Indigenous populations are generally reported to suffer greater active tuberculosis (TB) disease burden. The objective of this study was to examine ecological associations between cases of active adult and pediatric TB reported from 2002 to 2004 and community characteristics in indigenous communities of the Paraguayan Chaco. Adult and pediatric models were examined by negative binomial and Poisson GLM regression, respectively. Active TB prevalence in indigenous people was<i> eight times</i> higher than the nonindigenous population. Communities with a health post were more than twice as likely to report active adult TB (RR = 2.07, 95% confidence interval (CI) [1.14–3.83], and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32502pt" id="M1" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-113" d="M573 302C573 402 527 451 414 451C386 451 343 446 313 437L330 513L320 522C295 508 261 484 243 463L230 415C194 400 159 383 126 359L131 330C159 344 187 357 222 368L109 -147C96 -204 80 -214 18 -223L13 -255L256 -244L259 -212L236 -210C184 -205 180 -195 191 -141L219 -1C240 -10 268 -12 284 -12C352 4 431 48 484 104C543 166 573 240 573 302ZM481 290C481 165 381 37 305 37C280 37 249 56 235 71L302 395C328 399 353 402 372 402C427 402 481 378 481 290Z"/></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-91" d="M530 -6V57L144 261V263L530 468V530L81 290V234L530 -6Z"/></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z"/></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-54" d="M158 548H390L417 615L410 623H122L83 318C105 326 143 337 185 337C296 337 350 275 350 188C350 116 308 42 225 42C164 42 122 74 100 93C90 101 82 99 72 92C60 82 51 68 50 59C48 46 52 38 66 24C82 9 125 -12 172 -12C225 -11 292 15 346 59C408 108 437 166 437 226C437 309 371 397 242 397C214 397 170 382 133 369L158 548Z"/></g></svg>). Each additional average year of education in the community was associated with nearly 50% less likelihood of active pediatric TB (RR = 0.53, 95% CI [0.38–0.73], and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32502pt" id="M2" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 51.7247 11.6608" width="51.7247pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g50-113"/></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><use xlink:href="#g54-91"/></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,45.13,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z"/></g></svg>). Although nonsignificant, the presence of nonindigenous community members had a strong protective association in both the adult (RR = 0.56, 95% CI [0.30–1.03], and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32502pt" id="M3" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g50-113"/></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z"/></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-55" d="M141 347C171 480 264 541 327 570C364 587 403 599 436 605L429 641C389 634 339 622 300 609C191 570 37 458 37 239C37 86 126 -12 245 -12C367 -12 454 89 454 210C454 314 380 397 272 397C252 397 230 390 208 380L141 347ZM231 338C323 338 366 257 366 174C366 108 340 27 263 27C180 27 129 123 129 244C129 268 130 292 135 310C158 323 193 338 231 338Z"/></g></svg>) and pediatric models (RR = 0.64, 95% CI [0.34–1.14], and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32502pt" id="M4" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g50-113"/></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><use xlink:href="#g54-34"/></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><use xlink:href="#g50-50"/></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-53" d="M462 177V227H365V632H320C217 496 116 350 21 208V177H284V109C284 43 280 38 190 31V0H451V31C369 38 365 43 365 108V177H462ZM284 227H88C155 336 218 430 282 519H284V227Z"/></g></svg>). These results reinforce the importance of increasing epidemiologic surveillance and investigating the social determinants of TB disease among vulnerable indigenous populations.

