Incidence Area Research Articles

Influences of Differentiated Residence and Workplace Location on the Identification of Spatiotemporal Patterns of Dengue Epidemics: A Case Study in Guangzhou, China.

The location of the infections is the basic data for precise prevention and control of dengue fever (DF). However, most studies default to residence address as the place of infection, ignoring the possibility that cases are infected at other places (e.g., workplace address). This study aimed to explore the spatiotemporal patterns of DF in Guangzhou from 2016 to 2018, differentiating workplace and residence. In terms of temporal and spatial dimensions, a case weight assignment method that differentiates workplace and residence location was proposed, taking into account the onset of cases around their workplace and residence. Logistic modeling was used to classify the epidemic phases. Spatial autocorrelation analysis was used to reveal the high and early incidence areas of DF in Guangzhou from 2016 to 2018. At high temporal resolution, the DF in Guangzhou has apparent phase characteristics and is consistent with logistic growth. The local epidemic is clustered in terms of the number of cases and the time of onset and outbreak. High and early epidemic areas are mainly distributed in the central urban areas of Baiyun, Yuexiu, Liwan and Haizhu districts. The high epidemic areas due to commuting cases can be further identified after considering the workplaces of cases. Improving the temporal resolution and differentiating the workplace and residence address of cases could help to improve the identification of early and high epidemic areas in analyzing the spatiotemporal patterns of dengue fever in Guangzhou, which could more reasonably reflect the spatiotemporal patterns of DF in the study area.

266 The Importance of Opioid and Naloxone Education in the Emergency Department for High-Risk Age Groups

Throughout the United States, opioid abuse continues to be a major public health concern that many emergency departments (EDs) and communities face. New data shows that nearly 75,673 people died from opioid overdose over 12 months ending April 2021. This is up from 56,064 in the previous 12 months. Opioid treatment and education programs have shown effectiveness, especially in areas of high incidence. We hypostasize that specific demographic age groups are at higher risk of opioid abuse and could benefit from an ED opioid education and naloxone distribution program.

Widely targeted metabolomics analysis reveals the effect of exogenous auxin on postharvest resistance to Botrytis cinerea in kiwifruit (Actinidia chinensis L.)

Kiwifruit has high economic value but is susceptible to fungal infection after harvest. Botrytis cinerea (B. cinerea) is one of these fungal pathogens that cause huge economic losses and potential food safety problems. Auxin is a vital plant growth regulator that has been reported to play a role in plant defense. In this study, postharvest kiwifruit was treated with different concentrations of indole-3-acetic acid (IAA), after which the average incidence rate and lesion area were analyzed to determine the appropriate concentration of IAA for disease resistance. Defense enzymes, such as superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) were detected. Ultra-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS)-based widely targeted metabolomic analysis was used to investigate the mechanism of kiwifruit active compounds during IAA treatment and B. cinerea infection. Exogenous IAA treatment (especially at 50 μg/ mL) enhanced the resistance of kiwifruit to B. cinerea, resulting in reduced disease incidence and lesion area, and showed higher pathogen resistance-related defense enzyme activity in response to B. cinerea infection. Further metabolomic analysis revealed 776 metabolites in kiwifruit after IAA treatment, among which 51 metabolites in IAA_24h (24 h after IAA treatment) vs. CK (sterilized ddH2O treatment) fruit, 55 metabolites in IAA_72h (72 h after IAA treatment) vs. CK, and 67 metabolites in IAA_24h vs. IAA_72h were found to be significantly different. KEGG analysis showed that the resistance induced in kiwifruit by IAA treatment was closely related to the activation of phenylpropanoids, including flavonoids and phenols, terpenoids, carbohydrate metabolism, and hormone signaling pathways. These results might reveal the mechanism of IAA-induced resistance in kiwifruit and provide a new theoretical basis for the safe and efficient control of postharvest diseases in kiwifruit.

Prevalence and Genotyping of HPV in Oral Squamous Cell Carcinoma in Northern Brazil.

