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Potential toxic metal (PTM) is hazardous to human health, but the mechanism of spatial heterogeneity of PTM at a macro-scale remains unclear. This study conducts a meta-analysis on the data of PTM concentrations in the soil of 164 major cities in China from 2006 to 2021. It utilizes spatial analysis methods and geodetector to investigate the spatial distribution characteristics of PTMs. The geographic information systems (GIS) and geodetector were used to investigate the spatial distribution characteristics of PTMs, assess the influence of natural factors (NFs) and anthropogenic factors (AFs) on the spatial heterogeneity of PTMs in urban soils, and identified the potential pollution areas of PTMs. The results indicated that the pollution levels of PTMs in urban soils varied significantly across China, with higher pollution levels in the south than in the north. Cd and Hg were the most severely contaminated elements. The geodetector analysis showed that temperature and precipitation in NFs and land use type in AFs were considered as the main influencing factors, and that both AF and NF together led to the PTM variation. All these factors showed a mutually enhancing pattern which has important implications for urban soil management. PTM high-risk areas were identified to provide early warning of pollution risk under the condition of climate change.

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BACKGROUND: Pakistan has subpar childhood immunization rates and immunization activities have faced several challenges over the past years. We evaluated the social-behavioral and cultural barriers and risk factors for refusal of polio, Routine Immunization (RI), or both in high-risk areas of poliovirus circulation. METHODS: A matched case-control study was conducted from April to July 2017 in eight super high-risk Union Councils of five towns in Karachi, Pakistan. A total of 3 groups, each with 250 cases, including refusals for the Oral Polio Vaccine (OPV) in campaigns (national immunization days and supplementary immunization activities), RI, and both, were matched with 500 controls and identified using surveillance records. Sociodemographic characteristics, household information, and immunization history were assessed. Study outcomes included social-behavioral and cultural barriers and reasons for vaccine refusal. Data were analyzed in STATA using conditional logistic regression. RESULTS: RI refusal was associated with illiteracy and fear of the vaccine's adverse effects, while OPV refusals were linked to the mother's decision authority and the assumption that the OPV caused infertility. Conversely, higher socioeconomic status (SES) and knowledge of and willingness to vaccinate with Inactivated Polio Vaccine (IPV) were inversely associated with RI; and lower SES, walking to the vaccination point, knowledge of IPV, and an understanding of contracting polio were inversely associated with OPV refusals, with the latter two also inversely associated with complete vaccine refusal. CONCLUSION: Education, knowledge and understanding of vaccines, and socioeconomic determinants influenced OPV and RI refusals among children. Effective interventions are needed to address knowledge gaps and misconceptions among parents.

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BACKGROUND: Although endoscopic screening for esophageal cancer has been performed in high-risk areas in China for decades, there is limited and inconsistent evidence regarding the starting age for individuals participating in screening. The aim of this study is to investigate the optimal starting age of esophageal cancer screening. METHODS: This study is based on a multicenter prospective cohort consisting 338,017 permanent residents aged 40-69 years in six high-risk areas of esophageal cancer in China. The participation rate, detection rate, hazard ratios (HRs), cumulative incidence and mortality and number needed to screen (NNS) were calculated in each age group. Screening burden, benefit and risk were compared among screening strategies with different initiation ages to explore the optimal starting age for population-based screening in high-risk areas. RESULTS: Individuals aged 50-69 had a higher participation rate, a higher detection rate and improved screening effectiveness than those aged 40-49. The endoscopic screening had no significant effect on reducing the incidence of esophageal cancer in individuals under 55 and mortality in individuals under 45. Increasing the starting age to 50 years reduced the screening demand and NNS by 40% and 55%, and resulted in 12% of detectable positive cases, 16% of preventable incident cases, and 14% of preventable deaths being missed. CONCLUSIONS: Postponing the starting age of endoscopic screening to 50 years might yield a more-favorable balance between screening benefit and burden in high- risk areas with limited resources.