Amanda VanSteelandt

Ana Magdalena Hurtado

Miriam Rol&#xf3;n

Antonieta Rojas de Arias

Juan Carlos Jara

High Tuberculosis Disease Burden among Indigenous People of the Paraguayan Chaco and Associated Community Characteristics, 2002&#x2013;2004: An Ecological Study

Previous studies on violence against prehospital personnel have mainly reported on &#x201c;verbal&#x201d; and &#x201c;physical&#x201d; violence. This study explored how provider demographic and work-related characteristics were associated with five different forms of workplace violence (being cursed or threatened; being punched, slapped, or scratched; being spat upon; being stabbed/stabbing attempt; and being shot/shooting attempt). A cohort of nationally registered United States Emergency Medical Services professionals was surveyed to determine the experience of each of these types of patient initiated violence by these providers and their partners. Multivariable logistic regression analyses indicated gender was significantly associated with both being cursed/threatened and being stabbed or experiencing a stabbing attempt (odds ratio (OR) = 0.65, CI = 0.44&#x2013;0.96; OR = 0.27, CI = 0.09&#x2013;0.75, resp.). Level of EMT practice was significantly associated with being cursed/threatened, being spat upon, and being punched, slapped, or scratched (OR = 0.17, CI = 0.11&#x2013;0.27; OR = 0.30, CI = 0.21&#x2013;0.43; OR = 0.31, CI = 0.22&#x2013;0.44, resp.). Both community size and experience were significantly associated with all the types of violence investigated. EMS workplace violence research is at its infancy; thus this study adds to a limited but growing body of knowledge.

Anthony Oliver

Roger Levine

Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

Intestinal parasitic infections are common among children worldwide. This study was aimed at determining risk factors for infection with soil transmitted helminths, <i>Cryptosporidium</i> spp., and <i>Giardia duodenalis</i>, among children in preschools. The study was in two parts: a cross-sectional study in which data were collected from 403 children from 10 preschools and a longitudinal study in which 100 children from four preschools from the previous 10 were selected. Prevalence of <i>Ascaris lumbricoides</i> was 12.0&#x25;, while that of hookworm was 8.3&#x25;. Overall prevalence of <i>Cryptosporidium</i> and <i>G. duodenalis</i> was 28.0&#x25; and 29.0&#x25;, respectively. Low education level of parent/guardian was a significant risk factor for <i>A. lumbricoides</i> (OR = 2.35, 95&#x25; CI: 1.02&#x2013;5.41; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M1" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg>), while roofing types other than corrugated iron sheets were found to be protective for <i>G. duodenalis</i> infection in both bivariate and multivariate analyses (multivariate: OR = 0.67, 95&#x25; CI: 0.45&#x2013;0.99; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M2" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><use xlink:href="#g113-53"/></g></svg>). Low socioeconomic level was found to be protective for <i>Cryptosporidium</i> spp. infection in multivariate analysis (OR = 0.59, 95&#x25; CI: 0.35&#x2013;0.99; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M3" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><use xlink:href="#g113-53"/></g></svg>). In the longitudinal study, none of the factors were associated with either infection. These findings may have implications for other preschools in other districts in Zambia.

Joyce Siwila

Annette Olsen

Risk Factors for Infection with Soil Transmitted Helminths, <i>Cryptosporidium</i> spp., and <i>Giardia duodenalis</i> in Children Enrolled in Preschools in Kafue District, Zambia

