High-incidence Regions Research Articles

The Burden of Gastric Cancer in Northern Central America.

Gastric cancer is the fourth leading cause of cancer-related death worldwide, with nearly one million new cases diagnosed in 2020. There is marked variation in gastric cancer incidence globally, with highest incidence rates reported in the United Nations regions of Eastern Asia, Eastern Europe, and Latin America. Although the United States is considered a low-incidence country, gastric cancer presents an important cancer disparity, with higher incidence in minoritized populations, including immigrants from high-incidence regions. The Northern Central America nations are low- and middle-income countries with a high gastric cancer incidence and large US immigrant populations. These countries lack comprehensive cancer registries, but recent GLOBOCAN-imputed gastric cancer estimates are in the range of 8 to 12/100,000 age-standardized incidence rates. Three epidemiologic studies carried out in El Salvador, Nicaragua, and Honduras demonstrate a higher than predicted burden of gastric cancer with low 5-year survival (<10%). The gastric cancer burden is projected to increase in the absence of changes to national and regional cancer control plans. Twelve evidence-based recommendations to reduce gastric cancer mortality in the Americas have recently been proposed, ranging from the "test-and-treat" Helicobacter pylori eradication strategy to endoscopic screening and surveillance programs. Translating these recommendations into a practical plan for this resource-limited setting could address the disproportionate gastric cancer burden. See related article by Peña-Galo et al., p. 1564 See related article by Ruiz de Campos et al., p. 1571 See related article by Dominguez et al., p. 1578.

Social Determinants of Health Associated with Cholangiocarcinoma Risk in High-Risk Areas of Thailand: A Case-Control Study.

This case-control study sought to explore the social determinants of health (SDH) associated with cholangiocarcinoma (CCA) risk in high-incidence regions of Thailand. The research was conducted in two phases. Phase 1 assessed the prevalence, context, and conditions among at-risk populations for CCA in Yasothon, located in Northeast Thailand. This phase utilized a survey-based research design, employing verbal screening methods to categorize individuals into risk groups (at-risk vs. not at-risk). Phase 2 aimed to identify the SDH associated with CCA risk through a case-control study. Of 496 recruited participants, 238 cases of subjects were at risk of CCA, and 258 controls were not at risk of CCA. Data were collected using structured questionnaires. Multiple logistic regression was employed to analyze the factors associated with CCA risk. The study revealed that 48.00% of participants were at risk for CCA, with 32.06% having a history of liver fluke eggs detected in their feces. Despite this, only 45.40% of participants engaged in adequate preventive behaviors. Analysis of SDH among the cases identified significant challenges, including high levels of poverty (49.14%), food security (52.22%), social exclusion (48.82%), inadequate housing (50.22%), and overall SDH burden (53.42%). In contrast, relatively lower levels of health inequality (48.78%) and unfavorable working conditions (51.65%) were observed. Multivariate analysis indicated that overall SDH was a significant risk factor for CCA (AOR=1.63; 95% CI: 1.09-2.46), while perceived disease severity (AOR=0.57; 95% CI: 0.39-0.83) and safe working conditions (AOR=0.61; 95% CI: 0.42-0.90) were protective factors. Improving CCA prevention behaviors should focus on enhancing perceived severity and addressing the relevant SDH.

Study on the Driving Factors of the Spatiotemporal Pattern in Forest Lightning Fires and 3D Fire Simulation Based on Cellular Automata

