 . PCR results from various specimens in study of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024

Suggested citation for this article : Burrough ER, Magstadt DR, Petersen B, Timmermans SJ, Gauger PC, Zhang J, et al. Highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus infection in domestic dairy cattle and cats, United States, 2024. Emerg Infect Dis. 2024 Jul [ date cited ]. https://doi.org/10.3201/eid3007.240508

DOI: 10.3201/eid3007.240508

Original Publication Date: April 29, 2024

Table of Contents – Volume 30, Number 7—July 2024

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618 Disease Essay Topics & Examples

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After the Covid-19 pandemic, students are regularly assigned to explore health issues and precautions. Whether you’re interested in writing about risk factors, chronic illnesses, or lifestyles, we can help! Check our disease essay topics and get a perfect title for your paper.

• Control of Communicable Diseases Hence, there is a need to prioritize the control and prevention levels for these diseases upon the occurrence of the calamities.
• Hypertension. Disease Analysis The successful detection of genes that leads to the development of hypertension enables health experts to develop the appropriate strategies to mitigate the impact of the said disease.
• Living With a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
• Cell Organelles, Their Functions, and Disease Mitochondria-associated membrane, a specialized sub-group of the ER has specific lipid and protein composition and is involved in cross-communication with mitochondria.
• AIDS/HIV: Description of the Disease This is the very reason why many who have acquired HIV or AIDS result to an eventual death because of the lack of immune system that protects them from acquiring other forms of illnesses.
• Chronic Kidney Disease Diagnosis and Treatment Timely intervention and the search for appropriate treatment can help to reduce the impact of the ailment on the human body, and the use of various methods to combat the disease can be effective in […]
• Health Promotion and Disease Prevention and Management Strategies Since its founding in 1884, Montefiore Medical Center has worked tirelessly to improve the health and well-being of the people of New York City.
• Family Trend Change and Disease Factor The hastening of our customs and the organization of the family as the leading structure has led to a new family trend.
• The Case Study of Patient With Late-Stage Alzheimer’s Disease In the majority of cases of Alzheimer’s, it has been shown that patients are unable to make decisions on their own and are also unable to communicate their assent verbally.
• Health Behaviors That Impact Risk Factors for Diseases High BMI characterizing overweight and obesity is a risk factor for According to Key et al, healthy eating is second to lack of smoking in the prevention of cancers.
• Poverty and Diseases A usual line of reasoning would be that low income is the main cause of health-related problems among vulnerable individuals. Such results that the relationship between mental health and poverty is, in fact, straightforward.
• The Role of Man in Environment Degradation and Diseases The link between environmental degradation and human beings explains the consequences of the same in relation to the emergence of modern-age diseases.
• Noncommunicable Diseases, Risk Factors and Prevention Alcohol use is a significant preventable risk factor for noncommunicable diseases such as cirrhosis of the liver, certain types of cancer and cardiovascular disease, and injury from violence and road clashes and collisions.
• Meningitis Disease: Symptoms and Treatment The various transmission paths are detailed below: Mother to child-During delivery, some of the bacteria and viruses that cause meningitis can be transmitted from the mother to the baby.
• Aspects of Childhood Diseases In my opinion, to some factors that may be contributing to an increased incidence of childhood allergies and asthma belong the state of the environment and people’s lack of responsibility for the health of others.
• Sexually Transmitted Diseases: Community Teaching Plan Based on the study by Hailu, Mergal, Nishimwe, Samson, and Santos, the majority of adolescents receive no advice from parents concerning the unwanted consequences of sexual relationships, including STDs. Since 2013, in people aged 15-24, […]
• Genitourinary System Diseases Diagnostics Current medical problem: 28-year-old female presents to the clinic with a 2-day history of frequency, burning, and pain upon urination; increased lower abdominal pain and vaginal discharge over the past week.
• Gastroesophageal Reflux Disease (GERD) Treatment The proton pump inhibitor is in the class of drugs that permanently block gastric proton pump which is essential for the secretion of the gastric acid by the parietal cells of the stomach.
• Family Nursing Care Plan – Health Promotion and Disease Prevention Therefore, it is critical to consider a holistic approach to take care of the family and improve the quality of their lifestyle.
• Chronic Obstructive Pulmonary Disease and Lifestyle Secondary inhalation increases the total burden of the gases taken into the lungs leading to COPD and respiratory symptoms. In summary, COPD obstructs the flow of air from an individual’s lungs.
• Vesicoureteral Reflux Disease and Nursing Intervention The main cause of the disease is the dysfunction of the bladder as a result of nerve or muscle failure and blockage of the processes that control bladder emptying nursing care plans, 2019).
• Gallstone Disease Pathology and Treatment She further claims that the pain rotates around the chest and on the lower side of the inferior angle of the scapula.
• Cardiovascular Disease and Caffeine Effects There have been conflicting ideas about the effects of caffeine on the body especially in relation to the development of cardiovascular diseases. The increased prevalence of cardiovascular diseases is mainly due to the changes in […]
• The Pathophysiology of Hashimoto’s Disease The antibodies that bind and block the thyroid-stimulating hormone receptor are a potential cause of the impairment of the functionality of the thyroid gland.
• Sexually Transmitted Diseases and Infections Education Before discussing the benefits of normalizing the dialogue about STDs and STIs, it is crucial to examine their impact on the health of the infected persons and current incidence and distribution in the United States.
• Coronary Artery Disease The inner walls of the arteries contain a lot of plaques, which leads to the restriction of the blood flow to the heart since arteries have abnormal function and tone.
• Rheumatoid Arthritis: Disease’ Biology Autoimmune diseases include a range of common conditions that affect the health of people in the United States, and according to the statistics, being a female is an important risk factor in the majority of […]
• Chronic Kidney Disease: Prevention and Treatment A transplant surgery does not cure CKD. Therefore, recipients need to continue with other disease management strategies such as medications, diet, or dialysis.
• Bacteria Infectious Diseases: Strep Throat Practitioners need to closely follow the current research about infectious pathogens to suggest the most effective and safe treatment to the patients. Further analysis is necessary to understand the dynamics of infectious disease development and […]
• Chronic Kidney Disease Etiology and Management The statistics show the percentage of the population having CKD and the relation between demographic factors and the risk of developing this disease.
• Chronic Kidney Disease (CKD) This paper assesses the magnitude of CKD, develops a program, and sets objectives on how the program can be used to achieve the aim of the Healthy People 2020 in relation to CKD.
• Diagnosis and Treatment of Crohn’s Disease The research was primarily conducted to report the causes of crohn’s disease and the people who can be infected by the disease.
• Social Determinants of Chronic Obstructive Pulmonary Disease and Inequalities in the UK Consequently, social determinants are one of the key factors determining people’s health in the UK. Social determinants significantly impact people’s health, particularly the emergence of chronic obstructive pulmonary disease in the UK.
• Analysis of Coronary Heart Disease In such a manner, the delivery of blood with oxygen and nutrients to the whole body is timely and undisrupted, which guarantees the healthy functioning of the whole physiological system.
• Poliomyelitis: Disease Overview The international agencies in health courses will help in the comprehension of the various health agencies in the world. This will help me in choosing the correct agency to work for so that it will […]
• Blood Disorder: Disease Analysis One of the common causes of the disease is the taking of foods poor in iron. This is a condition of the blood.
• Policy Proposal in Regards to Sex Workers as a Site of Disease Spread Sex workers generally refer to those who work in the sex industry and provide sexual services. According to the International Union of Sex Workers, the term encompasses all those who work in the industry whether […]
• Mercury Toxicity: Description of Disease These different forms of mercury produce different levels of toxicity; however, all of them are toxic depending on the route of exposure, the period of such and the dose involved.
• “Disease of the Skin and Disease of the Heart”: China History At the same time, inside of the country the Government was facing a threat from the Communist protesters. He called these threats “the disease of the heart” and “the disease of the skin”.
• Addiction: Is It a Disease or Moral Failing? According to the journal article of clinical and research news, a disease can be defined as a complicated relationship existing between the environment of an individual and the general genetic makeup that combines together resulting […]
• Health, Disease and Social Problems As AIDS is relevant to the end of the last century, and the beginning of the millennium, there were questions, on whether the new disease is connected to the cultural changes that occurred in the […]
• Typhoid Fever as a Global Infectious Disease A detailed description of a place where the disease is located allows one to understand its geography and focus on a particular area for the study to estimate the probability of contamination of different communities.
• Community Teaching Work Plan: Diseases Prevention Topic: The topic of the teaching work plan proposal hereof is Prevention of Sexually Transmitted Diseases in Miami, Florida. Since the number of the affected is on the rise in Miami, preventive teaching is required.
• Disease Control and Prevention Centers The Centers for Disease Control and Prevention is one of the leading agencies in the United States that track, monitor, and evaluate emerging health problems. Such measures continue to meet the health needs of more […]
• Microbes and Human Health: Benefits, Disease, and Policies Microbes are capable of causing diseases to enter the body through different channels, including the digestive and respiratory tracts and damaged skin. Various policies are in place at the local, state, and federal levels to […]
• Methicillin-Resistant Staphylococcus Aureus Disease The primary measure in case of MRSA appearance is the activation of search-and-destroy protocols against its further dissemination, while settings that are affected by this pathogen are also prompted to utilize MRSA guidelines for personal […]
• Parkinson’s Disease: Pathogenic Mechanisms and Treatments The purpose of Parkinson’s disease research is to better understand the causes, mechanisms, and progression of the disease and to develop new treatments and management strategies to improve the lives of people living with Parkinson’s […]
• Chronic Obstructive Pulmonary Disease: Concept Map The goal of the study is to examine the issue in light of the patient’s other illnesses. Overall, Beryl’s past medical history and current symptoms can be explained by the pathological processes that occur in […]
• Parkinson’s Disease: Overall Information Various demographic and environmental factors may be involved in the genesis of Parkinson’s disease and influence the severity of the condition, which widens the perspective on the topic.