The time for the triggering event in neoplasms can be estimated using incubation period modeling techniques. We applied these techniques to primary osteosarcoma and Ewing&#x2019;s sarcoma of bone using the Surveillance Epidemiology and End Results database for all cases of osteosarcoma or Ewing&#x2019;s sarcoma of bone from 1993 through 2010. Secondary neoplasms were excluded. The age at diagnosis, gender, ethnicity, and anatomic location were collected. The time (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42779pt" id="M1" height="9.63795pt" version="1.1" viewBox="-0.0498162 -6.21016 11.4348 9.63795" width="11.4348pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-121" d="M536 404C536 423 520 448 491 448C445 448 398 404 308 283L286 338C255 416 242 448 217 448C182 448 138 402 92 341L111 321C149 368 169 378 178 378C188 378 198 363 214 320L254 212C185 117 138 65 107 65C98 65 85 69 82 75C79 82 73 86 65 86C44 86 23 60 23 39C23 7 44 -12 71 -12C119 -12 168 33 265 177L306 61C321 17 347 -12 373 -12C413 -12 465 33 507 96L491 119C459 84 432 60 413 60C395 60 378 92 358 148L321 250C341 279 369 310 389 332C417 363 439 382 456 382C466 382 475 376 481 368C486 361 492 358 496 358C513 358 536 381 536 404Z"/></g><g transform="matrix(.0095,0,0,-0.0095,7.506,3.264)"><path id="g50-117" d="M329 433H203L239 587L230 596L147 534L123 433H57L30 395L34 388H115L61 129C37 16 59 -12 85 -12C147 -12 222 58 260 98L241 125C212 95 160 62 144 62C132 62 127 71 138 126L192 386L305 394L329 433Z"/></g></svg>) of the insult/triggering event was calculated using the best fit frequency distribution of age at diagnosis. There were 4,356 patients with osteosarcoma and 1,832 patients with Ewing&#x2019;s sarcoma. The Pearson IV distribution was the best fit for both osteosarcoma (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129993pt" id="M2" height="12.2911pt" version="1.1" viewBox="-0.0498162 -12.0781 55.7356 12.2911" width="55.7356pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-115" d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"/></g><g transform="matrix(.0095,0,0,-0.0095,5.72,-5.984)"><path id="g50-51" d="M414 144C384 79 371 75 317 75H135L276 221C367 316 408 376 408 465C408 570 327 635 237 635C179 635 131 609 100 575L42 494L67 471C94 510 138 565 205 565C277 565 321 517 321 435C321 348 258 270 195 195C146 137 88 81 33 26V0H411C423 44 433 88 446 135L414 144Z"/></g><g transform="matrix(.0135,0,0,-0.0135,14.639,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,26.376,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,32.88,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,35.968,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,42.473,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g><g transform="matrix(.0135,0,0,-0.0135,48.976,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g></svg>) and Ewing&#x2019;s sarcoma (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129993pt" id="M3" height="12.2911pt" version="1.1" viewBox="-0.0498162 -12.0781 49.2081 12.2911" width="49.2081pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-115"/></g><g transform="matrix(.0095,0,0,-0.0095,5.72,-5.984)"><use xlink:href="#g50-51"/></g><g transform="matrix(.0135,0,0,-0.0135,14.639,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,26.376,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,32.88,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,35.968,0)"><use xlink:href="#g113-58"/></g><g transform="matrix(.0135,0,0,-0.0135,42.473,0)"><use xlink:href="#g113-58"/></g></svg>). For these distributions <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42779pt" id="M4" height="9.63795pt" version="1.1" viewBox="-0.0498162 -6.21016 11.4348 9.63795" width="11.4348pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-121"/></g><g transform="matrix(.0095,0,0,-0.0095,7.506,3.264)"><use xlink:href="#g50-117"/></g></svg> is &#x2212;0.7 years of age (4 weeks after conception) for Ewing&#x2019;s sarcoma, 0.45 years for long bone osteosarcoma, and 10.4 years for parosteal osteosarcoma. This confirms the genetic etiology of Ewing&#x2019;s sarcoma since an <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42779pt" id="M5" height="9.63795pt" version="1.1" viewBox="-0.0498162 -6.21016 11.4348 9.63795" width="11.4348pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-121"/></g><g transform="matrix(.0095,0,0,-0.0095,7.506,3.264)"><use xlink:href="#g50-117"/></g></svg> is 4 weeks after conception. Long bone osteosarcoma is not entirely genetic, as <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42779pt" id="M6" height="9.63795pt" version="1.1" viewBox="-0.0498162 -6.21016 11.4348 9.63795" width="11.4348pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-121"/></g><g transform="matrix(.0095,0,0,-0.0095,7.506,3.264)"><use xlink:href="#g50-117"/></g></svg> was 0.4 years for conventional osteosarcoma and 10.4 years for parosteal osteosarcoma. The etiologies for those two different types of osteosarcoma are thus different.