Lightning-induced forest fires frequently inflict substantial damage on forest ecosystems, with the Daxing’anling region in northern China recognized as a high-incidence region for such phenomena. To elucidate the occurrence patterns of forest fires caused by lightning and to prevent such fires, this study employs a multifaceted approach, including statistical analysis, kernel density estimation, and spatial autocorrelation analysis, to conduct a comprehensive examination of the spatiotemporal distribution patterns of lightning-induced forest fires in the Greater Khingan Mountains region from 2016–2020. Additionally, the geographical detector method is utilized to assess the explanatory power of three main factors: climate, topography, and fuel characteristics associated with these fires, encompassing both univariate and interaction detections. Furthermore, a mixed-methods approach is adopted, integrating the Zhengfei Wang model with a three-dimensional cellular automaton to simulate the spread of lightning-induced forest fire events, which is further validated through rigorous quantitative verification. The principal findings are as follows: (1) Spatiotemporal Distribution of Lightning-Induced Forest Fires: Interannual variability reveals pronounced fluctuations in the incidence of lightning-induced forest fires. The monthly concentration of incidents is most significant in May, July, and August, demonstrating an upward trajectory. In terms of temporal distribution, fire occurrences are predominantly concentrated between 1:00 PM and 5:00 PM, conforming to a normal distribution pattern. Spatially, higher incidences of fires are observed in the western and northwestern regions, while the eastern and southeastern areas exhibit reduced rates. At the township level, significant spatial autocorrelation indicates that Xing’an Town represents a prominent hotspot (p = 0.001), whereas Oupu Town is identified as a significant cold spot (p = 0.05). (2) Determinants of the Spatiotemporal Distribution of Lightning-Induced Forest Fires: The spatiotemporal distribution of lightning-induced forest fires is influenced by a multitude of factors. Univariate analysis reveals that the explanatory power of these factors varies significantly, with climatic factors exerting the most substantial influence, followed by topographic and fuel characteristics. Interaction factor analysis indicates that the interactive effects of climatic variables are notably more pronounced than those of fuel and topographical factors. (3) Three-Dimensional Cellular Automaton Fire Simulation Based on the Zhengfei Wang Model: This investigation integrates the fire spread principles from the Zhengfei Wang model into a three-dimensional cellular automaton framework to simulate the dynamic behavior of lightning-induced forest fires. Through quantitative validation against empirical fire events, the model demonstrates an accuracy rate of 83.54% in forecasting the affected fire zones.

Study on the correlation between the number of mushroom poisoning cases and meteorological factors based on the generalized additive model in Guizhou Province, 2023

BackgroundMushroom poisoning is a significant food safety issue in Guizhou Province, China. Studies on this topic are essential for its prevention and control. We aimed to analyze the epidemiological characteristics of mushroom poisoning and study the correlation between its cases and meteorological factors in Guizhou Province.MethodsWe collected data on mushroom poisoning and meteorological factors in Guizhou Province in 2023. A descriptive analysis was conducted on the epidemiological features of mushroom poisoning and meteorological factors. We used Spearman correlation analysis and the generalized additive model to examine the relationship between meteorological factors and the number of mushroom poisoning cases.ResultsIn 2023, mushroom poisoning cases in Guizhou Province were concentrated among individuals aged 20–59. Clinical symptoms were primarily gastrointestinal symptoms and occurrences peaked from June to October, mainly in the northeastern region of the province. Most incidents occurred in households. In 72 mushroom poisoning incidents where species were identified, 33 poisonous mushrooms were found. The number of mushroom poisoning cases in Guizhou Province was positively correlated with each meteorological factor(P < 0.05). The generalized additive model showed a significant nonlinear relationship between DGT, PRE, RHU, SSD, and the number of mushroom poisoning cases (P < 0.05). Interaction analysis showed that the risk of mushroom poisoning in Guizhou Province increased with the rising values of any two of these four meteorological factors.ConclusionMushroom poisoning incidents in Guizhou Province are characterized by high-risk groups, seasonality, and specific high-incidence regions and places. Public awareness for high-risk groups and early warnings for high-incidence regions and places should be strengthened every summer and fall. There is a correlation between meteorological factors and the number of mushroom poisoning cases, suggesting that these factors could serve as early warning indicators for the prevention and control of mushroom poisoning.

Establishment of a Mesoamerican-Caribbean South-South Research Platform: Challenges in the Meriva (Curcuminoids) Gastric Cancer Chemoprevention Trial.