• Aspects of Pelvic Inflammatory Disease This is an infection of the upper parts of the female genital organs, and inflammatory diseases of the pelvic organs usually occur in sexually active women.
• Infectious Disease and Public Health A comprehensive evaluation and analysis of the disease, including its overall description, strategies to address it, and current research on the disease, allows the government to develop more practical and effective strategies to address the […]
• Worst Infectious Disease Outbreaks in History: Plague The type of specimen to be studied may also include separable ulcers or punctate from the carbuncle in the cutaneous form of plague and material from the pharynx taken with a swab, and sputum in […]
• Managing Crohn’s Disease: A Comprehensive Approach A diet low in fiber and residue is also recommended to minimize the likelihood of intestinal blockage brought on by a constricted stricture.
• Chronic Diseases as a Public Health Issue A low level of education is related to the escalated risk of the chronic condition, and the illness poses a barrier to achieving higher educational levels.
• Mitochondrial Diseases Treatment Through Genetic Engineering Any disorders and abnormalities in the development of mitochondrial genetic information can lead to the dysfunction of these organelles, which in turn affects the efficiency of intracellular ATP production during the process of cellular respiration.
• The Gap in Quality Care of Chronic Obstructive Pulmonary Disease While nowadays, numerous efforts are made to address the gap in the quality of treatment of patients with COPD, the problem of poor communication between diverse services is rooted in history.
• Telemedicine for Chronic Diseases: PICOT (Research) Question Hypertension is a diagnosis related to diseases of the heart and blood vessels associated with high blood pressure for a long time. Doing this is virtually more convenient for both the doctor and the patient.
• The Urinary Disease and the Use of Diuretics Moreover, it is necessary to have a clear understanding of how diuretics, which are prescribed for other diseases of the body, act on the functioning of the nephron.
• The Use of Telemedicine in Chronic Diseases Effective management of chronic diseases is essential for improving patient outcomes, reducing healthcare costs, and decreasing the burden on healthcare systems. A specific opportunity in this area is the use of telemedicine for the management […]
• How Spirituality Affects Disease Development The appearance of various diseases can be considered from the point of view of religion as a consequence of this fall and means the punishment of a person.
• Mental Health Diseases in the Middle Ages and Today In the Middle Ages, the manner in which the conditions were addressed varied depending on the philosophical and religious beliefs of the patient as well as the caregiver.
• Diseases of the Past and Their Modern Names Although studying the history of diseases and epidemics of the past is valuable for identification, one must be aware of the risks of arriving at speculative conclusions due to a limited understanding of the contextual […]
• Heart Diseases in Florida: Cardiology The Centers for Disease Control in Florida encourages the management of heart ailments and dementia in all the regions and Districts of Florida.
• Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
• Cholera Disease: Diagnostics and Treatment Cholera may quickly become critical because in most serious cases, the swift loss of a large number of electrolytes and fluids in the body may contribute to death in a few hours.
• Sexually Transmitted Diseases Discussion Therefore, the reason why HIV is so hard to cure is that it resides in the nucleus, which is a stable reservoir where it goes undetected by the immune system and the medication administered. Chlamydia […]
• Ebola Disease, Its Nature and Treatment The virus takes its name from the Ebola River in the Democratic Republic of the Congo, where it was first reported.
• Sexually Transmitted Diseases: Curable and Incurable However, if an individual with the disease fails to get treatment and does not take care of themselves by not sharing needles or not wearing a condom, then they could spread the disease.
• Coronary Heart Disease Caused by Stress It is essential to study the degree of influence of stress on the development of coronary heart disease since, in this way, it will be possible to prevent it more successfully.
• Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
• Neurobiology of Disease: Article Summary Additionally, the study has demonstrated that activation of Akt by Ca2+ signaling, which is mediated by the AMPA receptor, controls glioblastoma cell growth and motility.
• Immunization: Vaccines for Infectious Diseases Vaccines induce active immune defense against a dangerous substance A vaccine is a portion of a microbial pathogen Vaccination evolved from homeopathic perspectives By the 11th century of the use of variola scabs in the […]
• Autoimmune Diseases: Types, Epidemiology, Symptoms & More The other type is a grave disease that alters the normal functioning of the thyroid gland, causing one to have weight loss. The existence of autoimmune diseases means a balance discrepancy between the regulator of […]
• Chronic Kidney Disease and Phosphorus Management The expected outcome is improved staff knowledge that will lead to better patient education and may raise the bar in the care of patients with CKD.
• Periodontal Disease: Patient-Focused Explanation Infections and inflammatory responses of the gums and jawbone that support the teeth are the primary causes of periodontal disease. Periodontal disease is caused by inflammation around a tooth because bacteria in the mouth infect […]
• Infectious Disease Assignment: Herpes Zoster Regarding agent factors, the presence of the varicella-zoster virus in the body after the recovery from chickenpox predisposes the host to develop HZ even if the virus remains dormant for years. HZ’s progression is linked […]
• Neurological and Musculoskeletal Systems and Diseases The role of trigger phenomena in the musculoskeletal system, as well as the participation of the peripheral component in the occurrence of headaches, is considered indisputable.
• Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
• Cardiovascular Disease in Minorities The disease in question is left ventricular dysfunction, which is caused by social determinants of health, as she is a minority.
• Lyme Disease and Its Clinical Spectrum However, the possibility of infection is not excluded by contact with the feces of the tick on the skin, with subsequent absorption by scratching. With effective therapy and recovery, the level of antibodies is normalized.
• Chronic Obstructive Pulmonary Disease in Vulnerable Settings In vulnerable settings, COPD becomes a challenge for healthcare facilities due to a combination of factors contributing to the prevalence of the condition, especially in rural areas.
• Anorexia as Social and Psychological Disease Many who were used to his weight knew, though Bob is not the most handsome, but a charming person, kind and friendly.
• Infectious and Lifestyle Diseases Negative impacts include a plethora of serious diseases, and not the least dangerous of them are infectious. In conclusion, a person’s body can be affected by a plethora of conditions that stem from outside intrusions […]
• Infectious and Chronic Diseases: Causes & Prevention These include poor nutrition, which leads to the emergence of vulnerabilities due to the failure to supply the necessary amount of nutrients and vitamins to the patient’s body, which leads to a drop in the […]
• Parkinson’s Disease: Symptoms and Predictors The hypothesis was: “differences in the genotype and gender of rats affect the predicates of motor activity deficit as a symptom of Parkinson’s disease, namely anxiety and ultrasonic vocalization”.
• Pollution and Respiratory Disease in Louisiana The United States of America is an industrial powerhouse, a powerful nation that devoted much of its time to the growth and development of the petrochemical industry.
• Alzheimer’s Disease Diagnosis and Intervention The accumulation of plaques and tangles in the brain is a hallmark of the disease, resulting in the death of neurons and a decline in mental capacity.
• Hand, Foot, and Mouth Disease in Children There is an increase in the number of confirmed cases, and the curve has a steep slope. The incubation period is the time from exposure to the onset of symptoms.
• Peripheral Arterial Disease: Symptoms, Treatment, and Complications Thus, the authors point to the need for a more thorough and thoughtful study of the disease and how it can affect the development of other abnormalities in the human body.
• Antioxidants: The Role in Preventing Cancer and Heart Disease Some of antioxidants are more widely known as vitamins E, C, and carotenoids, and have a reputation of preventing cardiovascular diseases and cancer.
• Alzheimer’s Disease: Assessment and Intervention The caregiver is recommended to install safety locks and alarms on all doors and windows to prevent the patient from leaving the apartment without supervision.
• Obesity and Coronary Heart Disease As shown in Table 1, the researchers have collected data about the rate of obesity and CHD in the chosen group.
• Colorectal Cancer Screening and Its Effect on Disease Incidence The purpose of this quantitative quasi-experimental quality improvement project was to determine if or to what degree the implementation of the Agency for Healthcare Research and Quality’s System Approach to Tracking and Increasing Screening for […]
• The End-Stage Renal Disease Program According to Benjamin and Lappin, the condition directly adds to the global incidence of death and morbidity by raising cardiovascular risk globally.
• Ascites as Gastrointestinal Disease Process Ascites is a condition characterized by the pathological accumulation of fluid in the abdominal cavity. The condition worsens the quality of life and can lead to complications such as kidney failure, increased risk of infections, […]
• Analysis of Communicable Disease: Influenza Droplets landing on the mouth or nose can promote transmission of the virus, which can also happen from touching infected surfaces and transferring into the mouth.
• COPD, Valvular Disease, and CHF: Risk of Heart Disease Under these conditions, it is possible to analyze the case regarding the high risks of chronic obstructive pulmonary disease, valvular disease, and congestive heart failure.
• Human Immunodeficiency Virus Among Emerging Diseases In the United States, the people affected by the disorder are children at the age of 13 or younger, gay and bisexual men. HIV can be discovered by assessing the number of CD4 and the […]
• Non-Alcoholic Fatty Liver Disease Factors Thus, the pathogenesis of NAFLD is linked to the accumulation of fat in the liver and the subsequent development of insulin resistance.
• Tetanus Infection, Disease and Treatment The disease interferes with breathing due to spasms in the ribs and the diaphragm muscles and rigidity in the abdominal and back muscles.
• Measuring Motor Functions in Parkinson’s Disease The main idea of the Hoehn and Yahr scale is to measure the progress of symptoms and the level of disability in PD patients.
• Nonalcoholic Fatty Liver Disease and Choline Theory The purpose of the paper lies in showing how ineffective conventional techniques have been to the masses and how the idea of choline supplements might be the key to mitigating NAFLD.
• Morbidity and Mortality Factors of Disease Management It is worth noting that it is necessary to take into account not only the number of deaths from a particular disease but also the total number, as well as the severity of tolerance.
• Preventing Sexually Transmitted Diseases Among Older Adults The Centers for Disease Control and Prevention provides a standard curriculum for adults that helps with understanding the types of STDs and how to avoid them.
• Pathophysiology of Chronic Obstructive Pulmonary Disease and Lung Cancer It is also evident that the illness acts fast due to the continuous multiplication of the cancer cells leading to breathing disruptions and eventual death. This sustained weight loss is primarily essential to the advancement […]