Highly oncogenic human papillomavirus (HPV) is well known to be associated with and a risk factor for various types of oral carcinomas such as oral squamous cell carcinoma (OSCC). The aim of this study was to evaluate and describe the HPV-induced OSCC prevalence and genotyping in the city of Belém, northern Brazil. This cross-sectional study features 101 participants who attended an oral pathology referral center in a dental college looking for diagnoses of oral lesions (OL). After signing the consent term and meeting the inclusion criteria, all participants went through a sociodemographic and epidemiological questionnaire. Then, OL were collected by excisional or incisional biopsy depending on OL size; after that, OL tissues were preserved in paraffin blocks to histopathological diagnoses. Afterwards, paraffin blocks were divided into benign and malignant/premalignant lesions based on the classification of potentially malignant disorders of the oral and oropharyngeal mucosa. Then, the paraffin blocks had DNA extraction performed by the ReliaPrep FFPE gDNA Miniprep method in order to identify HPV DNA of high oncogenic risk and low oncogenic risk. Then, the viral DNA was amplified and typed using the Inno-Lipa genotyping Extra II method, and the collected data were analyzed by Chi-square and G-tests. In total, 59/101 (58.4%) OL were malignant/premalignant lesions, of which OSCC was the most prevalent with 40/59 (67.7%) and 42/101 (41.6%) benign lesions. The most common area of OL incidence was upper gingiva 46/101 (45.5%). Regarding HPV DNA detection, approximately 27/101 (26.7%) had positive results; of these, 17/59 (28.8%) were malignant/premalignant lesions, and the most prevalent genotypes detected were 16, 18, 52 and 58, while among benign lesions, 10/42 (66.6%) had HPV-positive results, and the most prevalent genotypes detected were 6, 11 and 42. Age range was the only risk factor with a significant association between HPV and OSCC presence (p-value: 0.0004). A correlation between OSCC and oral HPV among analyzed samples could not be demonstrated in our small cohort.

Decrease in liver cancer incidence rates in Bamako, Mali over 28 years of population-based cancer registration (1987-2015).

BACKGROUNDPrimary liver cancer is common in West Africa due to endemic risk factors. However, epidemiological studies of the global burden and trends of liver cancer are limited. We report changes in trends of the incidence of liver cancer over a period of 28 years using the population-based cancer registry of Bamako, Mali.AIMTo assess the trends and patterns of liver cancer by gender and age groups by analyzing the cancer registration data accumulated over 28 years (1987-2015) of activity of the population-based registry of the Bamako district.METHODSData obtained since the inception of the registry in 1987 through 2015 were stratified into three periods (1987-1996, 1997-2006, and 2007-2015). Age-standardized rates were estimated by direct standardization using the world population. Incidence rate ratios and the corresponding 95% confidence intervals (CI) were estimated using the early period as the reference (1987-1996). Joinpoint regression models were used to assess the annual percentage change and highlight trends over the entire period (from 1987 to 2015).RESULTSAmong males, the age-standardized incidence rates significantly decreased from 19.41 (1987-1996) to 13.12 (1997-2006) to 8.15 (2007-2015) per 105 person-years. The incidence rate ratio over 28 years was 0.42 (95%CI: 0.34-0.50), and the annual percentage change was -4.59 [95%CI: (-6.4)-(-2.7)]. Among females, rates dropped continuously from 7.02 (1987-1996) to 2.57 (2007-2015) per 105 person-years, with an incidence rate ratio of 0.37 (95%CI: 0.28-0.45) and an annual percentage change of -5.63 [95%CI: (-8.9)-(-2.3)].CONCLUSIONThe population-based registration showed that the incidence of primary liver cancer has steadily decreased in the Bamako district over 28 years. This trend does not appear to result from biases or changes in registration practices. This is the first report of such a decrease in an area of high incidence of liver cancer in Africa. This decrease may be explained by the changes and diversity of diet that could reduce exposure to aflatoxins through dietary contamination in this population.