Gastric adenocarcinoma (GAC) is the fourth leading global cause of cancer mortality and leading infection-associated cancer. High-incidence regions of GAC include Latin America and Eastern Asia. Immigrants from high-incidence regions maintain their GAC risk. GAC is a major U.S. cancer disparity, and its incidence rates are 2 to 10 times higher in non-White populations. Emerging guidelines recommend 3-year surveillance endoscopy for patients with high-risk gastric premalignant conditions (GPMC). Clinical trials of GPMC chemoprevention agents are lacking. We conducted a NCI Division of Cancer Prevention-funded, phase II placebo-controlled chemoprevention trial in patients with GPMCs (atrophic gastritis and intestinal metaplasia) with a highly bioavailable preparation of curcuminoids (Meriva). The trial sites in Puerto Rico and rural Honduras had important characteristics: (i) representative Caribbean and Mesoamerican populations, linked to large U.S. immigrant populations; (ii) high prevalence of Helicobacter pylori infection and GPMCs; (iii) the absence of turmeric and curcuminoids in local diets; and (iv) proven bidirectional collaboration with U.S. academic institutions. H. pylori-negative patients with GPMCs were randomized to the study drug (500 mg po bid) or placebo for 180 days (NCT02782949), with primary outcomes based upon histologic parameters. Principal study challenges included (i) an international regulatory environment; (ii) research infrastructure strengthening, particularly in Central America; (iii) participant recruitment in Honduras, wherein only 10% to 15% are H. pylori negative; (iv) the COVID-19 pandemic; and (v) natural disasters (three hurricanes). There were no losses to follow-up related to the pandemic or natural disasters. In conclusion, the south-south partnership provides a model for chemoprevention and translational studies in Latino populations with prevalent cancers, such as GAC.

Understanding Cancer Epidemiology in Himachal Pradesh, India

Objective This study investigated the distribution of cancer cases across different age groups, sexes, and regions in Himachal Pradesh, India, with the aim of informing targeted public health strategies. Materials and Methods Cancer incidence data were collected from various age groups, sexes, and blocks. Statistical Analysis Chi-square tests were used to assess the significance of differences in cancer patient distribution according to age, sex, and region. Results Cancer incidence increased with age, peaking in the 58 to 67 years age group. The highest number of patient was reported, particularly among individuals aged 38 years and above. Minimal cases were observed in the youngest age groups (&lt; 17 and 18–27 years), while a significant increase was noted in the middle age groups (28–57 years). Cancer cases were nearly equally distributed between males (50.1%) and females (49.9%). A chi-square value of 180.18 indicated a statistically significant difference in cancer incidence according to age and sex. Gender-specific trends revealed higher cancer incidences in females during middle age (28–57 years) and in males during older age (58 years and above). The highest number of cases was 18.1%, followed by 14.7 and 14.6%, while the lowest incidence was 1.5%. Conclusion The present study underscores the need for comprehensive and targeted public health strategies to manage cancer burdens effectively. Focusing on high-incidence regions and ensuring equitable health care access for all genders can improve cancer outcomes and reduce mortality rates associated with the disease.

Informing an investment case for Japanese encephalitis vaccine introduction in Bangladesh.

Japanese encephalitis virus (JEV) is a major threat to human health. Bangladesh is considering introducing a JEV vaccine; however, the investment case is hampered by a limited understanding of key aspects of JEV ecology. We conducted a seroprevalence study in a high-incidence region using an assay that limits cross-reactivity with dengue virus. We also trapped mosquitoes and collected information about potential host species. We used mathematical models to recover risk factors for infection and underlying probabilities of severe disease and death. We observed 19.0% [95% confidence interval (CI):17.1 to 21.1] of JEV antibodies. On average, 0.7% (95% CI: 0.2 to 2.0) of the susceptible population gets infected yearly, with pig proximity being the main human infection risk factor. Our traps captured 10 different mosquito species that have been linked with JEV transmission. We estimated that 1 in 1000 infections results in severe disease, 1 in 10,000 results in death, and 76% of severe cases are missed by surveillance.

Multidisciplinary Effort Leading to Effective Tuberculosis Community Outbreak Containment in Israel.