• Sickle Cell Disease and Its Hereditary Factor Given that SCD affects over 100,000 Americans, I do not support the practice of testing African Americans for the sickle-cell trait.
• Sexually Transmitted Diseases Analysis Since the topic is sensitive and it might even be uncomfortable for the audience, the teacher will have to set the tone of the lesson to be serious and devoid of humor.
• US Centers for Disease Control and Prevention Given the number and effect of barriers, CDC is committed to reducing their impact and helping the public to provide equal opportunities and improve the quality of life.
• Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
• Infectious Diseases Affect the International Health Community Infectious diseases present a severe issue for the global health situation due to the transition ways and risk of a potential epidemic.
• The Effect of Vitamin E on Cardiovascular Diseases In conclusion, the apparent difference is linked with the bias during the selection of participants for each study, as observational studies tend to be less objective.
• Bilinguals’ Cognitive-Linguistic Abilities and Alzheimer’s Disease This irregularity is reflected in the preserved linguistic abilities, including code-switching and semantic fluency, and the declined functions in translation, picture naming, and phonemic fluency, calling for improved therapy and testing practices.
• Epidemiology of Heart Disease Among Canadians At the end of the study, the connection between heart disease epidemiological evidence, community strategies, and internal and external impacts will be revealed to contribute to a better application of knowledge.
• Chronic Obstructive Pulmonary Disease Prevalence The studies discussed to provide an in-depth analysis of the risk factors of COPD, the relation that the environment and other respiratory conditions have on the development of the condition, and the burden it has […]
• Chronic and Communicable Diseases Prevention The weakness faced by each agency in relation to its mission may be the lack of research of the groups they work with.
• Cushing Disease and Endocrine Control In turn, ACTH stimulates the production of cortisol by the adrenal cortex in the adrenal glands. In general, it is possible to say that a 24-hour urine test may be regarded as a highly accessible […]
• America’s Growing Clean Water Crisis and the Resulting Diseases The current water crisis in Flint, Michigan, has focused a lot of attention on the state of water infrastructure. Lastly, there will be a not adequate amount of water to help in dissolving the nutrients […]
• An Overview of Ebola Virus Disease: Pathogen, Symptoms, and Treatment First recognized as an emerging disease in 1977, this pathogen belongs to the genus Ebolavirus and is characterized by virulence, with up to 80% mortality rate among the infected.
• Air Pollution and Lung Disease To design a study in order to explore the link between lung disease and air pollution, it would be possible to follow a four-step process started by identifying the level or unit of analysis.
• Occupational Skin Disease Development In order to control the risk of developing OSD, it is necessary to use various preventive measures and changes in the process of performing official duties at the enterprise.
• Communicable Diseases: Hepatitis C The disease poses a threat to the public health of global populations and health security due to the increase in the number of international travel and the economic growth of countries.
• Ebola Viral Disease Impact Analysis The Ebola Virus Disease can be caused by various viruses, including the Tai Forest virus, Bundibugyo virus, the Zaire Ebola virus, and the Sudan virus.
• Preterm Delivery: Risks of Disease and Mortality in Healthy People 2030 Efforts to lower the risk of disease and mortality associated with preterm delivery might be primary, secondary, or tertiary in nature.
• Vitamin E for Prevention of Heart Diseases As experiments on the benefits of vitamin E show, ‘swimming’ is not always the key to a completely healthy life, in which the risk of a heart attack is reduced to a minimum.
• Managing Dementia and Alzheimer’s Disease The PICOT question is “In the care of Alzheimer’s and dementia patients, does integrated community-based care as compared to being in a long-term care facility improve outcome throughout the remainder of their lives”.
• Emergency Preparedness: Disease Control and Prevention Prevention, vaccination, vital capacity, and others matter. Risk factors, prevention, and treatment are essential.
• Obesity and Related Inflammatory Diseases in the Cardiovascular System The hypothesis is to prove the decrease of TNF- concentration after ghrelin implementation on adipose cells. The study is quantitative with the measurement of the concentration of the pro-inflammatory molecule before and after adding the […]
• Types of Chronic Obstructive Lung Diseases Chronic obstructive pulmonary diseases are illnesses associated with the violation of the normal functioning of the human respiratory apparatus. The first health problem is characterized by the inflammation of the bronchi and is accompanied by […]
• Pathophysiology of Alzheimer’s Disease The study will discuss the pathophysiology of Alzheimer’s disease, such as risk factors, cellular involvement, genetic influences, and the interventions of the available therapy’s pharmacological Interventions.
• Obesity and Inflammatory Diseases in the Cardiovascular System One of the largest risks connected to obesity is the damage to the proper functioning of the cardiovascular system. However, when a part of this system is impaired due to obesity, the delivery process becomes […]
• Center for Disease Control Wonder Database Telehealth clinical, or the administration, monitoring, and synchronization of nursing support, the Prevention Guidelines Database delivered using digital techniques to expand coverage to sufferers within the United States.
• Heart Failure and Chronic Obstructive Pulmonary Disease Respiratory: The patient is diagnosed with COPD and continues to smoke up to two packs a day. Psychosocial: The patient is conscious and able to communicate with the staff, informing them of his state of […]
• Preventing Readmission: Chronic Obstructive Pulmonary Disease To reduce the possibility of Marcia’s readmission, authorities should provide her with social interaction and communities that would support her case and issue. In addition, Marcia should stop smoking and develop a healthy routine to […]
• Plan for Management of Patient with Schizophrenia and Heart Disease About 1% of the world’s population suffers from schizophrenia About 0. 7% of the UK population suffers from schizophrenia Schizophrenia can manifest any time from early adulthood onwards, but rarely when a person is below […]
• Family Nurse Practitioner Case Study: Infectious Diseases Second, the nurse practitioner should ask about any medications that the patient has used to treat the pain and the time when the cough is more pronounced.
• Gastroesophageal Reflux Disease (GERD) For instance, cardiovascular problem such as chest pain or angina due to the lack of oxygen can cause a burning pain in the epigastric areas. The excessive consumption of alcohol can cause inflammation and bleeding […]
• Pfizer Vaccine: Centers for Disease Control and Prevention The researcher adds that the MHRA claims that people with severe allergic reactions to the components of the vaccines should not receive the medicine.
• Aspects of Chronic Disease Management The main difference between the treatment of chronic and acute ailments is that the indicators used to analyze the effectiveness of the treatment of acute diseases are usually associated with the recovery time of the […]
• Hospitalization Chronic Obstructive Pulmonary Disease Prevention Plan Since Albuterol Oral Inhalation did not work best for Marcia, her care providers had to alter the medications that she used in managing the COPD to acquire effectiveness and keep her away from the hospitals […]
• Alzheimer’s Disease: Definition, Stages, Diagnosis Alzheimer’s disease is the most common type of dementia, and it is a condition in which the brain stops appropriately performing its functions.
• Acromegaly: Assessment and Disease Research Cushing’s disease is caused not by medications but by the presence of a benign tumor in the pituitary gland and adrenocorticotropic hormone production.
• Health Maintenance Plan For Coronary Artery Disease In the initial stages of the atheroma, the transfer of SMCs from tunica-based media towards the intima seems to be a vital outcome of the ongoing inflammatory fermentation.
• Climate Change and Disease-Carrying Insects In order to prevent the spreading of the viruses through insects, the governments should implement policies against the emissions which contribute to the growth of the insects’ populations.
• The History of Human Disease: COVID-19 The symptoms, severity of the disease, and duration of the illness vary greatly based on numerous factors, such as the immunity of a person, strain of the virus, and others.
• Systemic Links to Periodontal Diseases Periodontitis is a chronic inflammatory disease that damages the tooth-supporting apparatus that is, its soft tissue and bone which, if untreated, will lead to tooth loss.
• Nursing Care for End-Stage Renal Disease These issues are worsened by the fact that the patient has edema, the signs of which are swelling under the skin in the legs and arms produced by a buildup of fluid in one body’s […]
• Avian Influenza as Viral Disease It is spread by influenza type A, and some of the strains can bypass the species barrier and cause infections to others, such as pigs and humans.
• Minors Seeking Treatment for Sexually Transmitted Diseases Without Parental Consent Due to the severity of sexually transmitted diseases, it is very important for doctors to provide minors with the necessary care.
• Parkinson’s Disease: Neurological and Musculoskeletal Pathophysiologic Processes The condition results from the deficiency of dopamine in the brain that interferes with the functions of the motor movements like body movement.
• The Kidney Disease Blog Analysis The second essential element of this blog is the opportunity to get to the latest research in my field and see what rehabilitation methods promise the best results.
• Epidemiology of Chronic Obstructive Pulmonary Disease The effects of air pollution on human health are primarily dependent on the pollutants, their components, and the sources of the pollution.
• Aspects of Chronic Disease and Obesity Obesity is a complex condition that enhances the risk of other diseases’ development and complications. Chronic inflammation in the body that obesity causes leads to pain, in particular the development of arthritis.
• Nutrition in Relation to Heart Diseases in African Americans While the causes of such an occurrence are varied, dietary and nutrition-based difficulties are one of the factors that can increase the risk of cardiovascular diseases among African Americans.
• Alzheimer’s Disease in an Iranian Patient The patient in the company of his son returns to the clinic after four weeks. Since the patient shows no side effects of the disease and an increase in Exelon to 6 mg orally BID […]
• Growing Burden of Chronic Disease in Australia It an important intervention to reduce the burden of chronic diseases because individuals will not depend entirely on healthcare providers in the management of the conditions2.
• Features of Treatment and Diagnosis of Severe Diseases The main topic of the previous module was pneumonia and the methods of its treatment. The amount and intensity of the drug should match the weight of the patient and the type of pathogen.
• Chronic Obstructive Pulmonary Disease and Bacterial Bronchitis In chronic bronchitis, bronchial inflammation causes bronchia edema and an increase in the number and size of the goblet cells and mucus glands in the epithelium. The incidence and prevalence of COPD in the US […]
• Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
• How the Eczema Disease Affects Epithelial Tissues Because of the wide coverage of epithelial tissues in the body, there are many types of diseases affecting the tissue, and it is essential to know them to understand how the disease affects epithelial tissues. […]