N-nitrosamines-mediated downregulation of LncRNA-UCA1 induces carcinogenesis of esophageal squamous by regulating the alternative splicing of FGFR2

Concerns are raised over the risk to digestive system's tumors from the N-nitrosamines (NAs) exposure in drinking water. Albeit considerable studies are conducted to explore the underlying mechanism responsible for NAs-induced esophageal squamous cell carcinoma (ESCC), the exact molecular mechanisms remain largely unknown, especially at the epigenetic regulation level. In this study, it is revealed that the urinary concentration of N-Nitrosodiethylamine is higher in high incidence area of ESCC, and the lncRNA-UCA1(UCA1) is significantly decreased in ESCC tissues. In vitro and in vivo experiments further show that UCA1 is involved in the malignant transformation of Het-1A cells and precancerous lesions of the rat esophagus induced by N-nitrosomethylbenzylamine (NMBzA). Functional gain and loss experiments verify UCA1 can affect the proliferation, migration, and invasion of ESCC cells in vitro and in vivo. Mechanically, through binding to heterogeneous nuclear ribonucleoprotein F (hnRNP F) protein, UCA1 regulates alternative splicing of fibroblast growth factor receptor 2 (FGFR2), which promotes the FGFR2IIIb isoform switching to FGFR2 IIIc isoform, and the latter activates epithelial-mesenchymal transition via PI3K-AKT signaling pathways impacting tumorigenesis. Therefore, NAs-mediated downregulation of UCA1 promotes ESCC progression through targeting hnRNP F/FGFR2/PI3k-AKT axis, which provides a new chemical carcinogenic target and establishes a previously unknown mechanism for NAs-induced ESCC.

Geographical Inequality on Cataract Surgery Uptake in 200,000 Australians: Findings from the "45 and Up Study".

Using a geographical information system (GIS), we investigated the spatiotemporal evolution of a cataract surgery service and its association with socioeconomic factors and private insurance, based on 10-year real-world medical claim data in an Australian population. The data collected cover a decade (2007–2016) from the “45 and Up Study”. A total of 234,201 participants within the cataract surgery service were grouped into 88 Statistical Area Level 3 (SA3s) according to their residential postcodes in New South Wales Australia. We analyzed the spatiotemporal variations and geographical distribution inequality in cataract surgery incidence and its respect to socioeconomic status (SES) and private health insurance coverage by Spearman correlation analysis and Moran's I test. Then these variations were intuitive displayed by six-quartile maps and a local indicator of spatial association (LISA) maps based on GIS. The average cumulative age-gender-standardized of the incidence of cataract surgery (ICS) was 8.85% (95% CI, 5.33–15.6). Spatial variation was significant (univariate Moran's I = 0.45, P = 0.001) with incidence gradually decreasing from the coastal regions to the north-western inland regions, suggesting inequality in the cataract surgery service across the state of New South Wales. Notably, clustering of the low incidence areas had gradually disappeared over the decade, suggesting that the cataract surgery service has improved over time. Low scores on the “index of socioeconomic disadvantages” (IRSD) and high private health insurance coverage were significantly associated with a higher incidence of cataract surgery (bivariate Moran's I = −0.13 and 0.23, P < 0.01; Spearman correlation r = 0.25 and −0.25, P = 0.02), which is displayed on the map visually and obviously. Spatiotemporal variations in the incidence of cataract surgery are significant, but the low incidence area had gradually disappeared over time. High socioeconomic status and private insurance contribute to a higher incidence of cataract surgery in Australia.

Pollution levels and health risk assessment of potentially toxic metals of size-segregated particulate matter in rural residential areas of high lung cancer incidence in Fuyuan, China.

The highest incidence and mortality rate of lung cancer in rural area of Fuyuan has been a research hotspot, and the pathogenesis is still unclear. Therefore, atmospheric particulate matters (APMs) samples were collected between 18 February and 01 March 2017, exploring water-soluble potentially toxic metals (WSPTMs) and water-soluble inorganic ionic species (WSIIs) levels, size distribution, sources, acidity and alkalinity, and potential carcinogenic and non-carcinogenic risks, hoping to provide scientific basic data to solve this problem.In our study, the average ratio of nitrate ion (NO3-)/sulfate ion (SO42-) within PM1.1, PM1.1-2.0, PM2.0-3.3, PM3.3-7.0, and PM>7.0 were 0.22, 0.18, 0.15, 0.34 and 0.36, respectively, that revealed that combustion sources contributed to PM were more significant. The anions in equilibrium (ANE) / cations in equilibrium (CAE) < 1 for all samples within PM1.1, PM2.0-3.3, PM3.3-7.0 indicate that the APMs were alkaline, but PM1.1-2.0 particulate matter shows weak acidity. SO42-prefers to combine with NH4+to form (NH4)2SO4, which hinders the formation ofNH4NO3, the remainingSO42-and NO3- to neutralize the K+,KNO3was formed at all particulate, however, K2SO4 can only be formed in PM<3.3. Arsenic (As) and Selenium (Se) were identified as the most enriched WSPTMs in all PM sizes, predominantly from anthropogenic emissions, were suggested that coal combustion is a significant source of PM-bound WSPTMs. Total WSPTMs exhibited high total carcinogenic risks (TCR) values (9.98 × 10-6, 1.06 × 10-5, and 1.19 × 10-5 for girls, boys and adults, respectively) in the smaller particles (< 1.1μm). Se was considered as the major contributor (63.60%) to carcinogenic risk (CR) in PM2.0 and had an inverse relationship with PM size that should be of prime concern.