Tuberculosis (TB) is the second-most prevalent cause of mortality resulting from infectious diseases worldwide. It is caused by bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). In Israel, TB incidence is low, acknowledged by the WHO as being in a pre-elimination phase. Most cases occur among immigrants from high TB incidence regions like the Horn of Africa and the former Soviet Union (FSU), with occasional outbreaks. The outbreak described in this report occurred between 2018 and 2024, increasing the incidence rate of TB in the region. Control of this outbreak posed challenges due to factors including a diverse population (including Ethiopian immigrants, Israeli-born citizens, and immigrants from other countries), economic and social barriers, and hesitancy to disclose information. The unique multidisciplinary team formed to address these challenges, involving the local TB clinic, district health ministry, health maintenance organization (HMO) infectious disease consultant, neighborhood clinic, and National Mycobacterium Reference Laboratory (NMRL), achieved effective treatment and containment. Whole genome sequencing (WGS) proved pivotal in unraveling patient connections during the outbreak. It pinpointed those patients overlooked in initial field investigations, established connections between patients across different health departments, and uncovered the existence of two distinct clusters with separate transmission chains within the same neighborhood. This study underscores collaborative efforts across sectors that successfully contained a challenging outbreak.

Clinical Trials in Gastroesophageal Cancers: An Analysis of the Global Landscape of Interventional Trials From ClinicalTrials.gov.

To describe the global landscape of clinical research into interventions for gastroesophageal cancers (GECs), with examination of trial characteristics, geographic distribution of trial sites, and factors associated with trial termination. We queried ClinicalTrials.gov to identify all completed or terminated phase III interventional studies investigating GECs (esophageal squamous cell carcinoma [ESCC], esophageal adenocarcinoma [EAC], gastroesophageal junctional [GEJ], and gastric adenocarcinoma). Data on all reported trial characteristics were extracted. Pearson's chi-square and Fisher's exact tests were used to compare differences in completed and terminated trials. Multivariate logistic regression evaluated predictors of termination. A total of 179 trials were identified; of these, 90% were therapeutic. Most included sites in Asia (61%) and Europe (32%); few included sites in Africa (4%). Thirty percent included sites in low- and middle-income countries (LMICs). Most (70%) focused on gastric or GEJ adenocarcinoma, 13% on EAC and ESCC, and 9% on ESCC alone. Sixteen percent (n = 29) of trials terminated prematurely. In multivariate analysis, study site number, location of recruitment sites, and patient population emerged as predictors of termination. Trials recruiting from US-based sites were more likely to terminate (odds ratio [OR], 7.22 [95% CI, 1.59 to 32.69]). Trials conducted exclusively in LMICs were less likely to terminate (OR, 0.04 [95% CI, 0.01 to 0.59] v conducted in high-income countries [HICs] alone). Studies on ESCC were more likely to terminate (OR, 17.74 [95% CI, 1.49 to 210.69]). Although 80% of GECs occur in LMICs, trial activity disproportionately occurs in HICs. Few trials focus on EAC/ESCC despite being highly fatal, highlighting an unmet need. Overall, this study highlights (1) a missed opportunity to recruit patients from high-incidence regions globally; and (2) a pressing need for increasing funding, infrastructure, and support for GEC trials in LMICs.

Impact of the COVID-19 Pandemic on Tumor Stage and Pathohistological Parameters of Vulvar Cancer.

Background/Objectives: Vulvar cancer (VC) comprises a small fraction of female neoplasms with notable high-incidence clusters among German regions. Despite a proposed impact of nationwide lockdowns in response to the COVID-19 pandemic on oncological diseases, the effect on VC staging and tumor characteristics remains yet to be resolved; therefore, analyzing pathological data from patients with squamous cell VC pre-, during, and post-COVID in a high-incidence region may offer insights into potential epidemiological and clinical trends. Methods: We identified a total of 90 patients who were diagnosed at the Institute of Pathology, University Hospital Saarland, between 2018 and 2023, and defined three distinct cohorts: a pre-COVID cohort (2018-2019), a COVID cohort (2020-2021), and a post-COVID cohort (2022-2023). Histomorphological data were collected from the individual patient reports and statistically analyzed using Fisher's exact test or the Kruskal-Wallis test. Results: Although we found no statistically significant differences in age, T-stage, perineural infiltration, blood vessel infiltration, resection status, grading, or resection margin between our three cohorts, surprisingly, we determined a greater extent of lymphovascular infiltration (Fisher's exact test; p = 0.041), as well as deeper tumor infiltration depth (Kruskal-Wallis test; p < 0.001) before the COVID-19 pandemic. Furthermore, we did not identify any soft indications of abnormalities in patient care within our center (unchanged status of the resection margins across all three cohorts). Conclusions: Our results clearly do not support a negative affection of clinical or pathobiological characteristics of VC during or after the pandemic. However, final assessments regarding the pandemic's effect on VC require additional study approaches in various regions, preferably with future extended timeframes of a longer follow-up.