• Benefits of Bicycling for Persons With Parkinson’s Disease: Analysis The key issue in this article’s introduction is the goal-directed physical exercise and general physical activities that are in practice to alleviate the challenges faced by PD patients.
• Diets to Prevent Heart Disease, Cancer, and Diabetes
• Disease Pandemics in the Situations of Typhoid Mary and Novak Djokovic
• The Chronic Obstructive Pulmonary Disease: Improving the Patients’ Services
• Chronic Renal Failure Disease: Causes, the Population Affected, and Prognosis
• Genetic Disease in a Pregnant Woman and Fetus
• Chronic Obstructive Pulmonary Disease and Bowel Resection
• Aspects of Parkinson’s Disease
• Diagnoses and Medication of Bowel Disease
• Treatment and Diagnosis of Crohn’s Disease
• Reducing Risks of Heart Diseases
• Critiquing Research: Fatigue in the Presence of Coronary Heart Disease
• J.P.’s Case Assessment: Patient With Sickle Cell Disease
• Malaria Disease Control and Prevention
• Chronic Obstructive Pulmonary Disease in a Female Patient
• The Infectious Diseases Policy Process
• Examination of Albinism Genetic Disease
• Diagnosis, Treatment, and Prognosis of Naegleria Fowleri Disease
• Gout Disease: Variations and Treatments
• Parkinson’s Disease: The Main Aspects
• Epidemiology: Eye Diseases and COVID-19
• Mr. Akkad and Alzheimer’s Disease: Case Study
• Social Marketing in Reducing Cardiovascular Disease
• Discussion of Neurofibromatosis Disease
• Analysis of Sources for COVID-19 and Eye Diseases
• Ethical Challenges in Healthcare and Nursing Practice: Obesity-Related Diseases
• Hyperphosphatemia and Chronic Kidney Disease Link
• Gonorrhea Disease Transmission and Treatment
• Dietary Approaches to Heart Disease and Hypertension
• Threat Factors of Coronary Artery Disease
• Alzheimer’s Disease: History, Mechanisms and Treatment
• American Heart Association on Coronary Artery Disease
• Obesity and Kidney Disease Treatment and Rehabilitation
• Stroke: The Human Disease Project
• Helicase and Deficiencies-Related Diseases
• Disease Surveillance Program: Hepatitis A Awareness
• Cardiovascular Disease Drugs: Amiodarone, Flecainide, Hydrochlorothiazide
• Epidemics and Diseases of the Past and Microbiomes
• Quality of Life and Chronic Pain: Musculoskeletal Diseases
• The Coronavirus Disease 2019: Health Services for Non-Communicable Diseases
• Strategies to Control the Incidence of Diseases
• How Outbreaks of Respiratory Disease Affect the Way Mass Events Are Held Indoors
• Do Mental Diseases Cause Obesity?
• Centers for Disease Control and Prevention’s Role in Influenza Preparedness
• How Is Globalization Affecting Rates of Disease
• Coronavirus Disease 2019: Statistical Analysis
• Nutrients: Food and Nutrients in Disease Management
• Medicare in Case of End-Stage Renal Disease
• Blood Transfusions in the Management of Hematological Diseases
• Coronary Artery Disease Causes and Related Hypotheses
• Infectious and Noninfectious Diseases Acquisition
• Public Health. Burden of Disease in Nigeria
• Governmental Challenges of Disease Surveillance
• Self-Management and Prevention of Diseases
• Heart Disease: Population Affected- Brooklyn
• Grave’s Disease: Symptoms and Treatment
• Crohn’s Disease: Treatment Plan and Prognosis
• Effects of Age and Aging on the Immune Response to Diseases Such as COVID-19
• Alzheimer’s Disease: Causes and Treatment
• Distribution of Funds for Subsequent Management of Zoonotic Infectious Diseases
• Osteoporosis: Pathophysiology, Health Promotion, and Disease Prevention
• Chronic Disease Aggravation in Joint Surgery
• Pregnant Women With Type I Diabetes: COVID-19 Disease Management
• Gastroesophageal Reflux Disease Overview
• Lecithin, Trimethylamine Oxide, and Heart Diseases
• Sexually Transmitted Diseases and Implications
• Centers for Disease Control and Prevention
• Soybean: Physiological Traits, Management, Main Disease
• Diabetes Insipidus: Disease Process With Implications for Healthcare Professionals
• Chlamydia Sexually Transmitted Disease
• Cardiovascular Disease Research in the Arab World
• Lyme Disease Diagnostics: Culturing and Staining Procedures
• The Parkinson’s Disease Analysis
• Chronic Disease Prevention With Physical Activity
• Center for Disease Control, National Archives Catalog Photo
• Michael J Fox: Parkinson’s Disease Case Study
• Chronic Obstructive Pulmonary Disease, Hypertension, and Heart Failure: The Case Study
• Social Stigma of Sexually Transmitted Diseases in North America
• Approaches to Health Promotion and Disease Prevention
• Covid-19: Serious Disease in Comparison to Flu
• Cardiac Diseases in Pregnancy
• Frontotemporal Dementia vs. Alzheimer’s Disease in a Patient
• Inflammatory Bowel Disease and Irritable Bowel Syndrome
• Ulcerative Colitis and Crohn’s Disease Comparison
• Kidney Function Tests: Chemical Methods Used to Diagnose Kidney Disease
• Global Health Issue: The Coronavirus Disease
• Alzheimer’s Disease: Diagnostic and Treatment
• Communicable Disease Health Education Tool: HIV, AIDS
• Parkinson’s Disease Case Study Analysis
• Heart Disease Among Hispanic and Latino Population
• Pharmacologic Treatment for Gastroesophageal Reflux Disease
• Werner Syndrome: Disease Process and Nursing Management
• Business Intelligence Systems: Coronavirus Disease
• Frail Elderly: Geriatric Chronic Disease
• Communicable Diseases: Rubeola and Pertussis
• Primary Adrenocortical Insufficiency (Addison’s Disease)
• Cardiovascular Disease Profile in Female Patient
• The Types of Sexually Transmitted Diseases
• The Effect of Music on People With Alzheimer’s Disease
• Nutrition Importance in Preventing Future Diseases
• Detection of Newborn Disease by Liquid Chromatography-Mass Spectrometry
• The Global Burden of Disease
• Zoonotic Diseases: Leishmaniasis
• Allergic Diseases and the Hygiene Hypothesis
• The Relationship Between Vitamin D Deficiency and Asthma Disease in Children
• Public Health and Chronic Disease – Obesity
• Emerging Infectious Diseases (EIDs)
• Chronic Kidney Disease Analysis
• Asthma: Culture and Disease Analysis
• Cardiovascular Diseases and Health Promotion in Women
• Creutzfeldt – Jakob Disease: Diagnosis, Control, Treatment
• HIV and AIDS as a Chronic Disease: The Unique Contributions of Nursing Through Philosophical, Theoretical, and Historical Perspectives
• Sickle Cell Disease Complications and Management
• End-Stage Renal Disease: Creating Awareness Among Patients
• Health Disparities & Chronic Kidney Disease
• Epidemiological, Trends and Patterns of Norovirus Disease
• Cardiology: Women and Heart Diseases
• Disease Control and Prevention: The Evaluation Process
• Swine Flu Disease in Australia
• Researching Chlamydia Trachomatis Disease
• Parkinson’s Disease: Aetiology, Risk Factors, and Symptoms
• Chronic Obstructive Pulmonary Disease: 80-Year-Old Female Patient
• The Diagnosis and Prevention of Chronic Diseases
• Heart Disease and Stroke in Sarasota County
• Rabies in South Africa: Tropical Disease Control
• End Stage Renal Disease and Hemodialysis
• Community Health: Alzheimer’s Disease
• Tasmanian Devil’s Facial Tumor Disease
• Coronary Heart Disease: Review
• End Stage Renal Disease Prevalence in African American
• Hypoparathyroid Disease: Review
• Celiac Disease Description and Treatment
• End-Stage Renal Disease and Hemodialysis
• Risk Factors Involving People with Ischaemic Heart Disease: In-Depth Interview
• Osteoarthritis Disease and Its Risk Factors
• Disease Trends and the Delivery of Health Care Services
• Emerging Infectious Disease: Epidemiology and Evolution of Influenza Viruses
• Food Borne Diseases Associated With Chilled Ready to Eat Food
• Inherited Mutant Gene Leading to Pompes Disease
• Challenges of Living With Alzheimer Disease
• The Burden of Alzheimer’s Disease
• Congestive Heart Failure – One of the Most Devastating Diseases
• Critical Analysis on Neurodegenerative Diseases
• Nutrition: Preventing Food Born Diseases
• The Impact of Chronic Disease in the Community
• Progeria: Disease Etiology, Symptoms, and Prognosis
• Childhood Development and Cardiovascular Disease
• Depressive Symptoms and HIV Disease Relationship
• Lyme Disease: What Is the Mystery Behind It?
• Lyme Disease and the Mystery Behind It
• Identifying Lyme Disease Host Species
• Genetic Counseling – Tay Sachs Disease
• Meningococcal Disease: Causes, Phases, Prevention
• Coronary Heart Disease Aggravated by Type 2 Diabetes and Age
• Osteomyelitis and the Differential Diagnosis of the Disease
• Chronic Care For Alzheimer’s Disease
• Coronary Artery Disease: Normal Physiology and Pathology
• Legionnaires’ Disease: Causative Agents, Methods of Reproduction
• Heart Disease in New York State
• Chronic Obstructive Pulmonary Disease Physiology
• Viral Skin Diseases: Plantar Warts and Hand, Foot and Mouth Disease
• Cardiovascular Diseases and Associated Risk Factors
• Disease Control Prevention & Epidemiology Concepts
• Psychiatric Genetics. Epigenetics and Disease Pathology
• Communicable Disease Control Strategies for AIDS
• The Problems Associated With Cardiovascular Disease
• Heart Disease and Low Carbohydrate Diets
• Heart Disease: Cell Death During Myocardial Infarction
• The Mechanisms That Auto Infectious Parasites Use in the Treatment of Autoimmune Diseases
• Intervention of Heart Diseases in Children
• Identification and Assessment of Heart Disease
• Multiple Sclerosis. Disease Analysis
• Epidemiology Discussions: Childhood Obesity Disease
• Researching Cystic Fibrosis Disease
• Hypertension Disease Causation
• Heart Disease Among Hispanic & Latino Population
• Synopsis of Research Studies of Individuals Afflicted by Mild Alzheimer’s Disease
• Oral Disease Prevention: Past and Present Practices
• Diet Therapy & Cardiovascular Disease
• The Function of Kinase Inhibitor Staurosporine in Healthy and Disease States
• Communicable Diseases: Tuberous Sclerosis-1
• Communicable Diseases and Precautionary Measures
• Alzheimer’s Disease and Naturopathic Medicine
• Genetic Diseases: Sickle Cell Anemia
• Biological Basis of Asthma and Allergic Disease
• Managing Sickle Cell Disease
• Brain Reduction and Presence of Alzheimer’s Disease
• Heart Failure: Prevention of the Disease
• Prevention of Heart Disease and Stroke in Collier County
• Public Health Problems and Neglected Diseases
• Maple Syrup Urine Disease Pathogenesis
• Pediatrics: Kawasaki Disease
• Acute Tonsillitis: Disease Analysis
• Arthritis: Disease Analysis
• Acne: Disease Analysis
• Pharmacokinetics and Pharmacodynamics: Coronary Heart Disease
• Chronic Inflammation: Metabolic Syndrome and Cardiovascular Disease
• Pathophysiology of Crohn’s Disease
• Renewed Focus on Non-Communicable Diseases
• Polycystic Kidney Disease (PKD): Overview
• Sexually Transmitted Diseases in Community
• Communicable Disease Control
• Saturated Fatty Acids and Coronary or Cardiovascular Disease
• The Nature and Control of Non-Communicable Disease – Asthma
• Quality of Life in African Americans With the End-Stage Renal Disease
• Genetically Identical Twins and Different Disease Risk
• Dietary Calcium Intake and Mortality From Cardiovascular Diseases
• Understanding Emerging Diseases
• Researching the Giardiasis Disease
• Bacterial Diseases of Marine Organisms
• Epilepsy Disease Discussion
• Current Challenges in Infectious Diseases
• Social, Behavioral, and Psychosocial Causes of Diseases: Type 2 Diabetes
• Causes & Preventing Proliferation of Cardiovascular Disease (CVD)
• Disease Surveillance and Monitoring
• Cardiovascular Disease Among Disorders of the Heart
• Leishmaniasis: Disease of the New World
• Acquired Immunodeficiency Syndrome: Thirty Years of a Disease
• Addison’s Disease: A Long-Term Endocrine Disorder
• Parkinson’s Disease and Its Nursing Management
• Human Diseases: Exploring Malaria
• Effects of Whole Body Vibration in People With Parkinson Disease
• Human Disorders: Alzheimer’s Disease and Dementia
• Chronic Disease: Survey on Beliefs and Feelings
• Screening for Diseases as Caution Against Potential Infections
• Environmental Interview on a Patient With Alzheimer Disease
• Resistant Salmonella: Analysis and Cause of the Disease
• Consumption of Caffeine Is Associated With Reduced Risk of Parkinson’s Disease
• Periodontal and Cardiovascular Diseases: Research Development Project
• Demographic Paper – Parkinson’s Disease
• Experimental Studies on Williams Syndrome Disease