EPIZOOTIC SITUATION OF ANIMAL EMCAR (BlACKLEG) ON THE TERRITORY OF THE REPUBLIC OF KAZAKHSTAN FOR 2010- 2020

The article presents the results of epizootological monitoring of emcar in animals based on the analysis of official reporting data of the veterinary service of the Republic of Kazakhstan for 2010-2020 and the results of the authors' own research. The main epizootological indicators of the epizootic process in the country have been established, the incidence areas that affect the unfavorable and tense epizootic situation for this disease have been determined. The focality indicator on emcar, for this period of time, averaged from 1 to 4 animals, which indicates the non-contagiousness of the infection. By studying the occurrence of the disease onthe territory of the Republic of Kazakhstan over the years, the frequency of epizooties has not been established. An analysis of the monthly dynamics of the disease focus showed that blackleg manifests itself in a greater number mainly in October and November. Emcar foci are least or not registered at all in the winter months and early spring (December, January, February and March). For the period from 2010 till 2020 (11 years) on the territory of the Republic of Kazakhstan, a high degree of incidence was observed in 3 regions (West Kazakhstan, East Kazakhstan, Zhambyl), an average degree - in 3 regions (Almaty, Aktobe, Pavlodar), and in other 4 regions (Kostanay, Atyrau, Karaganda, Akmola) - the degree of incidence was low. Based on assessing and retrospective analysis of the established epizootological indicators, epizootological zoning maps were developed showing the balckleg status of each region. According to the compiled map of the epizootic situation, for the period from 2010 to 2020, 71.4% of the territory of 10 regions of the Republic of Kazakhstan turned out to be disadvantaged for animal blackleg. The territory of the remaining 4 regions (28.6%) of the republic (Kyzylorda, North Kazakhstan, Mangystau, Turkestan) is safe from animal emcar. The obtained new scientific data on the dynamics of epizootic situation onemcar on the territory of the Republic of Kazakhstan can be used in drawing up a plan and carrying out preventive measures, development of effective measures to control animal emcar.

Impact of COVID-19 Pandemic on Emergency Department Volume and Acuity in Low Incidence Area: Taiwan's Experience in Three Hospitals.

The decrease in emergency department (ED) patient visits during the COVID-19 pandemic was reported by various studies. Our study aimed to investigate whether a similar trend can be observed in a country with a low incidence of COVID-19 as well as the impact caused by the pandemic on ED patients in different triage levels and categories. This multicenter retrospective study collected data from three regional hospitals between March 2019 and December 2020. We evaluated the differences between patient volume, disease severity, and patient composition in ED before and after the COVID-19 pandemic among these hospitals. There was a 23% reduction in ED patient volume in the urban hospital (hospital A) as well as a 16% reduction in suburban hospitals (hospitals B and C) during the pandemic period, respectively. The regression analysis showed a high correlation in the change in monthly patient volume among these hospitals. In terms of severity, there was a 24% reduction in ED visits with high severity levels (Taiwan Triage and Acuity Scale [TTAS] I, II) in hospital A, as well as 16% and 12% in hospitals B and C during the pandemic period, respectively. Similarly, there was a 23% reduction in ED visits with low severity levels (TTAS III, IV, V) in hospital A, as well as 20% and 16% in hospitals B and C during the pandemic period, respectively. In terms of patient types, there was a significant decline in non-traumatic adult patients (19%, 17%, and 10%), and pediatric patients (49%, 50%, and 46%) in hospitals A, B, and C, respectively. Despite the low incidence of COVID-19 in Taiwan, a decrease in total ED visits was still found during the pandemic, especially in non-trauma adult visits and pediatric visits. In addition, ED visits in both high and low severity levels decreased in these regional hospitals.