Identification of the health education targeted susceptible population of tuberculosis in Ningxia, Northwest China

Knowledge, Attitude, and Practice (KAP) survey, as an effective measure tool, is of practical significance for identifying the susceptible population in high-incidence regions of tuberculosis (TB). We aim to identify the health education targeted susceptible population of TB and discuss the acting pathway of KAP in Ningxia. A multistage random sampling method was used to conduct a face-to-face questionnaire survey for residents. The latent class analysis (LCA) model was used to classify susceptible populations of TB, and the structural equation modeling (SEM) model was also employed to investigate the interaction mechanisms of KAP (mediation analysis). We further applied the ordered logistic regression model to explore the associated factors. A total of 973 residents were enrolled, 70.6% were male, aged from 16 to 89. The LCA analysis demonstrated that 3 categories of susceptible populations of TB ("overall good", "positive attitude" and "overall poor") have optimal goodness of fit (BIC = 7889.5, Entropy = 0.923). SEM model indicated that the attitude plays a significant mediation effect from knowledge to practice toward TB (an indirect effect of 0.038, and a direct effect of 0.138). The ordered logistic regression results found that age, sex, marital status, education level, occupation, family income, self-perceived health status, having a family member or friend with TB, and knowing the DOTS strategy were significantly associated with classifications of KAP level towards TB. Based on the LCA model, we accurately classified the susceptible population of TB into 3 groups with different degrees of KAP. We found that TB attitude plays a mediating role between knowledge and practice. Therefore, we should pay more attention and carry out targeted health education in the community to these populations with overall poor KAP towards TB, and develop effective strategies and measures to realize the End TB Plan.

Spatiotemporal patterns of Lyme disease in North Carolina: 2010–2020

Lyme disease is the most common vector-borne disease in the United States with the majority of cases occurring in the Northeast, upper Midwest, and mid-Atlantic regions. While historically considered a low incidence state, North Carolina (NC) has reported an increasing number of cases over the past decade. Therefore, the aim of this study was to characterise the spatiotemporal evolution of Lyme disease in NC from 2010 to2020. Confirmed and probable cases reported to the NC Division of Public Health without associated travel to high-transmission state were included in the analysis. The study period was divided into four sub-periods and data were aggregated by zip code of residence. The absolute change in incidence was mapped and spatial autocorrelation analyses were performed within each sub-period. We identified the largest absolute changes in incidence in zip codes located in northwestern NC along the Appalachian Mountains. The spatial distribution of cases became increasingly clustered over the study period (Moran's I of 0.012, p=0.127 in 2010-2012 vs. 0.403, p<0.0001 in 2019-2020). Identified clusters included 22 high-incidence zip codes in the 2019-2020 sub-period, largely overlapping with the same areas experiencing the greatest absolute changes in disease incidence. Lyme disease has rapidly emerged in northwestern NC with some zip codes reporting incidence rates similar to historically high incidence regions across the US Northeast, mid-Atlantic, and upper Midwest. Efforts are urgently needed to raise awareness among medical providers to prevent excess morbidity. Funding was provided by a "Creativity Hub" award from the UNC Office of the Vice Chancellor for Research. Additional support was provided by Southeastern Center of Excellence in Vector Borne Diseases (U01CK000662).

Global burden and trends of acute viral hepatitis among children and adolescents from 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019.