• Cholera: A Waterborne Disease
• Technostress: An Emerging Man-Made Modern-Day Disease
• Doxycycline in Periodontal Disease
• Pelvic Inflammatory Disease: Managing Partners
• Hemolytic Disease of the Newborn
• The Cystic Fibrosis Disease Analysis
• Disease Causing Organism: Salmonella Enterica Typhi
• Pain, Disease and Health Relationship
• Alzheimer’s Disease Article and Clinical Trial
• Center for Disease Control and Prevention Program for Tanzania
• Periodontal Disease and Contribution of Bacteria
• Osteoporosis and Periodontal Disease Relationship
• Therapeutic Properties of Fish Oil: Reduction of Heart Diseases
• Swine Flu H1N1: Populations Affected, Course of the Disease, Intervention
• Chronic Disease Management Framework
• Concepts of the Ankylosis Disease
• Concepts of Pneumonia Disease
• Anemia Disease: Types and Causes, Treatment
• Melanocyte Disease and Its Treatment
• Thalassemia – Inherited Autosomal Recessive Blood Disease
• Graves Disease: Medical Case Assessment
• Alzheimer’s Disease: Regarding Physiology
• Huntington’s Disease Analysis
• Infectious Diseases Overview and Analysis
• Social Determinants of the Heart Disease
• World Health Organization, US Center of Disease Control and Individual Countries
• Kawasaki Disease Analysis
• Race-Based Medicine: Diseases in Different Groups of the Population
• Application of Healthcare IT in Treatment of Cardiovascular Diseases
• Concepts of Culture and Disease Paper: AIDS
• AIDS and Its Trends: An Infectious Disease That Causes the Vulnerability of the Human Internal System
• Periodontal Disease and the Gram Negative Bacteria
• Periodontal Disease: Medical Analysis
• My Path of Dealing With Limes Disease
• Mapping the Neurofibrillary Degeneration From Alzheimer’s Disease Patient
• The Role of Bacteria in Human Health and Disease Giving Specific Examples
• The Status of Hand Hygiene Practices and a Cause in Disease Outbreaks
• Bleeding on Probing: Progression of Periodontal Disease
• Disease Specific Program: Disease Management
• Motor Neuron Disease: Types, Diagnostics, and Treatment
• Pediatric Gastroenterology and Infectious Diseases
• Crohn’s Disease and Perianal Manifestations
• Crohn’s Perianal Disease: A Comprehensive Review
• Infectious Disease Control in Different Scenarios
• Ehlers-Danlos Syndrome: Description of Disease
• Menkes Disease: Disorder of Copper Metabolism
• Infectious Diseases and Their Impact on History
• Diabetes Mellitus Effects on Periodontal Disease
• Lifestyle Diseases and Reduce Productivity
• Diabetes Type II Disease in the Community
• Pathophysiology of Disease: High BP and NIDDM
• Climate Change and the Occurrence of Infectious Diseases
• Cardiovascular Disease: Acute Coronary Syndrome in Women
• Huntington’s Disease, Huntingtin Protein (Mhtt)
• Important Information of Parkinson’s Disease
• Clearing the Air: An Examination of Modes of Disease Transmission on Airlines
• Organ Transplants and Communicable Diseases
• Health Promotion Program: Cardiovascular Disease Mortality Decrease
• Systemic Lupus Erythematosus Disease
• Plasminogen Activator Inhibitor -1 and Cardiovascular Diseases: The Connection
• Nervous System: Parkinson’s Disease
• Parthenogenesis of Celiac Disease
• Kinds and Methods of Treatment of Prion Diseases
• Alzheimer’s Disease: Key Aspects
• Coronary Artery Disease, Parathyroid Adenoma, and 99mTc-SestaMIBI
• Connection Between Nutrition and Cardiovascular Diseases
• Nursing Legacy. Elderly Care Problems and Age-Related Health Diseases
• Strawberry Pest and Diseases Management
• Chronic Obstructive Pulmonary Disease Treatment Protocols
• Basic Information of Huntington’s Disease
• COVID-19: Epidemiology of the Disease
• Obstructive Sleep Apnea and Heart Diseases
• Typhoid Disease: Risk Factors, Symptoms and Prevention
• The Evaluation of the Website for the American Autoimmune Related Diseases Association
• More People Die by Guillain-Barre Disease Than by Swine Flu
• Dementia: Disease Analysis and Treatment Strategies
• Parasitic Wedge and COVID-19 (Coronavirus Disease)
• Corona Virus Disease: Proposed Policy and Results
• A Proband for the Pedigree: Hypertension as Hereditary Disease
• US Centers for Disease Control and Prevention Review
• Ebola Virus Disease Analysis
• Fatty Liver and Gastrointestinal Tract Disease in Dogs
• Opioid Disease Prevention: Levels of Disease Prevention
• Alcoholism as a Disease
• Tuberculosis: History and Current State of a Disease
• The Problem of Food Safety and the Spread of Various Diseases
• Sexually Transmitted Diseases: Statistics in the New Jersey
• Global Health Issue Analysis: HIV – A Relatively New Disease
• Emerging Infectious Disease Preparedness and Response
• Ongoing Gingivitis With Periodontal Disease: Symptoms and Prevention
• Hepatitis A: A Fatal Infectious Disease That Affects the Liver
• “Field Epidemiology” by Gregg and “Infectious Diseases” by Tamarack
• Disease Testing and Phenotype
• Genomics, Prevention, and Control of Common Chronic Diseases
• Centers for Disease Control and Prevention Website Tools
• Culture & Disease: Malaria in Sub-Saharan Africa
• Cardiovascular Diseases and Saudi Male Patients Aged 40 – 65 Years
• Molecular Techniques Used in Hirschsprung Disease Study
• Anatomy Diagnosis: Cardiovascular Disease
• Non-invasive Ventilation in Non-Chronic Obstructive Pulmonary Disease Respiratory Failure
• Anthropology. Diseases and Their Impact on Humans
• Endocrine System and Diseases
• Gout Disease: Prevention and Treatment
• Communicable Diseases: Tuberculosis
• Measles Disease Pathophysiology and Its Vaccination
• Sexually Transmitted Diseases: Causes and Treatment
• Lifestyle and Cardiovascular Disease
• Role of Alzheimer’s Disease Advanced in Our Understanding of the Aging Process
• Disease in the News: “Bird Flu: If or When?” by Sellwood
• A Boxing Legend Muhammad Ali: Parkinson’s Disease
• The Mad Cow Disease in Britain
• Effect of Disease on Native Americans
• World Health Organisation (WHO) And Infectious Diseases
• Heart Diseases: History, Risks and Prevention
• Culture and Disease: Tuberculosis and African Americans
• Parkinson Disease: Diagnosis and Treatment
• Nutrition for People With Hearth Disease
• Posttraumatic Stress Symptom Disease
• Neuropsychological Assessment of Patients With Parkinson Disease
• The Effect of Disease on Modern America
• Empirical Project: Social Networks and Lyme Disease
• Alcoholism: The Disease Is Often Progressive and Fatal
• The Hot Zone: Making of A Global Disease
• Disorder of Movements: Parkinson’s Disease
• Recent Advances in Respiratory Care For Neuromuscular Disease
• Parkinson’s Disease Etiology
• Insects and Civilization: Vector-Borne Diseases
• Biology. Coral Reef Disease as an Emerging Issue
• Biology: Coral Reef and Its Diseases
• Genetics of Parkinson Disease-Associated PARK2 Gene
• Disease Risk Measures in Public Health
• Diabetes: Encapsulation to Treat a Disease
• Phenylketonurea, Galactosemia, Tay-Sachs Disease
• Sexually Transmitted Diseases and Medical Issues
• Clinical Heath Psychology and Cardiovascular Disease
• Chronic Disease That Affects Minority Populations
• Depression and Alzheimer’s Disease
• Chronic Obstructive Pulmonary Disease in a Male Adult
• Center for Disease Control and HIV Prevention Goals
• Congestive Heart Failure and Coronary Artery Disease
• World AIDS Day Celebration: Increasing the Awareness of the People About the Disease
• Neuroscience. Huntington’s Disease Epidemiology
• Diabetes: Discussion of the Disease
• Alcohol Consumption and Cardiovascular Diseases
• Conventional Angiography for Coronary Artery Diseases
• Congenital Diseases and Disorders
• Chronic Obstructive Pulmonary Disease. Medical Issues.
• Celiac Disease: Medical Analysis
• Alzheimer’s Disease: Medical Analysis
• Sex and Gender-Related Differences in Infectious Disease
• Sexually Transmitted Diseases in the Mediterranean Region in the 15th-16th Century
• Comparing Alzheimer’s Disease and Parkinson’s Disease
• Parkinson’s Disease: Neuroscience of Aging
• Infectious Diseases Analysis and Review
• Sexually Transmitted Diseases: Teaching Plan
• Schizophrenia as a Common Mental Disorder
• Disease Prevention and Health Promotion Initiatives
• Cardiovascular Diseases: Statistics, Factors, Diets
• Cigar Smoking and Relation to Disease
• Disease Prevention and Health Promotion Laws
• Beta Thalassemia: Disease Description
• Alzheimer’s Disease and Long Term Care
• Skeletal System. Osteoporosis and Paget’s Disease
• Integumentary System Diseases. Skin Cancer and Eczema
• Cirrhosis: Non- and Alcoholic Fatty Liver Disease
• Baclofen (Lioresal) and Cerebral Diseases
• AIDS: Emergence Factors of Infectious Disease
• Infectious Diseases Caused by Insects
• Radiation as a Diseases Cause
• Polluted Water and Human Diseases
• Lyme Disease: On Its History and Prevention
• AIDS and Its Impact on Humankind: The Leading Killer Disease in the World
• The Effects of Alzheimer’s Disease on Family Members
• Environmental Factors and Autoimmune Diseases Review
• Adherence to Cardiac Therapy for Men with Coronary Artery Disease
• Multiple Sclerosis as a Neurological Disease
• Chronic Obstructive Pulmonary Disease Treatment
• Kerataconus: Disease Development and Modern Treatment
• Heart Diseases and Their Pathophysiology
• Chronic Diseases: Heart Failure and Cancer
• Women’s Health. Sexually Transmitted Diseases
• Medical Nutritional Therapy for Celiac Disease Patients
• Heart and Lung Diseases: Health History and Assessment
• Examining Pathophysiological Processes: Heart Failure & Chronic Kidney Disease
• Combating Heart Disease in the African American Community of Kings County, NY
• How Is Disease Beautified in the Modern Society Under the Guise of Beauty?
• Implementation of Clinical Decision Support Systems for Cardiovascular Diseases
• Cardiovascular Disease in African American Women: Reasons
• Beautifying Diseases in Modern Society
• Chronic Obstructive Pulmonary Disease’s Treatment
• Chronic Obstructive Pulmonary Disease and Medication Treatment
• Epidemiology of Cardiovascular Diseases in the Middle East
• Disease Diagnosis & Treatment in Historical Contexts
• Huntington’s Disease: Diagnosis and Prevention
• “COMT Val158Met Polymorphism Modulates Huntington’s Disease Progression” by de Diego-Balaguer et al.
• Ebola Virus Disease: Global Health at a Glance
• Physical Therapy and Occupational Therapy in Parkinson’s Disease
• Women’s Diseases: Cervical Ectropia
• Are Hypometric Anticipatory Postural Adjustments Contributing to Freezing of Gait in Parkinson’s Disease?
• Why Is Coronary Heart Disease an Important Health Concern?
• What Types of Heart Disease Are Caused by Stress?
• Does Cannabis Intake Protect Against Non-alcoholic Fatty Liver Disease?
• What Is the Deadliest Disease in Human History?
• How Does Cardiovascular Disease Affect the Lungs?
• What Diseases Are Caused by Deforestation in the Amazon Rainforest?
• How Can Genetic Technologies Be Used to Treat Specific Diseases?
• Why Does Mediterranean Diet Reduce Heart Disease?
• How Does Alzheimer’s Disease Affect the Entire Human Lifestyle?
• Can Emotional Stress Cause Cardiovascular Disease?
• What Were the Common Diseases Found in London During the 19th Century?
• How Can Lifestyle Changes Help With the Management of the Diseases?
• What Diseases Can Be Prevented by Vaccination?
• How Is Coronary Heart Disease Affecting the World?
• Does Diet Protect Against Parkinson’s Disease?
• How Does Chronic Kidney Disease Affect the Body System?
• What Lifestyle Factors Influence the Development of Coronary Heart Disease?
• Is Smoking the Leading Cause of Disease?
• How Does Flossing Prevent Periodontal Disease?
• What Disease Was Killing Hundreds of People in London During 1854?
• Does Heart Disease Cause Lung Infection?
• What Are the Complications of Chronic Kidney Disease Dialysis?
• How Does Heart Disease Affect Women Differently From Men?
• What Are the Modern Ways of Genetic Diseases Treatment?
• How Can Epigenetics Be Used to Treat Diseases?
• Does Human Behavior Influence the Occurrence of Diseases?
• What Is the Pathophysiology of Kawasaki Disease?
• How Far Can Countries Be Prepared for Serious Outbreak of Disease?
• What Is the Role of Probiotics in Preventing Allergic Disease?
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1. IvyPanda . "618 Disease Essay Topics & Examples." November 9, 2023. https://ivypanda.com/essays/topic/disease-essay-topics/.

