C.Immunization for travelers

8.
Fill in the blanks with words from ex.5.
A.
1. _________for heart disease include smoking, high cholesterol and a family history of heart disease.
2. In a small number of cases screening will not identify patients with early signs of a disease. These are _______________.
3. Some people without signs of the disease will be wrongly identified as having the disease. These are______________.
4. People______________blood or body fluids should be immunized against Hepatitis B.
5. A ___________vaccination is given some time after the first vaccination to make sure the level of antibodies remains high.
6. Hepatitis B can be ___________ through exposure to body fluids.
7. Penicillin now has no effect against some hospital-acquired infections as they are _______________________penicillin.
8. An ________of measles has affected a number of children who has not been immunized with the MMR (measles, mumps & rubella) vaccine.

B.
1. Women aged from 50 to 70 should have mammography every three years to check for breast cancer.
2.Patients with heart disease____________________________________________________________.
3. Women between 20 and 60 ___________________________________________________________.
4. Patients over 40 with high risk factors___________________________________________________.
5. Patients with diabetes________________________________________________________________.
6. Pregnant women____________________________________________________________________.

⃰ 9.
Which of the immunizations listed in ex.5 (C) would you recommend for the following visitors to South Asia?
1. A tourist who will stay for a few nights in five-star hotels in major cities
2. A backpacker who will travel by local transport from one city to another
3. A medical student doing an elective in a city hospital
4. A volunteer who will live a year in a rural community
5. A traveller who has not had tetanus vaccination for ten years.

What immunizations are advised for visitors to your country, or a country you would like to visit?

IN PARTICULAR…
DENTISTRY

Primary dental care
Key words: preventive, on a regular basis, to vary, gum disease, orthodontic treatment, referral, to heal, plaque, cavities and gum disease

Primary dental care typically refers to the regular, preventative care a patient receives from his or her dentist. If the patient has any dental issues, the dentist may treat them, or they may refer the patient to a specialist. This is where the "primary" comes from; it refers to the fact that the regular dentist is the patient's first point of contact for care, and the one who monitors his or her dental health on a regular basis. The type of primary dental care that each person receives can vary depending on his or her specific needs and overall health.

The most common example of primary dental care is a regular cleaning of the teeth and gums, also known as dental prophylaxis. This is done to remove plaque and helps in preventing cavities or gum disease. The dentist also examines the teeth at this time to make sure there are no existing problems that will require treatment. This type of preventative care is very important for dental health, and is the reason that most people visit their dentists on a regular basis. Most dentists recommend getting the teeth professionally cleaned every six months.

Often, primary dental care will also require taking regular X-rays of the teeth to check for any other problems or to ensure the teeth are not moving, such as following orthodontic treatment. Orthodontic treatment is not considered part of primary dental care; typically, such treatment will require a referral from the primary dentist. Other treatments that might be received as part of primary dental care include fluoride treatments, tooth whitening, or other cosmetic procedures. The treatment and filling of cavities may also be part of dental care if necessary. More extensive procedures might require referral to an oral surgeon.

This is the other important aspect of primary dental care; obtaining referrals to an oral surgeon or other specialist if it is required. Because the primary dentist has records of the patient's past health and regularly monitors his or her teeth, he or she can determine if it is necessary for a patient to have further treatment. For instance, treatments like wisdom tooth extraction or a root canal may require treatment from specialists, and the dentist will be able to refer patients for treatment. The primary dentist may then continue to monitor the patient after he or she has oral surgery to make sure he is healing as necessary.

⃰CONTEMPORARY DENTAL CARE FOR CHILDREN
Emphasis on Early Initiation of Oral Health Care
key words: decay, destructive disease, bacterium, to acquire, reversible, intervention, dentition, disturbance, gingivitis, trauma, teething, cleft

Science has provided a clear understanding that tooth decay is an infectious, transmissible, destructive disease caused by acid-forming bacteria acquired by toddlers from their mothers shortly after their first teeth erupt (generally around six months of age). In its early stages, the effects of dental caries are largely reversible through existing interventions (e.g., fluorides) that promote replacement of lost minerals from the outer layer of the tooth (enamel). These findings, combined with epidemiological data on the occurrence of tooth decay in infants and young children, suggest that true primary prevention must begin in the first to second year of life. This evidence also suggests that particular attention should be paid to the oral health of expectant and new mothers.