Children and adolescents are at high risk for acute viral hepatitis (AVH), but epidemiological research focusing on them has been overshadowed by adult chronic B and C. We provide global, regional, and national estimates of the AVH burden and their trends on people under 20years from 1990 to 2019. AVH data from Global Burden of Disease Study (GBD) 2019 was used. Incidence and disability-adjusted life years (DALYs) were calculated, analyzing trends with estimated annual percentage change (EAPC) and Joinpoint regression. In 2019, 156.39 (95% uncertainty interval 145.20-167.16) million new cases of AVH were reported among children and adolescents globally, resulting in 1.98 (1.50-2.55) million DALYs. Incidence rates for young children (< 5years), older children (5-9years), and adolescents (10-19years) were 12,799 (11,068-14,513), 5,108 (4829-5411), and 3020 (2724-3339) per 100,000 population, respectively. The global AVH incidence displayed a linear decline with an EAPC of - 0.66 (- 0.68 to - 0.65). High-incidence regions included sub-Saharan Africa, Oceania, South Asia, and Central Asia, with India, Pakistan, and Nigeria facing the greatest burden. Leading causes were hepatitis A, followed by hepatitis E, B, and C. All hepatitis types showed declining trends, especially hepatitis B. Furthermore, we confirmed the association between the AVH incidence and the socioeconomics, vaccine, and advanced liver diseases. Effective vaccines and treatments for hepatitis B and C offer eradication opportunities. Broadening diagnostic and therapeutic coverage is vital to address disparities in service provision for children and adolescents.

Prokaryotic and eukaryotic skin microbiota modifications triggered by Leishmania infection in localized Cutaneous Leishmaniasis.

Cutaneous Leishmaniasis (CL) is a tropical disease characterized by cutaneous ulcers, sometimes with satellite lesions and nodular lymphangitis. Leishmania parasites, transmitted by sandfly vectors, cause this widespread public health challenge affecting millions worldwide. CL's complexity stems from diverse Leishmania species and intricate host interactions. Therefore, this study aims to shed light on the spatial-temporal distribution of Leishmania species and exploring the influence of skin microbiota on disease progression. We analyzed 40 samples from CL patients at three military bases across Colombia. Using Oxford Nanopore's Heat Shock Protein 70 sequencing, we identified Leishmania species and profiled microbiota in CL lesions and corresponding healthy limbs. Illumina sequencing of 16S-rRNA and 18S-rRNA genes helped analyze prokaryotic and eukaryotic communities. Our research uncovered a spatial-temporal overlap between regions of high CL incidence and our sampling locations, indicating the coexistence of various Leishmania species. L. naiffi emerged as a noteworthy discovery. In addition, our study delved into the changes in skin microbiota associated with CL lesions sampled by scraping compared with healthy skin sampled by brushing of upper and lower limbs. We observed alterations in microbial diversity, both in prokaryotic and eukaryotic communities, within the lesioned areas, signifying the potential role of microbiota in CL pathogenesis. The significant increase in specific bacterial families, such as Staphylococcaceae and Streptococcaceae, within CL lesions indicates their contribution to local inflammation. In essence, our study contributes to the ongoing research into CL, highlighting the need for a multifaceted approach to decipher the intricate interactions between Leishmaniasis and the skin microbiota.

Anti-Interference Bottom Detection Method of Multibeam Echosounders Based on Deep Learning Models

Multibeam echosounders, as the most commonly used bathymetric equipment, have been widely applied in acquiring seabed topography and underwater sonar images. However, when interference occurs in the water column, traditional bottom detection methods may fail, resulting in discontinuities in the bathymetry and distortion in the sonar images. To solve this problem, we propose an anti-interference bottom detection method based on deep learning models. First, the variation differences of backscatter strengths at different incidence angles and the failure conditions of traditional methods were analyzed. Second, the details of our deep learning models are explained. And these models were trained using samples in the specular reflection, scatter reflection, and high-incidence angle regions, respectively. Third, the bottom detection procedures of the along-track and across-track water column data using the trained models are provided. In the experiments, multibeam data with strong interferences in the water column were selected. The bottom detection results of the along-track water column data at incidence angles of 0°, 35°, and 60° and the across-track ping data validated the effectiveness of our method. By comparison, our method acquired the correct bottom position when the traditional methods had inaccurate or even no detection results. Our method can be used to supplement existing methods and effectively improve bathymetry robustness under interference conditions.