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Class of 2024: Always Asking Why Leads to a Destiny in Disease Research

A first-person essay by Grayson Walker, a native of Collettsville, North Carolina, who received his Ph.D. in 2022 as part of a dual DVM/Ph.D. program at NC State. After Oath and Hooding, he will be a veterinary medical officer at the U.S. Department of Agriculture.

By Grayson Walker

More than 50,000 emails. Seven years. Two doctoral degrees. One College of Veterinary Medicine. My NC State journey poetically ends with becoming a veterinarian. 

This journey started when I was 6. I would find injured critters in the woods surrounding our home and try to fix them. I soon converted a 90s-era laptop bag into a veterinary medical kit so I could treat the various injuries our pets would get on their rural misadventures.

If an animal died, I was profoundly sad but never stopped wondering why. Not “Why did this happen,” but more like, “Why did disease beat out health?” “How exactly did it happen?” and “What could have been done to prevent death?”

I started planning for vet school in fifth grade. My career projects were predictable and my academic interests steadfastly scientific. I knew even then that I had one path: Attending the NC State College of Veterinary Medicine. 

I was on a high school 4-H trip the first time I walked these hallowed halls. Finally, I had entered the building I had beheld only on brochures and webpages during years of research. I was amazed at how everyone greeted one another by name and spoke like old friends. It felt like … home. 

For the first of only two times in my life, something clicked: I would be here one day.

I assumed I would follow the traditional steps toward becoming a veterinarian – an undergraduate degree and four years of vet school. I started with an undergraduate degree in poultry science at NC State in 2013. I didn’t know I’d cut my teeth in academia with poultry research, fall in love with microbiology and complete my master’s in poultry science in 2017. This primed me for a new path to the College of Veterinary Medicine: the combined DVM/Ph.D. program. I started in 2019 and completed my Ph.D. with a focus on infectious diseases in 2022 with unwavering support from my mentors, Dr. Luke Borst and Mitsu Suyemoto.

In hindsight, I was destined to become a veterinary infectious disease researcher. I love to explore and collaborate through interdisciplinary research, and there’s no better place to do that than at NC State. 

The diversity of my research interests has increased 100-fold during the past seven years. I’ve identified bacterial diseases in avian and canine patients with state-of-the-art diagnostics. I’ve worked tirelessly to characterize the causative pathogens with cutting-edge research methods. As a clinician scientist, I’ve researched important topics ranging from COVID-19 impacts on veterinary education to measles epidemiology at the Centers for Disease Control and Prevention during my clinical year.

Anything I’ve been interested in, I’ve been able to pursue with unwavering support from my peers and faculty at the NC State College of Veterinary Medicine.

I’ve walked out of this building with pure joy after experiencing a research discovery, a successful surgery or patients I’ve helped care for go home. I’ve endured my hardest days here. I remember the patients who didn’t leave, the loss of a mentor and a late-night trip to say a final goodbye to my spunky cat, Savannah, who passed unexpectedly while I was traveling. 

Still, I asked, “Why?” In this case, it was my classmates who helped me answer that question as they completed her autopsy and granted me closure with answers. 

This is the spectrum of experiences that define a life chapter, and it’s more vivid to me than any other. Not because of what I’ve done, but because of the people I’ve experienced it with.

The second time it clicked, when I knew would end up somewhere, I was standing on a hill in Manhattan, Kansas. I was looking down on the National Bio and Agro-Defense Facility where my job as a veterinary medical officer with the U.S. Department of Agriculture awaits. I’ll be doing diagnostic work for animal diseases that are so horrible, we’ve eradicated them from this country and can only study and diagnose them in highly equipped, secure facilities such as NBAF. 

As my classmates move forward with incredible careers in clinical medicine, I’m excited to embark on this lesser known but vital discipline of veterinary medicine. There’s no place like home, but I’m clicking my heels to go study pathogens on the prairie at my new home. The experiences I’ve lived here at the NC State College of Veterinary Medicine have become woven into the fibers of my being. It has been and always will be home.

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Career Path in Public Health Informative Research

This essay about the career path in public health informatics outlines the intersection of technology and public health practices. It begins with the educational foundations necessary for entering the field, emphasizing the importance of a specialized master’s degree for handling data and designing health information systems. The essay describes various career opportunities ranging from government positions to roles in private sectors, highlighting the diversity and impact of potential job roles. It discusses the significant real-world impacts of informatics during health crises like the COVID-19 pandemic and the daily contributions to improving public health systems. Looking forward, the essay predicts the expansion of public health informatics with advancements in technology such as AI and machine learning, emphasizing the field’s growing importance and potential for future professionals.

How it works

Exploring a career in public health can often feel like you’re preparing to make a big, altruistic splash on a global canvas. It’s about harnessing your expertise to ward off diseases, extend life spans, and boost the health standards of communities from bustling city neighborhoods to remote rural areas. When you throw informatics into the mix, this field isn’t just about well-meaning initiatives but also about smart, data-driven decision-making. Public health informatics marries technology with traditional public health practices to create powerful tools that strategize against health crises both mundane and monumental.

At its core, public health informatics is about using technology to solve puzzles in health care and preventive measures. Think of it as data wizardry; where every number crunched and every pattern deciphered can lead to insights that save thousands of lives. This subfield has become increasingly crucial as our world grapples with health data that’s burgeoning in volume, variety, and velocity—thanks, in part, to more widespread use of digital health records and the advent of big data technologies.

Those drawn to a career in public health informatics are typically those who find a calling in caring for the community but are also fascinated by the potential of technology. It’s a field for the empathetic innovator, the healthcare warrior who is also a bit of a tech geek, someone who sees data streams as pathways to progress.

### Education and Entry into the Field

To embark on this path, you’d typically start with a foundational education in public health. This could be a bachelor’s degree in public health, health science, or a related discipline where you learn about everything from epidemiology and biostatistics to environmental health and health policy. However, diving into informatics requires more specialized training. Here, a master’s degree often becomes pivotal. Courses in public health informatics focus not just on data analysis and management, but also on how to tailor information systems to the nuanced needs of public health initiatives.

Such programs are rigorous. They blend theoretical knowledge with practical tech skills, preparing students to handle large-scale health data and use it to forge effective public health strategies. Students learn to design information systems, manage health databases, and analyze health information to aid decision-making and policy planning.

The career paths in public health informatics are as varied as they are impactful. You could end up working in government, crafting the digital backbone of national health surveillance systems, or in global health organizations where you might help strategize international responses to epidemics. Nonprofits, academic institutions, and private sector companies also offer roles for public health informaticians, often looking to them to understand health trends and to design interventions that are both effective and efficient.

Job titles in this field range from Health Data Analyst to Chief Information Officer, each with responsibilities as critical as the next. You might analyze data to understand a disease outbreak, design software that helps in tracking vaccination drives, or lead projects that use mobile health apps to monitor patient health remotely.

The real thrill of a career in public health informatics comes from its direct impact on real-world issues. During health crises like the COVID-19 pandemic, public health informaticians were essential. They analyzed rates of infection and transmission, modeled disease predictions, and provided critical data that informed global responses to the virus. Their work supported strategies that ranged from social distancing recommendations to vaccine distribution plans, significantly affecting the course of the pandemic.

The daily impact is just as profound, albeit less dramatic. On a routine basis, public health informaticians might work on improving the accuracy of health surveillance reports or on enhancing the effectiveness of health promotion campaigns. Each project not only challenges one’s skills but also offers the gratifying sense that one’s work is directly contributing to healthier communities.

Looking forward, the scope of public health informatics only promises to expand. Technological advancements like artificial intelligence (AI) and machine learning are setting the stage for even more sophisticated approaches to public health. Imagine AI models that predict outbreaks before they happen or mobile apps that help patients manage chronic diseases in real-time; these are the kinds of projects that future public health informaticians might undertake.

Moreover, as health crises continue to emerge, the need for innovative public health strategies becomes more acute. The professionals ready to meet these challenges will likely find themselves at the forefront of both technology and healthcare, making public health informatics not just a smart career choice, but a crucial one.

Embarking on a career in public health informatics thus means preparing to enter a field where change is the only constant and where the potential to do good grows with every technological advance. It’s an exciting, evolving field that promises not just career satisfaction but also a chance to make a significant difference in the world. This path is ideal for those who aspire to stand where technology meets humanity, driven by the belief that health information can and should be used to foster better, healthier lives.

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Diseases Research Paper

View sample diseases research paper. Browse other  research paper examples and check the list of history research paper topics for more inspiration. If you need a history research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our custom writing service for professional assistance. We offer high-quality assignments for reasonable rates.

The study and treatment of disease is a neverending pursuit due to human evolution and our ability to adapt to and resist diseases over time. Research shows that disease increased as foraging stopped and humans began settling together in one place. Only in the twentieth century did epidemiologists recognize that hosts and germs adjust to one another, so symptoms (and medical diagnoses) change.