Squamous Cancer of the Esophagus in Africa: A Causal Pathway Established

Squamous cancer of the esophagus has been endemic in much of East, Central and Southern Africa since the 1940s. Much research has concentrated on attempts to identify major carcinogenic influences, and failure to do so has made it clear that the problem in high incidence areas (HIAs) is not primarily of potent environmental carcinogens, but of population susceptibility. In Africa the association with maize is constant and strong. Research in the last decade has helped to explain that association. Considered along with historical findings there is now enough evidence to establish causal associations of a nutritionally deficient maize diet and use of maize meal with squamous cancer of the esophagus. Evidence is available in a high incidence area of degenerating maize meal resulting in excess production of PGE2, gastric hypochlorhydria and a predominant pattern of non-acid gastroesophageal reflux. This pathway explains the existence of major population susceptibility: a poor maize-based diet provides specific nutritional deficiencies and n-6 fatty acid dominance which cause failure of homeostasis of the arachidonic acid cascade; with this background chemically degenerating maize meal then triggers duodenogastric reflux and non-acid gastro-esophageal reflux; non-acid reflux causes squamous cancer of the esophagus. Within a susceptible population, environmental carcinogens including tobacco increase individual risk. There is sufficient evidence that this is an active pathway, and the dominant pathway to SCCE in high incidence areas in Africa.There is sufficient evidence to justify appropriate preventative measures.

Developing Machine Learning Algorithms on Routinely Collected Administrative Health Data - Lessons from Ontario, Canada.

There has been considerable growth in the development of machine learning models for clinical applications; however, less attention has been paid to applications at the health systems level. Here, we survey recent models developed using provincial administrative health data holdings in Ontario, Canada to synthesize key learnings across use cases. We have developed four models in the areas of diabetes incidence and complications, hospitalization due to ambulatory care sensitive conditions, and hospitalization due to SARS-CoV-2 infection. Our team was highly multidisciplinary with expertise across clinical medicine, administrative health data, epidemiology, and computer science. We used a “sliding window” approach to aggregate healthcare events across multiple health administrative data sets chronologically and map them dynamically onto a patient timeline. Tree-based algorithms, specifically gradient boosted decision trees, are well suited for the underlying tabular structure of administrative data and were used for each prediction task. Our models achieved excellent discrimination, measured by the area under the receiver operating characteristic curve, between 0.77-0.85 at prediction windows between 30 days and 3 years in advance. They were also well-calibrated, both in-the-large and in population subgroups such as older adults, those living in rural areas, and the materially deprived. Measures of feature importance revealed that our models were leveraging predictors across administrative datasets (e.g. demographics, interactions with the healthcare system, medications) in intuitive and defensible ways. Finally, we demonstrated the utility of our models with “recall at top k” metrics - for example, the top 1% of patients predicted at risk of diabetes complications represented a cost of over $400 million to the healthcare system. We identify three key learnings needed for the successful application of machine learning methods to health administrative data: synergy between nature of training data and intended algorithm use, adherence to methodological best practices for rigour and transparency, and multidisciplinary teams with expertise across data provenance, methodological approach, and impact assessment.

COVID-19 incidence in a cohort of public transport workers.

Previous research has shown an excess risk of COVID-19 among several occupations, but data on public transport workers are scarce. To investigate the occupational risk posed by contact with the public, we followed up the incidence of COVID-19 in a cohort of public transport workers. We identified the incident cases of COVID-19 between 1 September 2020 - 6 May 2021 in a cohort of 2,052 employees of a public transport agency in Sardinia, Italy. The diagnosis of COVID-19 was based on a positive molecular test. To calculate the expected events, we applied the age- and gender-specific incidence rates of the regional population in the same time period to the correspondent strata of the study cohort. We estimated the relative risk (RR) of COVID-19 as the ratio between the observed and the expected events and its 95% confidence interval (95% C.I.) among the total cohort and in two sub-cohorts: bus drivers, and the rest of the personnel (administrative staff, train and metro drivers, workers in the mechanical shop, and in the railroad maintenance, and security). Bus drivers run an elevated risk of COVID-19 (RR = 1.4, 95% C.I. 1.07 - 1.79). There was no excess risk among the sub-cohort including the rest of the personnel. Our study suggests an excess risk of COVID-19 among bus drivers even in a relatively low incidence area, which could imply inadequacy of the preventive measures in place. Further, larger size studies with detailed information on personal and lifestyle characteristics are warranted.