Randall T. Loder

Meagan Sabatino

The Time of the Insult/Triggering Event in Primary Osteosarcoma and Ewing&#x2019;s Sarcoma of Bone as Determined by Incubation Period Modeling and Age Distribution of Such Malignancies

<i>Background</i>. Leishmaniasis is a parasitic disease caused by obligate intracellular protozoans of the genus <i>Leishmania</i>. <i>Objective</i>. To assess the distribution of human leishmaniasis and assess community knowledge, attitude, and practice with regard to assumed risk factors and control options used by the society. <i>Methods</i>. Retrospective study from November 2013 to May 2014 was used. Six-year data from Metemma hospital record was reviewed and 89 people were interviewed. <i>Results</i>. The rates were 29&#x25; (<i>n</i> = 374/1270) and 26&#x25; (<i>n</i> = 328/1270) in 2005 E.C and 2003 E.C, respectively. 94&#x25; (1194/1270) of the affected individuals were in the age exceeding 15 years. At the same time, the rates in males and female were 97&#x25; (<i>n</i> = 1226/1270) and 3&#x25; (<i>n</i> = 44/1270), respectively. According to 88.8&#x25; (<i>n</i> = 79/89) of the respondents, transmission occurs through bite of sandflies, while 98.9&#x25; (<i>n</i> = 88/89) of the respondent&#x2019;s indicated that waste disposal in an open space was one of the risk factors for disease occurrence. Regarding the control measures, respondents replied that 73&#x25; (<i>n</i> = 65/89) of them use impregnated bed net and others use cleaning and proper waste disposal. <i>Conclusion</i>. The current finding indicated that the disease was common in the study area; as a result, proper use of impregnated bed net, early diagnosis and treatment, and reduction of different risk factors were essential.

Yibeltal Terefe

Berihun Afera

Abrha Bsrat

Zewdu Syoum

Distribution of Human Leishmaniasis (VL) and Its Associated Risk Factors, in Metemma, Ethiopia

<i>Background.</i> Many longitudinal epidemiological studies collect specimens into biobanks to investigate how biomarkers predict future disease. In 1968-1969, the Population Study of Women in Gothenburg (PSWG) established a biobank of serum samples. <i>Objective.</i> To examine the validity of 25-hydroxyvitamin D (25(OH)D), total cholesterol, triglycerides, insulin, and potassium after 40 years of storage at &#x2212;20&#xb0;C in terms of relative and absolute agreement. The quality of these markers under such condition has not been previously investigated. <i>Methods.</i> Baseline and remeasured levels were compared in selected samples through percentage change, correlation, and regression. 25(OH)D levels, not assessed at baseline, were compared by season, by BMI, and longitudinally over six years. <i>Results.</i> Despite some lack of absolute agreement, Spearman correlations were &#x3e;0.7 and statistically significant for all biomarkers. The 1968-1969 25(OH)D correlated with BMI <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M1" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 115.736 12.0395" width="115.736pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-41" d="M300 -147C201 -63 143 98 143 270S200 602 300 686L282 710C136 610 70 450 70 271V270C70 89 136 -72 282 -170L300 -147Z"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><path id="g113-115" d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"/></g><g transform="matrix(.0135,0,0,-0.0135,14.192,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 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119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.0135,0,0,-0.0135,56.482,0)"><path id="g113-45" d="M95 130C70 130 46 113 46 88C46 72 54 64 59 64C93 55 121 33 121 -3C121 -41 93 -68 44 -88L55 -117C117 -98 186 -56 186 22C186 91 131 130 95 130Z"/></g><g transform="matrix(.0135,0,0,-0.0135,64.113,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,76.262,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,88,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,94.503,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,97.592,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,104.095,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.0135,0,0,-0.0135,110.599,0)"><path id="g113-42" d="M275 270C275 450 212 609 64 710L45 686C145 604 203 442 203 270S147 -63 45 -147L64 -170C213 -68 275 89 275 270Z"/></g></svg> and with levels six years later <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M2" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 114.281 12.0395" width="114.281pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-41"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><use xlink:href="#g113-115"/></g><g transform="matrix(.0135,0,0,-0.0135,14.192,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,25.93,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,32.433,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,35.522,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g><g transform="matrix(.0135,0,0,-0.0135,42.025,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.0135,0,0,-0.0135,48.529,0)"><use xlink:href="#g113-45"/></g><g transform="matrix(.0135,0,0,-0.0135,56.16,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,68.309,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.0135,0,0,-0.0135,80.047,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,86.55,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,89.639,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,96.142,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,102.645,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.0135,0,0,-0.0135,109.149,0)"><use xlink:href="#g113-42"/></g></svg>. Summer 25(OH)D was higher than winter 25(OH)D <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M3" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 56.1364 12.0395" width="56.1364pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-41"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,16.837,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,28.575,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,35.078,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,38.167,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,44.67,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.0135,0,0,-0.0135,51.173,0)"><use xlink:href="#g113-42"/></g></svg>. <i>Conclusion.</i> For all markers, baseline and remeasured levels exhibited high relative agreement. 25(OH)D was comparable with expected levels on fresh blood and varied with season. In future studies, PSWG individuals will be ranked according to these markers in order to predict incidence of disease.

