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Snakebite in children can often be severe or potentially fatal, owing to the lower volume of distribution relative to the amount of venom injected, and there is potential for long-term sequelae. In the second of a two paper series, we describe the pathophysiology of snakebite envenoming including the local and systemic effects. We also describe the diagnosis and management of snakebite envenoming including prehospital first aid and definitive medical and surgical care.

Snakebite disproportionally affects children living in impoverished rural communities. The WHO has recently reinstated snakebites on its list of Neglected Tropical Diseases and launched a comprehensive Strategy for the Prevention and Control of Snakebite Envenoming. In the first of a two paper series, we describe the epidemiology, socioeconomic impact and key prevention strategies. We also explore current challenges and priorities including the production and distribution of safe and effective antivenom. Revisión por pares

Background Young gay, lesbian, bisexual, transgender, and other sexuality/gender minority identities (LGBT+) exhibit poor sexual health outcomes (e.g., higher STI/HIV rates). In the UK, there is currently an effort to shift high-volume, low-cost testing (i.e., asymptomatic STI testing) away from expensive specialist settings and into primary care. The aim of this study was to explore young LGBT+ people’s experiences and attitudes towards STI/HIV testing in primary care. Methods 39 individual-interviews were conducted with young LGBT+ people (16–24 years; N=19 transgender). Study materials were developed through expert and lay consultation. Participants were recruited via LGBT+ organisations and social media websites. Data were analysed using an inductive thematic analysis. Results Many participants preferred sexual health clinics to primary care for STI/HIV testing due to expectations of stigma, fear of judgement, heteronormative assumptions, and experiences of misgendering. Some lesbian participants were concerned over receiving relevant STI tests - many felt they had little knowledge regarding protection against STIs; their discussions around sexual health with general practitioners rarely surpassed contraception. Some transgender participants reported body dysphoria feelings and perceived STI testing as invasive making physical examinations difficult. Others felt primary care services were too restrictive for transgender patients with some tests unavailable for those registered as being a specific gender. Potential strategies to improve STI/HIV testing in primary care were suggested, such as increased awareness of minority identities in healthcare settings (e.g., leaflets/posters in waiting and consultation rooms) and staff sensitivity training (e.g., use of inclusive language). Conclusion Barriers to STI/HIV testing in primary care (at individual, interpersonal, and structural levels) were identified for young LGBT+ people. Healthcare professionals and policy makers must consider patient diversity to ensure healthcare is both optimal and inclusive. Addressing the health issues affecting this population is a crucial part of improving national public health and eliminating HIV/STIs. Disclosure No significant relationships.