In early childhood there is tremendous growth and development of the face and mouth, with dentition-associated disturbances that may require the attention of dental professionals. Other common oral conditions of childhood (in addition to tooth decay) include: gingivitis and mucosal (soft tissue) infections; accidental and intentional trauma; developmental disturbances associated with teething or tooth formation and craniofacial abnormalities (including clefts of the lip and/or palate). Additionally, parents frequently request information on a diverse array of concerns including: sucking habits; fluoride usage; tooth alignment; timing and order of tooth eruption; and discolored teeth.

IN PARTICULAR …
PEDIATRICS

How Vaccines Prevent Disease
key words: vaccine, antibody, to invade, preventable, immunity, to be exposed to, to be immunized

Parents are constantly concerned about the health and safety of their children and they take many steps to protect them. These preventive measures range from child-proof door latches to child safety seats. In the same respect, vaccines work to safeguard children from illnesses and death caused by infectious diseases. Vaccines protect children by helping prepare their bodies to fight often serious, and potentially, deadly diseases.

A weakened form of the disease germ is injected into the body. The body makes antibodies to fight these invaders. If actual disease germs ever attack the body, the antibodies will still be there to destroy them.

Disease prevention is the key to public health. It is always better to prevent a disease than to treat it. Vaccines prevent disease in the people who receive them and protect those who come into contact with unvaccinated individuals. Vaccines help prevent infectious diseases and save lives. Vaccines are responsible for the control of many infectious diseases that were once common in this country, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Haemophilus influenzae type b.

Vaccine-preventable diseases have a costly impact, resulting in doctor's visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work.

Each child is born with a full immune system composed of cells, glands, organs, and fluids that are located throughout his or her body to fight invading bacteria and viruses. The immune system recognizes germs that enter the body as "foreign" invaders, or antigens, and produces protein substances called antibodies to fight them. A normal, healthy immune system has the ability to produce millions of these antibodies to defend against thousands of attacks every day, doing it so naturally that people are not even aware they are being attacked and defended so often. Many antibodies disappear once they have destroyed the invading antigens, but the cells involved in antibody production remain and become "memory cells." Memory cells remember the original antigen and then defend against it when the antigen attempts to re-infect a person, even after many decades. This protection is called immunity.

Vaccines contain the same antigens or parts of antigens that cause diseases, but the antigens in vaccines are either killed or greatly weakened. When they are injected into fatty tissue or muscle, vaccine antigens are not strong enough to produce the symptoms and signs of the disease but are strong enough for the immune system to produce antibodies against them. The memory cells that remain prevent re-infection when they encounter that disease in the future. Thus, through vaccination, children develop immunity without suffering from the actual diseases that vaccines prevent.

If a child is not vaccinated and is exposed to a disease germ, the child’s body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but babies are now protected by vaccines, so we do not see these diseases as often.

Immunizing individual children also helps to protect the health of our community, especially those people who are not immunized. People who are not immunized include those who are too young to be vaccinated (e.g., children less than a year old cannot receive the measles vaccine but can be infected by the measles virus), those who cannot be vaccinated for medical reasons (e.g., children with leukemia), and those who cannot make an adequate response to vaccination.
Immunization also slows down or stops disease outbreaks.

⃰ Pediatric Obesity Prevention

Key words: obesity, hypertension, decrease

As attested to by popular media and epidemiological surveys alike, pediatric obesity and overweight have reached epidemic levels in the United States and much of the developed world. The most recent US National Health and Nutrition Evaluation Survey indicates that approximately 17 percent of children and adolescents in the United States are obese and about 32 percent are— a three-fold increase over rates estimated in 1980.

In addition to increased risk of persistent obesity through adulthood, children and adolescents who are overweight or obese are at increased risk for a number of physical and mental health conditions, including insulin resistance, hypertension, abnormal glucose intolerance, sleep apnea and decreased health-related quality of life. Some of these conditions have been associated with further decreases in positive health behaviors (e.g., moderate/vigorous physical activity), thereby resulting in a feedback loop of decreasing health quality, increasing distress and increasing risk for obesity.

The epidemiological patterns suggest that risk for overweight in the U.S. varies across social, economic, and racial/ethnic groups. Specifically, individuals with lower household incomes, those from rural communities and those who are African-American or Latino/a are at increased risk for obesity and overweight.

Although there are likely genetic vulnerabilities for the development of obesity, environmental, economic, cultural and behavioral factors are also important contributors to the risk. For example, foods high in caloric density (e.g., fast food) are frequently less expensive than those of higher nutritional value, increasing risk in low-income families. Similarly, the risk of obesity is increased for children who live in poorly resourced communities and therefore have fewer opportunities for safe physical activity. Regardless of economic or environmental conditions, children who receive modeling of unhealthy diets or patterns of physical activity are at increased risk.

ACUTE CARE
IN GENERAL…