DETERMINING FACTORS OF LEPROSY: A CASE-CONTROL STUDY IN A HYPERENDEMIC AREA OF THE BRAZILIAN LEGAL AMAZON

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It can result in permanent physical disabilities if not diagnosed early. A case-control study was conducted to identify the factors associated with the occurrence of leprosy in individuals living in a region of high incidence of the disease in the Tocantins state in northern Brazil. Sixty cases were diagnosed between 2016 and 2018, and 120 controls were included in the study. The control group consisted of residents from the same area as the cases, the same sex, and with an age variation of up to 5 years. Data were collected through interviews with each participant. Associations were assessed by univariate analysis, followed by logistic regression analysis. The following factors were associated with leprosy in the logistic regression model: households with no more than four rooms (OR = 4.01), absence of a BCG vaccination scar (OR = 2.16), and a previous case of leprosy in the family (OR = 4.32). The data indicated that a close relationship between individuals of the same family in small households, without any immunological protection, and with a history of leprosy cases, significantly increased the risk of M. leprae infection and development of leprosy.

Genome-wide DNA methylation and transcriptomic patterns of precancerous gastric cardia lesions.

Intestinal metaplasia (IM) and intraepithelial neoplasia (IEN) are considered precursors of gastric cardia cancer (GCC). Here, we investigated the histopathologic and molecular profiles of precancerous gastric cardia lesions (PGCLs) and biomarkers for risk stratification of gastric cardia IM. We conducted a hospital-based evaluation (n = 4578) for PGCL profiles in high-incidence and non-high-incidence regions for GCC in China. We next performed 850K methylation arrays (n = 42) and RNA-seq (n = 44) in tissues with PGCLs. We then examined the protein expression of candidate biomarker using immunohistochemistry. Of the 4578 participants, 791 were diagnosed with PGCLs (600 IM, 62 IM with IEN, and 129 IEN). We found that individuals from high-incidence regions (26.7%) were more likely to develop PGCLs than those from non-high-incidence areas (13.5%). DNA methylation and gene expression alterations, indicated by differentially methylated probes (DMPs) and differentially expressed genes (DEGs), exhibited a progressive increase from type I IM (DMP = 210, DEG = 24), type II IM (DMP = 3402, DEG = 129), to type III IM (DMP = 3735, DEG = 328), peaking in IEN (DMP = 47 373, DEG = 2278). Three DEGs with aberrant promoter methylation were identified, shared exclusively by type III IM and IEN. Of these DEGs, we found that OLFM4 expression appears in IMs and increases remarkably in IENs (P < .001). We highlight that type III IM and IEN share similar epigenetic and transcriptional features in gastric cardia and propose biomarkers with potential utility in risk prediction.

Seroprevalence of tick-borne encephalitis virus and vaccination coverage of tick-borne encephalitis, Sweden, 2018 to 2019.

BackgroundIn Sweden, information on seroprevalence of tick-borne encephalitis virus (TBEV) in the population, including vaccination coverage and infection, is scattered. This is largely due to the absence of a national tick-borne encephalitis (TBE) vaccination registry, scarcity of previous serological studies and use of serological methods not distinguishing between antibodies induced by vaccination and infection. Furthermore, the number of notified TBE cases in Sweden has continued to increase in recent years despite increased vaccination.AimThe aim was to estimate the TBEV seroprevalence in Sweden.MethodsIn 2018 and 2019, 2,700 serum samples from blood donors in nine Swedish regions were analysed using a serological method that can distinguish antibodies induced by vaccination from antibodies elicited by infection. The regions were chosen to reflect differences in notified TBE incidence.ResultsThe overall seroprevalence varied from 9.7% (95% confidence interval (CI): 6.6-13.6%) to 64.0% (95% CI: 58.3-69.4%) between regions. The proportion of vaccinated individuals ranged from 8.7% (95% CI: 5.8-12.6) to 57.0% (95% CI: 51.2-62.6) and of infected from 1.0% (95% CI: 0.2-3.0) to 7.0% (95% CI: 4.5-10.7). Thus, more than 160,000 and 1,600,000 individuals could have been infected by TBEV and vaccinated against TBE, respectively. The mean manifestation index was 3.1%.ConclusionA difference was observed between low- and high-incidence TBE regions, on the overall TBEV seroprevalence and when separated into vaccinated and infected individuals. The estimated incidence and manifestation index argue that a large proportion of TBEV infections are not diagnosed.

