Ethnic Dis
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The purpose of this review is to address the global incidence and management of snakebite envenomation and to describe the clinical characteristics and pathogenesis of envenomation by species of the family Viperidae, genera Bothrops and Crotalus, the most common venomous snakes in Brazil. We focus on the pathogenesis of the acute renal failure induced by these snakes. ⋯ In developed nations, snake bite typically occurs during recreational activities, whereas in developing countries it is an occupational disease more likely to affect young agricultural workers, predominantly men. Scarcity and delay of administration of antivenom, poor health services, and difficulties with transportation from rural areas to health centers are major factors that contribute to the high case-fatality ratio of snakebite envenomation.
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There are well-known Black-White disparities in adverse birth outcomes, health behaviors, and chronic diseases such as asthma, diabetes, and hypertension. These disparities hold across socioeconomic status and have remained stable for the past 50 years despite efforts to reduce them. ⋯ We review evidence that Black neighborhoods have significantly poorer healthcare facilities staffed by less competent physicians, higher environmental exposures, and poorer built environments than do White neighborhoods, and we argue that these neighborhood disparities are 3 pathways through which segregation contributes to health disparities. We summarize the research needed on the role of segregation in health disparities and emphasize the hypothesis that these may be differences between Whites and segregated Blacks alone.