How does the side of lumbar disc herniation influence the psoas muscle size at the L4-5 level in patients operated for unilateral hip arthroplasty?

Study Design: Retrospective study. Objection: There can be a relationship between degenerative diseases in the spine and hip. Summary of Background Data: Degenerative diseases in the spine and hip may occur concomitantly. This study was done to investigate the cross-sectional area of psoas muscle size and incidence of lumbar disc herniation after unilateral hip arthroplasty. Methods: The data files of patients who were operated on for unilateral hip arthroplasty between January 2014- and 15 May 2021 at the Recep Tayyip Erdogan University Hospital were retrospectively analysed for the relationship between the psoas muscle volume and the incidence of lumbar disc herniation. The patients were divided according to their operated sides. Results: The data files of 48 patients were retrospectively analysed. The patients were divided into two groups according to the operated side of their hip joints. Gender and age differences were not significant, and the mean ages were 68,68 years old in the right hip arthroplasty group, and 69,39 in the left hip arthroplasty group. Conclusions: A complex interaction between the development of lumbar disc herniations and increased contralateral cross-sectional area of the psoas muscle at the L4-5 level was observed in patients operated for unilateral hip arthroplasty. This interaction can be a compensatory mechanism to counteract the spinal imbalance.

Findings of a community screening programme for human cystic echinococcosis in a non-endemic area.

Cystic Echinococcosis (CE) is a zoonosis caused by infection with the larval stages of the taeniid cestodes of the species complex Echinococcus granulosus sensu lato. It is prevalent among transhumant communities in East Africa, including those residing in northern Kenya. The movement of livestock from these regions of high incidence to areas of low incidence creates an indirect risk of disease spill-over to humans. To assess possible establishment of the CE life cycle outside known endemic regions, we used a portable ultrasound scanner to screen for the presence of human CE in Bungoma County of western Kenya, an area which imports substantial numbers of cattle for slaughter from neighbouring pastoralist regions. Eight sentinel sites were purposively selected based on their proximity to slaughterhouses handling animals introduced from pastoralist regions, and necessary permissions to conduct the study were sought. Regression analyses were conducted to identify risk factors associated with the presence of abdominal and cystic lesions (CL). In total, 1002 participants were screened; of these, 654 (65.3%) were female and the median age was 43. Farming (n = 403; 43.4%) was the most frequent occupation, followed by professional (i.e. on regular salary) (n = 215; 23.1%), and business (n = 207; 22.3%) categories. Sixty-seven participants (6.7%) had abnormal ultrasound findings, of these, 7 (1.1%) had simple liver cysts/CL, as per WHO classification. As such, their outcome was inconclusive and they were not put on treatment but advised to attend follow-up investigations in a referral health facility. Other abnormal findings included splenomegaly (n = 14), ovarian cysts (n = 14), uterine fibroids (n = 10), polycystic kidneys (n = 6), and benign prostatic hyperplasia (n = 6). Age was unconditionally associated with the presence of presumptive CL. These results contribute to CE baseline data while providing insights on the implementation of ultrasound diagnosis in the field, as recommended by the WHO for targeted control of echinococcosis by 2030.

Epidemiology of Lyme borreliosis based on outpatient claims data of all people with statutory health insurance, Germany, 2019.