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Disease refers to many kinds of bodily malfunction: some lethal, some chronic, and some merely temporary. Some diseases, like cancer and Alzheimer’s disease, increase with age and result from disordered processes within our bodies; others arise from infection by invading germs and afflict children more frequently than adults because we develop immunities after early exposure to them. Symptoms of infectious diseases vary with time and place, owing to changes in human resistance and to evolutionary changes in the germs themselves. Consequently, written descriptions of ancient infections, even when quite detailed, often fail to match up with what modern doctors see. Hence, even when records exist, determining exactly when a particular infection first afflicted people in a given place is often unknowable. And no one can doubt that major disease encounters also took place among peoples who left no records for historians to examine. Nonetheless, and despite all such difficulties, some landmarks in the history of the human experience of disease are discernible from the deeper past, while in recent times the changing impact of diseases and medical efforts to control them are fairly well known.

Diseases among Foragers and Early Farmers

It is safe to assume that our remote foraging ancestors encountered many sorts of parasites, some of which, like the organism that causes malaria, were seriously debilitating. Sleeping sickness, spread by tsetse flies, was so lethal for human hunters that parts of east Africa remained uninhabited until recently, thus preserving vast herds of game animals that tourists now come to see. All the same, it is probable that our early ancestors were tolerably healthy and vigorous most of the time. That, at any rate, is the case among surviving African foragers as observed by modern anthropologists. Probably infectious organisms and their human hosts were fairly well adjusted to one another, having evolved together in tropical Africa; diseases of aging scarcely mattered since their lives were far shorter than ours.

Since many of Africa’s tropical parasites could not survive freezing temperatures, infections probably diminished sharply when human bands expanded their range, penetrating cooler climates and spreading rapidly around the entire globe. Leaving African infections behind presumably increased human numbers and helped to sustain their extraordinary geographic expansion.

But infections began to increase again when, in different parts of the Earth, a few human groups began to cultivate the soil and settled down in the same place all year round. That was partly because food production allowed more people to crowd together and exchange infections, and more especially because supplies of water were liable to become contaminated by bacteria from human wastes. This increased exposure to infections of the digestive tract. Moreover, wherever farmers resorted to irrigation, wading in shallow water exposed them to a debilitating infection called schistosomiasis (or bilharzia), which they shared with snails. And whenever cultivators came to depend on a single crop for nearly all their food, dietary deficiencies were liable to set in. A diet of maize, for example, lacks some of the amino acids humans need and provokes a chronic disease called pellagra. Finally, the domestication of animals, though their meat and milk improved farmers’ diets, intensified disease transfers back and forth between humans and their flocks and herds. A large array of bacteria and viruses traveled this path.

Yet intensified exposure to such diseases did not halt the increase in farming populations. Instead more people cultivated more ground, producing more food to feed more children. Farming villages therefore multiplied and spread from the regions where they had initially established themselves, and human beings soon ceased to be rare in the balance of nature, as their foraging ancestors and other top predators, such as lions and tigers, had always been.

All the same, farmers had to labor longer and at more monotonous tasks than foragers did, and they faced famine whenever bad weather or an outbreak of plant disease provoked crop failure. Seizure of stores of food by human raiders was another serious risk that increased wherever grain farmers became dense enough to occupy nearly all suitable farmland. And when raiders became rulers by learning to take only part of the harvest as rent and taxes, farmers faced another drain on their resources and had to work still harder to feed themselves and their new overlords. Life remained short by our standards, so diseases of old age remained exceptional.

Then, beginning about 3500 BCE, rulers and their various hangers-on began to create cities in a few densely inhabited farming regions of Earth, and disease patterns changed again, manifesting diverse and unstable local equilibria. These may be described as regional agrarian disease regimes; they were succeeded after about 1550 CE by an equally unstable global disease regime within which we still find ourselves. The balance of this research paper will explore these successive disease environments.

Regional Agrarian Disease Regimes

When large numbers of persons began to cluster close together in cities, the problem of waste disposal multiplied as never before. Exposure to new infections multiplied as well, since long-distance comings and goings by soldiers, merchants, seamen, and caravan personnel often crossed disease boundaries and spread infections far and wide. Moreover, when urban populations exceeded a critical threshold, a new class of herd diseases began to afflict humans for the first time. These diseases existed initially among large populations of wild flocks and herds, or dense populations of burrowing rodents and other small animals. A distinguishing characteristic of these diseases was that when they were not fatal, they provoked antibodies in their animal or human hosts, so survivors became immune from a second infection. This meant that the germ could only persist when it found enough newborns to feed upon for a few weeks before death or recovery created another crisis of survival for the infection in question.

Just how large the total host population had to be to permit a chain of infection to continue indefinitely depended on birth rates and how closely in contact potential hosts might be. To move from host to host, many infections depended on airborne droplets, set adrift by breathing, coughing, and sneezing, and therefore they needed close encounters for successful transmission. In the modern era (from about 1750), for example, measles—a viral disease dependent on droplet propagation—required at least 7,000 susceptible individuals within a community of something like 300,000 persons to keep going. Obviously, infections like measles could only persist in urban settings and among villagers in contact with large urban centers.

Some of these, like smallpox and measles, were highly lethal; others like mumps and influenza were milder. No one knows when or where they made good their transfer from animal herds to human hosts, but it is certain that it took place somewhere in Asia, perhaps at several different times and places. It is equally sure that they could do so only in and around cities, thus becoming distinctive new “civilized” diseases.

Their arrival had paradoxical effects. By killing off urban dwellers, they soon made most cities so unhealthful that they needed a stream of migrants from surrounding villages to sustain their numbers. Yet these same diseases also created a new and very powerful advantage for disease-experienced populations in contact with previously unexposed populations. That was because among peoples who lacked acquired immunities, herd infections spread like wildfire, killing adults as well as children. In the modern era, initial exposure to measles or smallpox commonly killed off something like a third of the entire population in a few weeks, leaving survivors dazed and distraught and quite unable to resist further encroachment by the disease-bearing newcomers. The effect was multiplied when successive civilized diseases followed one another in rapid succession. Smallpox, measles, influenza, and even the common cold could all be, and often were, lethal.

Before that drastic pattern could establish itself generally, different centers of civilization had to survive the arrival of these infections from wherever they first started. Everything about the initial spread of herd diseases within Eurasia and Africa remains unknown, but disease disasters that ravaged the Roman Empire between 165 CE and 180 CE, and a second time between 251 CE and 266 CE, probably register the arrival of smallpox and measles in Mediterranean lands, brought back by soldiers returning from Mesopotamia. Written records also show that China suffered unusually lethal epidemics in 161–162 CE and again in 310–312 CE.

It looks, therefore, as though extended contacts within Eurasia, arising from the establishment of the so-called Silk Roads that connected China with Syria, allowed highly lethal outbreaks to occur at both extremes of Eurasia at nearly the same time, inflicting severe damage both on the Roman and Chinese empires. But surviving records say little or nothing about lands in between, and guesswork is useless. By contrast, we know that the Americas were exempt from these herd diseases until the Spaniards arrived, and the same was true of other isolated populations around the globe. Consequently, in the sixteenth century, when European seamen began to encounter people lacking immunities to these diseases, massive die-offs regularly ensued.

By then the agrarian peoples of Eurasia had another twelve hundred years of disease exchange and exposure behind them. One well-known episode came between 534 CE and 750 CE, when sporadic outbreaks of bubonic plague ravaged Mediterranean coastlands, only to disappear for the next six centuries. The historian Procopius wrote an exact description of the initial onset of that plague, explaining that it came by ship and originated in central Africa. Other factors were in play; modern studies show that bubonic plague is spread normally by bites of rat fleas, which transfer to humans only after their normal hosts die of the disease. The domestic rats in question were probably native to India, and in 534 CE they were relatively recent arrivals in Mediterranean coastlands.

The infection itself was at home in underground burrows of various species of rodents in central Africa and northern India, where it behaved like a childhood disease among rats and became a lethal epidemic only when it invaded inexperienced populations of domestic rats and, of course, humans. But under those circumstances it was indeed highly lethal.

Procopius says that when the disease first struck in 534 CE, ten thousand persons died daily in Constantinople for forty days. Loss of population and wealth were certainly severe and prevented the Byzantine emperor Justinian (reigned 527–565 CE) from reconquering the richest provinces of the western empire, which he had started to do.

Germanic and northern Europe escaped this bout with plague, probably because rats had not yet established themselves there. But in the so-called Dark Ages other serious epidemics—including smallpox, measles, and influenza—did break out in the north from time to time, and as ships began to travel the northern seas more frequently, all of Europe became more and more tightly tied into the disease pool centered upon the network of Mediterranean cities. Leprosy, tuberculosis, and diphtheria were among the infections that spread more widely during these centuries. But their spread cannot be traced since they did not provoke sudden, massive die-offs as smallpox, measles, and the plague did.

Nothing equally detailed is known about how other centers of civilization in Eurasia and Africa encountered new infections in ancient and medieval times. But two Chinese texts describe an outbreak of bubonic plague along the southern coast in 610 CE, so it looks again as though China’s disease history matched that of Europe quite closely. This is not really surprising, since the ships and caravans that moved back and forth among all the Eurasian civilized lands carried infections with them, and invading armies occasionally exposed thousands of inexperienced soldiers to a new infection all at once.

North and East Africa shared in this homogenizing process, while the African interior, Southeast Asia, and northern Eurasia took more sporadic parts and so lagged somewhat behind. But overall, as disease exposures intensified across the entire Old World, resistance to infections increased, and local populations got used to living with heavier disease burdens. The assortment of prevalent diseases always differed from place to place, since climate set limits to many infections. In general, warmer and wetter conditions favored disease organisms; infections that depended on mosquitoes, fleas, or other insects to move from host to host also fared best under those conditions. Winter frost set limits to the spread of many kinds of parasites, and so did desert heat and dryness. In addition, local customs sometimes minimized disease exposures. In southwestern China, for example, where bubonic plague germs were endemic among burrowing rodents, European doctors in the nineteenth century scoffed at superstitious villagers who fled to higher ground whenever they found dead rats in their houses, yet half a century later, after Europeans had learned how the plague was transmitted, they realized that such behavior was an effective precaution against catching the disease. Some customs, on the other hand, intensified infections. Religious pilgrimage is a prime example, as was ritual footwashing in Muslim mosques, where the water in the fountains sometimes contained the organisms that cause bilharzia.

Most disease disasters were soon forgotten, which is why so little is knowable about the spread of infections. But the Black Death was an exception. The heavy die-off provoked when bubonic plague returned to Europe in 1346 continued to haunt folk memory and still colors our common speech. About a third of the population of Europe died of the plague between 1346 and 1350, but what kept the memory of the Black Death alive was the fact that plague continued to break out from time to time in Europe and North Africa down to the present, even after effective antibiotic cures were discovered in the 1940s. We know something about how this came to pass.