Monica Leu

Kirsten Mehlig

Monica Hunsberger

&#xc5;sa Torinsson Naluai

Kaj Blennow

Henrik Zetterberg

Cecilia Bj&#xf6;rkelund

Lauren Lissner

Quality Assessment of 25(OH)D, Insulin, Total Cholesterol, Triglycerides, and Potassium in 40-Year-Old Frozen Serum

For young atomic-bomb (A-bomb) survivors, A-bomb radiation&#x2019;s (total) effect on standing height is thought to comprise the sum of direct effect and indirect effect via inflammation. With the data of five inflammatory markers&#x2014;white blood cell count, sialic acid, corrected erythrocyte sedimentation rate (ESR), <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129903pt" id="M1" height="6.42315pt" version="1.1" viewBox="-0.0498162 -6.21016 7.82384 6.42315" width="7.82384pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-223" d="M545 106L524 126C493 85 467 65 455 65C438 65 427 113 405 238C448 295 498 362 543 439L533 448L478 435C453 386 423 331 398 295H395C370 404 347 448 282 448C169 448 23 309 23 153C23 54 65 -12 128 -12C203 -12 283 70 339 155H341C360 29 380 -12 411 -12C444 -12 491 11 545 106ZM333 204C265 95 210 54 169 54C137 54 113 96 113 171C113 302 191 405 252 405C301 405 318 306 333 204Z"/></g></svg>1 globulin, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129903pt" id="M2" height="6.42315pt" version="1.1" viewBox="-0.0498162 -6.21016 7.82384 6.42315" width="7.82384pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-223"/></g></svg>2 globulin&#x2014;obtained in adulthood during the period 1988 to 1992, a summary inflammatory index was constructed as a surrogate for the five subclinical inflammatory markers. For 3,327 A-bomb survivors exposed at ages of less than 25 years, a structural equation model was analyzed to measure direct radiation effects on adult height as well as mediating effect of radiation via inflammation on the height after adjustment for other risk factors, smoking, cancer, inflammatory disease, obesity, and diabetes mellitus. The mediation proportion of the radiation effect on height via inflammation was approximately 5&#x25; for both sexes for all ages, and indirect dose effects via inflammation were statistically significant for both sexes combined and for females exposed at ages 0 to 5 years. Indirect dose effects for all ages via sialic acid, corrected ESR, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129903pt" id="M3" height="6.42315pt" version="1.1" viewBox="-0.0498162 -6.21016 7.82384 6.42315" width="7.82384pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-223"/></g></svg>2 globulin were marginally significant for both sexes combined and for females. These proportions are likely underestimated.

Eiji Nakashima

Kazuo Neriishi

Wan-Ling Hsu

Radiation May Indirectly Impair Growth Resulting in Reduced Standing Height via Subclinical Inflammation in Atomic-Bomb Survivors Exposed at Young Ages

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