IntroductionEvidence of nationwide and regional morbidity of Lyme borreliosis (LB) in Germany is lacking.AimsWe calculated the total number of incident LB cases in Germany in 2019, compared regional variations, investigated the extent of possible under-reporting in notification data and examined the association between high incidence areas and land cover composition.MethodsWe used outpatient claims data comprising information for people with statutory health insurance who visited a physician at least once between 2010 and 2019 in Germany (n = 71,411,504). The ICD-10 code A69.2 was used to identify incident LB patients. Spatial variations of LB were assessed by means of Global and Local Moran’s Index at district level. Notification data were obtained for nine federal states with mandatory notification from the Robert Koch Institute (RKI).ResultsOf all insured, 128,177 were diagnosed with LB in 2019, corresponding to an incidence of 179 per 100,000 insured. The incidence varied across districts by a factor of 16 (range: 40–646 per 100,000). We identified four spatial clusters with high incidences. These clusters were associated with a significantly larger proportion of forests and agricultural areas than low incidence clusters. In 2019, 12,264 LB cases were reported to the RKI from nine federal states, while 69,623 patients with LB were found in claims data for those states. This difference varied considerably across districts.ConclusionsThese findings serve as a solid basis for regionally tailored population-based intervention programmes and can support modelling studies assessing the development of LB epidemiology under various climate change scenarios.

Prevalence and Risk Factors of Glaucoma Among Chinese People From the China Health and Retirement Longitudinal Study.

This study demonstrated the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases in China using the baseline data from China Health and Retirement Longitudinal Study (CHARLS), a nationwide population-based cohort. The purpose of this study is to estimate the prevalence of self-reported glaucoma and its risk factors using data from the CHARLS. Data on age, sex, area of residence, education, marital status, health-related behaviors, and preexisting comorbidities for this cross-sectional study were retrieved from the CHARLS for 17,713 subjects who completed a questionnaire between June 2011 and March 2012. The prevalence of glaucoma was estimated, and a multivariate weighted analysis was performed to estimate the odds ratios (ORs) of its risk factors. Of 16,599 respondents (93.7%) who answered questions regarding glaucoma and their history of systemic chronic diseases, 314 (1.89%) reported having glaucoma before the index date. Qinghai and Beijing had the highest prevalence of glaucoma in China. Glaucoma was significantly associated with hypertension [OR: 1.362; 95% confidence interval (CI), 1.801-2.470], diabetes (OR: 2.597; 95% CI, 1.661-10.207), dyslipidemia (OR: 1.757; 95% CI, 1.157-3.650), lung disease (OR: 2.098; 95% CI, 1.674-6.527), stroke (OR: 5.278; 95% CI, 1.094-25.462), heart disease (OR: 1.893; 95% CI, 1.237-3.363), and health-related behaviors such as smoking and alcohol consumption after adjusting for age, sex, area, education, marital status, and medical insurance. Geographic variation in the prevalence of self-reported glaucoma and its strong association with preexisting systemic chronic diseases were observed, suggesting that in addition to ophthalmological examinations, regular physical examinations are necessary for glaucoma patients, especially in areas of high incidence. Appropriate strategies to improve preventive measures for glaucoma are recommended for the Chinese population.

Genotypic and hematological characteristics of 83 β-thalassemia mutation carriers and patients from Henan Province

To investigate the genotypic and hematological characteristics of β-thalassemia patients and carriers from Henan Province of China. Clinical data of the patients and carriers were collected. Results of routine blood test, hemoglobin electrophoresis and genetic testing were retrospectively analyzed. Of the 83 β-thalassemia patients and carriers, there were 46 females and 37 males, and their mean age was 27.37 ± 14.71, ranging from 5 months to 83 years. A total of 13 types of β-thalassemia alleles (86 alleles in total) were detected, with the most common three including ISV-II-654(C>T) (33.72%), CD41-42(-TTCT) (26.74%) and CD17(A>T) (18.60%). Five rare alleles, including CD8-9(+G), IVS-II-1(G>A), CD42(T>G), and start codons ATG>AGG and ATG>ACG were identified. Among these, HBB: c.128T>G(CD42T>G) was previously unreported in China. Fifteen β-thalassemia genotypes were detected, which included 12 simple heterozygote genotypes (80 cases, 96.40%), 2 double heterozygote genotypes (2 cases, 2.40%) and 1 homozygote genotype (1 case, 1.20%). The main manifestations were mild microcytic hypochromic anemia and raised HbA2. Compared with those with a β+/βN genotype, carriers with a β0/βN genotype have lower mean corpuscular volume (MCV) and mean corpusular hemoglobin (MCH) but higher HbA2 (P<0.05). β-thalassemia is not rare in Henan Province and its characteristics are different from those in high incidence areas, which deserves close attention. The newly discovered HBB: c.128T>G (CD42T>G) has enriched the spectrum of β-thalassemia mutations in China. Above results will also facilitate genetic counseling and prenatal diagnosis of β-thalassemia in Henan Province.