First of all, the vast Mongol Empire, extending from China to Russia, permitted rapid, long-range movement throughout Eurasia on a far greater scale than ever before. Plague was only one of several infections that took advantage of this fact to expand their domain. More particularly, a Mongol army invaded the borderland between China and India in 1252, penetrating a region where plague infection was chronic, and seems to have carried the infection back to its homeland in the steppes. At any rate, Pasteurella pestis (Yersinia pestis), as the bacterium that causes plague is called, somehow found a new home and spread among burrowing rodents of the northern grasslands, where it was discovered by Russian scientists only in the 1890s. This was the reservoir from which the plague of 1346 broke upon Europe and the Muslim world.

Ships spread it swiftly from Feodosiya (or Kaffa) in the Crimea, where it first broke out, to other Mediterranean and north European ports. Then the infection moved inland. Wherever the plague arrived, death came quickly and unpredictably to young and old. More than half of those infected died. In Muslim lands, the disease took a similar toll; China, too, lost about half its population from a combination of plague and warfare by the time the Mongol Empire collapsed and the Ming dynasty took power in 1368.

Plague continued to visit all these lands at irregular intervals thereafter. The population in Europe continued to decline until about 1480, when the accumulated resistances among survivors at last permitted population growth to resume. It accelerated once the plague disappeared from England and northern Europe after a final visit to London in 1665, partly because efforts at quarantining ships coming from plague-infected ports reduced exposure and partly because slate roofs, introduced as protection against fire, created greater distance between humans and hungry rat fleas than when rats nested overhead in the thatch. In Eastern Europe and Asia, plague continued to break out until the twentieth century, but little by little local adaptations reduced its impact everywhere.

Overall, the most enduring change came to the steppes—the Mongol homelands—where nomadic herdsmen found themselves permanently exposed to a very lethal infection. Losses were so heavy that nomads even withdrew from the fertile grasslands of the Ukraine, leaving them vacant for agricultural pioneers to encroach upon, beginning about 1550. This reversed a human tide that had favored nomad expansion ever since the first millennium BCE, carrying first Indo-European and then Turkish languages across Europe and much of Asia.

Other changes in disease patterns accompanied or soon followed the sudden expansion of bubonic plague. The most conspicuous was the retreat of leprosy, emptying thousands of leprosaria that Europeans had built to isolate lepers in accordance with biblical injunctions. Many lepers died of plague during the first onset; but something else must have been at work to overcome the various skin infections that medieval Europeans lumped together and called leprosy. One possibility is Europe’s reduced population had a proportionally larger supply of wool with which to clothe themselves, and by wearing long, warm nightclothes and thereby reducing skin-to-skin contact between people, they may have cut down on the transmission of skin diseases. No one knows for sure.

Ironically, another skin disease, yaws, caused by a bacterium indistinguishable from the one that causes syphilis, may also have been nearly banished from European populations. The epidemic of syphilis that broke out after 1494 may have been the result of the bacterium finding a new path of propagation via the mucous membranes of the sex organs. Again, no one can be sure.

Yet all the mingling and transformations of diseases across Eurasia and Africa before 1500 never erased local differences. Above all, large parts of the Earth remained unaffected by the rising tide of infection among Old World peoples, and they found themselves correspondingly vulnerable when crossing the oceans became routine and a new global disease regime began to emerge.

Global Disease Regimes

The first and most overwhelming effect of oceanic navigation was to spread a large array of lethal infections among inexperienced human populations. This process continues in remote Amazon jungles and Arctic shores even today, but by now almost every human population has been at least partially exposed, and the initial shattering effect is past. But when it was new, whole peoples disappeared, and vast landscapes in the Americas and Australia were severely depopulated. Immigrants from Europe and Africa—and subsequently also from Asia—were therefore able to supplant the older inhabitants, creating the mixture of peoples we know today.

Native Americans were the largest population exposed to destruction by the new disease regime. The native population of Hispaniola, where Columbus set up his headquarters, disappeared entirely within a few decades, and within the first fifty years of their exposure to new infections, the much larger populations of Mexico and Peru diminished to about a tenth of what they had been in 1500. Millions died of smallpox and innumerable other infections until immunities accumulating in survivors’ bloodstreams checked the die-off. In Mexico and Peru the worst was over by 1650. Gradually population growth began again, though in more isolated parts of the Americas local die-offs continued. Warfare and less organized forms of human violence played a part in destroying Native Americans, but Afro-Eurasian diseases always had the principal role.

Caribbean islands and tropical coastlands of the Americas also proved hospitable to malaria and yellow fever from Africa once the species of mosquito that carried them came across the Atlantic on board slave ships. No exact time horizon for the arrival of malaria in the New World can be discerned, but in 1648 a lethal epidemic of yellow fever in Havana announced the arrival of that disease unambiguously. When it subsequently became endemic, survivors acquired a very potent protection against invading armies, since soldiers from Europe regularly fell ill and died of it within about six weeks of their arrival. This allowed the Spanish to overcome British efforts to conquer the sugar islands in the eighteenth century, doomed Napoleon’s attempt to reconquer Haiti in 1801, and persuaded him to sell the Louisiana territory to Thomas Jefferson in 1803. Quite a political career for a virus from tropical Africa!

Elsewhere, inhabitants of Australia, New Zealand, and other isolated communities experienced approximately the same fate as Native Americans did when disease-experienced Europeans arrived among them. Always the newcomers also brought a rich array of other organisms with them: crops and weeds, together with domesticated animals and pests like lice, rats, and mice. The Earth is still reverberating from the ecological upheavals initiated when humans and innumerable other organisms began to cross the oceans, making the biosphere into a single interacting whole as never before.

Disease exchanges ran almost entirely one way, spreading from Afro-Eurasia to other lands. Reverse transmissions are hard to find, though some experts believe that syphilis came to Europe from the Americas. Europeans discovered that disease when it broke out in a French army besieging Naples in 1494, so its connection with Columbus’s return in 1493 is indeed possible. But there is no clear evidence of the prior existence of syphilis in the New World, so no one can be sure.

Another disease, typhus, also invaded Europe in 1490; but it came with soldiers from Cyprus and may not have been new, but only newly recognized by doctors of the day. More recently, other infections have also invaded disease-experienced populations of the Earth. AIDS is the most serious and widespread, and it may have been transferred recently from monkeys somewhere in the African interior, or perhaps, like typhus, AIDS is much older and remained unrecognized until increasing sexual promiscuity turned it into an epidemic.

Three other new disease exposures affecting industrialized populations in modem times are also worth mentioning. Tuberculosis (TB), a very ancient infection, gained fresh impetus after about 1780 when new factories, powered by coal and steam, began to crowd people together in industrial towns under unsanitary conditions. Its ravages crested in Europe about 1850, shortly before a German professor, Robert Koch, discovered the bacillus that caused it in 1882, thereby inaugurating a new age for preventive medicine. Yet despite modern medical skills, TB remains the most widespread and persistent human infection worldwide, sustained by the extraordinary growth of cities that had carried more than half of humankind into crowded urban settings by 1950 or so.

Cholera, too, was an ancient disease at home in India, where it flourished among Hindu pilgrims who came to bathe in the Ganges. The cholera bacillus can survive independently in freshwater for considerable periods of time, but it multiplies very rapidly in the human alimentary tract and causes diarrhea, vomiting, fever, and often death within a few hours of its onset. Bodily shrinkage from dehydration and skin discolored by bursting capillaries make the symptoms of cholera especially horrible. So when the disease broke through long-standing boundaries in 1819, spreading to Southeast Asia, China, Japan, East Africa, and western Asia, it aroused intense fear and panic even though mortality rates remained rather modest—a mere 13 percent of the total population of Cairo, for instance. Between 1831 and 1833 a fresh outbreak carried cholera across Russia to the Baltic and thence to England, Ireland, Canada, the United States, and Mexico. Even more important, cholera established itself in Mecca in 1831, where it infected Muslim pilgrims. They in turn carried it home with them, periodically spreading cholera all the way from Mindanao to Morocco until 1912. Then cholera disappeared from Mecca, and Muslim pilgrims ceased to spread it far and wide; but it lived on in India, where Hindu pilgrims continued to be its principal carriers.

European and American responses to this dread infection were strenuous indeed. Reformers in England set out to reengineer the water supply and sewer systems of London and other cities to assure germ-free drinking water. It took years to build new water systems, but as they spread from city to city, many other sorts of infections diminished sharply. Helped by vaccination against smallpox, dating back to the eighteenth century, cities became far more healthful than before. This sanitary effort involved new laws and medical boards of health with mandatory power to enforce preventive measures. It was the first great medical breakthrough of modem times. Bit by bit, vaccination and sanitation spread around much of the globe, changing human experience of infectious disease so fundamentally that we have difficulty imagining times when infant death was a matter of course and adults died of infections more often than from degenerative diseases of old age.

Yet some diseases were little affected by these preventive measures. The viruses that cause influenza, for example, vary from year to year, and regularly find receptive human hosts whose immunities from previous years are ineffective against the new variants. In 1918–1919 a new strain of the virus proved particularly lethal, killing about 20 million persons as it spread around the world, which made it far more deadly than World War I. Yet, as so often before, survivors soon almost forgot about their encounter with such a lethal epidemic.

That was partly because a second medical breakthrough, comparable to the sanitary successes of the nineteenth century, came after World War II. Suddenly, use of DDT to poison mosquito larvae almost eliminated malaria from many regions of the Earth, while penicillin and other antibiotics became generally available to kill other infections. All at once, instant cures for ancient diseases became a matter of course. On the prevention side, the World Health Organization carried out a successful campaign that eliminated (with the exception of laboratory specimens) smallpox in 1976. Yet these triumphs did not last very long. While effective against mosquitoes, DDT also poisoned so many forms of life that its use was soon abandoned. More generally, infectious agents began to develop resistances to the new antibiotics. As a result, malaria reclaimed some of its old importance, and other ancient infections did likewise.

Then when AIDS was recognized in 1981 and successfully resisted chemical cures, doctors, once so confident of victory over infections, had to admit that their new skills had unexpected limitations. Infections were coming back, and diseases of old age were increasing. All too obviously, and despite all the recent medical marvels, human bodies remain subject to infection and degenerate with age.

Diseases change, and have always done so. Human behavior changes too, affecting how diseases afflict us. Since 1750 or thereabouts, medical knowledge and practice drastically altered the global disease regime and lengthened human life for billions of persons. But all our skills do not change the fact that we remain part of the web of life on Earth, eating and being eaten, everywhere and always.

Bibliography:

• Cook, N. D. (1998). Born to die: Disease and the New World conquest, 1492–1650. Cambridge, U.K.: Cambridge University Press.
• Cunningham, A., & Williams, P. (1992). The laboratory revolution in medicine. Cambridge, U.K.: Cambridge University Press.
• Ewald, P. W. (1994). The evolution of infectious disease. New York: Oxford University Press.
• Grmek, M. (1989). Diseases in the ancient Greek world (L. Muellner & M. Muellner, Trans.). Baltimore: Johns Hopkins University Press.
• Kiple, K. (1993). The Cambridge world history of human disease. Cambridge, U.K.: Cambridge University Press.
• McNeill, W. H. (1998). Plagues and peoples (2nd ed). New York: Anchor Books.

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