Poor oral health and the risk of esophageal squamous cell carcinoma in Malawi.

Esophageal squamous cell carcinoma (ESCC) is the second most common cancer in Malawi. Risk factors for this cancer in Malawi are poorly understood. Poor oral health has previously been linked to increased ESCC risk in other high-incidence regions, including parts of Eastern and Southern Africa. We assessed the relationship between oral health and ESCC risk in a sex, age and location frequency-matched case-control study based at two hospitals in Lilongwe, Malawi from 2017 to 2020. Trained interviewers used a structured questionnaire and direct observation to collect data on demographics; behaviors; oral hygiene habits; the sum of decayed, missing or filled teeth (DMFT score); oral mucosa status; lip depigmentation and dental fluorosis via a visual scale. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), adjusted for known and suspected ESCC risk factors. During the study period, 300 cases and 300 controls were enrolled. Subjects in the highest tertile of DMFT score (≥7) had an increased risk of ESCC with an adjusted OR of 1.96 (95% CI: 1.16-3.36) compared to those with a DMFT score of 0. Severe dental fluorosis was associated with a statistically nonsignificant increased risk of ESCC (adjusted OR = 2.24, 95% CI: 0.97-5.49) compared to individuals with no fluorosis. Associations with oral mucosa status, lip depigmentation and toothbrushing method and frequency were mostly null or uncertain. Poor oral health, indicated by a higher DMFT score, was associated with increased ESCC risk in Malawi. Dental fluorosis is another possible risk factor in this population, but further evaluation is necessary to clarify any effects of fluorosis on ESCC risk.

Regional variations in the management of primary hyperparathyroidism in Sweden: population-based case-control study.

Substantial disparities in the utilization of parathyroidectomy for primary hyperparathyroidism have been reported. This study aimed to analyse regional variations in parathyroidectomy incidence with respect to the patient's disease burden and socioeconomic status. A population-based case-control study included all patients with primary hyperparathyroidism who underwent parathyroidectomy in Sweden between 2008 and 2017 and 10 matched controls. Data on demographic and socioeconomic variables, co-morbidities and drug prescriptions were collected from relevant national registers. Conditional logistic regression was used to analyse predictors of parathyroidectomy. A total of 8626 patients with primary hyperparathyroidism (77% women) underwent parathyroidectomy during the study interval. The annual incidence of parathyroidectomy was 9.0 per 100 000 persons. The annual age-adjusted regional incidences of parathyroidectomy varied between 3.3 and 16.9 operations per 100 000 inhabitants. Except for a small underrepresentation of patients with lower education, no effect of socioeconomic variables was observed. Compared with matched controls, the parathyroidectomy group had increased odds ratios of having developed classical symptoms of primary hyperparathyroidism and being prescribed medication against cardiovascular disorders and psychiatric illness at the time of parathyroidectomy. Increased risks of kidney stones and osteoporosis were observed 5 years before parathyroidectomy. Patients with primary hyperparathyroidism selected for parathyroidectomy from regions with a low incidence of operations had a higher prevalence of kidney stones, osteoporosis and hypertension, as well as larger adenomas and higher calcium levels at the time of parathyroidectomy compared with patients in high-incidence regions. The considerable variation in parathyroidectomy seems more likely associated with different clinical thresholds for detection of primary hyperparathyroidism and referral to surgery than socioeconomic disparities.