MALARIA INCIDENCE IN EAST KUTAI, EAST KALIMANTAN, INDONESIA 2016: AN EPIDEMIOLOGY STUDY

Highlights: 1. Most malaria infections found in East Kutai Regency were found within the male group and had high contact with forest areas.2. Malaria infections were found predominantly in the male group aged 25 to 34 years old.3. Most of the malaria infections found were caused by Plasmodium vivax. Abstract: Background: Malaria is endemic in Indonesia and knowing the factors that are involved in malaria infection will help the development of surveillance, prevention, and disease control. Objective: This study aimed to identify the profile of malaria infection and the vectors known in East Kutai Regency, Indonesia, in 2016. Material and Method: This research was a descriptive observational study with a cross-sectional design. The sample used was taken from the 2016 annual report of The Health Office, East Kutai Regency. We evaluated malaria indicators, disease distribution, incidence (age, sex, and occupation), plasmodium species found and known vectors. Result: In 2016, there were 55 confirmed cases of malaria infection in East Kutai. The Annual Parasite Index was 0.16 per 1,000. Malaria patients were dominated by males (85.5%), aged between 25-34 years old with a mean age of 29.56 years. Most of the patients lived in Rantau Pulung (41.8%). Most of the patients had work that had high contact with forest areas (70.9%). Most of the patients were infected with Plasmodium vivax (58.2%). Identified vectors were Anopheles balabacensis which was found in Kaliorang District. Conclusion: The East Kutai Regency was classified as Low Case Incidence Area with most cases found in males of 24 to 34 years old whose work had high contact with forest areas. The identified plasmodium species were Plasmodium vivax and Plasmodium falciparum while the identified vector was Anopheles balabacensis.

AMPK Activation Alleviates Myocardial Ischemia-Reperfusion Injury by Regulating Drp1-Mediated Mitochondrial Dynamics.

Mitochondrial dysfunction is a salient feature of myocardial ischemia/reperfusion injury (MIRI), while the potential mechanism of mitochondrial dynamics disorder remains unclear. This study sought to explore whether activation of Adenosine monophosphate-activated protein kinase (AMPK) could alleviate MIRI by regulating GTPase dynamin-related protein 1 (Drp1)-mediated mitochondrial dynamics. Isolated mouse hearts in a Langendorff perfusion system were subjected to ischemia/reperfusion (I/R) treatment, and H9C2 cells were subjected to hypoxia /reoxygenation (H/R) treatment in vitro. The results showed that AICAR, the AMPK activator, could significantly improve the function of left ventricular, decrease arrhythmia incidence and myocardial infarction area of isolated hearts. Meanwhile, AICAR increased superoxide dismutase (SOD) activity and decreased malondialdehyde (MDA) content in myocardial homogenate. Mechanistically, AICAR inhibited the phosphorylation of Drp1 at Ser 616 while enhanced phosphorylation of Drp1 at Ser 637. In addition, AICAR reduced the expression of inflammatory cytokines including TNF-ɑ, IL-6, and IL-1β, as well as mitochondrial fission genes Mff and Fis1, while improved the expression of mitochondrial fusion genes Mfn1 and Mfn2. Similar results were also observed in H9C2 cells. AICAR improved mitochondrial membrane potential (MMP), reduced reactive oxygen species (ROS) production, and inhibited mitochondrial damage. To further prove if Drp1 regulated mitochondrial dynamics mediated AMPK protection effect, the mitochondrial fission inhibitor Mdivi-1 was utilized. We found that Mdivi-1 significantly improved MMP, inhibited ROS production, reduced the expression of TNF-a, IL-6, IL-1β, Fis1, and Mff, and improved the expression of Mfn1 and Mfn2. However, the protection effect of Mdivi-1 was not reversed by AMPK inhibitor Compound C. In conclusion, this study confirmed that activation of AMPK exerted the protective effects on MIRI, which were largely dependent on the inhibition of Drp1-mediated mitochondrial fission.