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Background: The sporadic coronavirus disease (COVID-19) epidemic has placed enormous psychological stress on people, especially clinicians. The objective of this study was to examine depression, anxiety, quality of life (QOL), and related social psychological factors among young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic in China and to provide a reference for formulating reasonable countermeasures. Methods: In this cross-sectional study, demographic information, COVID-19-related questions, anxiety (Generalized Anxiety Disorder-7, GAD-7), depression (Patient Health Questionnaire-9, PHQ-9), insomnia (Insomnia Severity Index, ISI), stress (Perceived Stress Scale-10, PSS-10), and QOL (World Health Organization Quality of Life-brief version, WHOQOL-BREF) were collected. Binary logistic regression analysis was used to test the relationships between anxiety and/or depression and other related problems. Multiple linear regression analysis was used to test the relationships among factors influencing QOL. Results: A total of 146 young front-line clinicians were included. The prevalence rates of depression, anxiety, and anxiety-depression comorbidity were 37.7% (95% CI = 29.7-45.6%), 26.0% (95% CI = 18.8-33.2%), and 24.0% (95% CI = 17.0-31.0%), respectively. Severe stress (OR = 1.258, 95% CI = 1.098-1.442, P < 0.01) and insomnia (OR = 1.282, 95% CI = 1.135-1.447, P < 0.01) were positively correlated with depression. Severe stress (OR = 1.487, 95% CI = 1.213-1.823, P < 0.01) and insomnia (OR = 1.131, 95% CI = 1.003-1.274, P < 0.05) were positively correlated with anxiety. Severe stress (OR = 1.532, 95% CI = 1.228-1.912, P < 0.01) was positively correlated with anxiety-depression comorbidity. However, insomnia (OR = 1.081, 95% CI = 0.963-1.214, P > 0.05) was not correlated with anxiety-depression comorbidity. The belief that the vaccine will stop the COVID-19 pandemic (OR = 0.099, 95% CI = 0.014-0.715, P < 0.05) was negatively correlated with anxiety and anxiety-depression comorbidity (OR = 0.101, 95% CI = 0.014-0.744, P < 0.05). Severe stress (B = -0.068, 95% CI = -0.129 to -0.007, P < 0.05) and insomnia (B = -0.127, 95% CI = -0.188 to -0.067, P < 0.01) were negatively correlated with QOL. The belief that the vaccine could provide protection (B = 1.442, 95% CI = 0.253-2.631, P < 0.05) was positively correlated with QOL. Conclusions: The prevalence of depression, anxiety, and even anxiety-depression comorbidity was high among young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic in China. Various biological and psychological factors as well as COVID-19-related factors were associated with mental health issues and QOL. Psychological intervention should evaluate these related factors and formulate measures for these high-risk groups.

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The COVID-19 pandemic has posed a significant global health threat since January 2020. Policies to reduce human mobility have been recognized to effectively control the spread of COVID-19; although the relationship between mobility, policy implementation, and virus spread remains contentious, with no clear pattern for how countries classify each other, and determine the destinations to- and from which to restrict travel. In this rapid review, we identified country classification schemes for high-risk COVID-19 areas and associated policies which mirrored the dynamic situation in 2020, with the aim of identifying any patterns that could indicate the effectiveness of such policies. We searched academic databases, including PubMed, Scopus, medRxiv, Google Scholar, and EMBASE. We also consulted web pages of the relevant government institutions in all countries. This rapid review's searches were conducted between October 2020 and December 2021. Web scraping of policy documents yielded additional 43 country reports on high-risk area classification schemes. In 43 countries from which relevant reports were identified, six issued domestic classification schemes. International classification schemes were issued by the remaining 38 countries, and these mainly used case incidence per 100,000 inhabitants as key indicator. The case incidence cut-off also varied across the countries, ranging from 20 cases per 100,000 inhabitants in the past 7 days to more than 100 cases per 100,000 inhabitants in the past 28 days. The criteria used for defining high-risk areas varied across countries, including case count, positivity rate, composite risk scores, community transmission and satisfactory laboratory testing. Countries either used case incidence in the past 7, 14 or 28 days. The resulting policies included restrictions on internal movement and international travel. The quarantine policies can be summarized into three categories: (1) 14 days self-isolation, (2) 10 days self-isolation and (3) 14 days compulsory isolation.

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Toxic elements (TEs) in soil threaten the eco-environmental system and human health. The identification and prediction of sources and high-risk areas of TEs in soil are fundamental for regional pollution prevention and control. In this study, geostatistical methods and GIS-based approaches were used to quantitatively analyze the spatial distribution, geochemical characteristics, key driving factors, and their interactive effects of TEs in soil from a typical area of the Tethys-Himalaya tectonic domain in Tibet based on an integrated approach combining positive matrix factorization and GeoDetector models. The mean contents of chromium, arsenic (As), cadmium, mercury and lead in the soil exceeded the Tibetan background values, with 66.20% of As being higher than the screening values. The spatial distribution of TEs content in the soil was primarily affected by geogenic source factors (primarily geology types, soil parent materials, soil types, and soil pH), and environmental source factors (primarily precipitation and vegetation types) and anthropogenic source factors (primarily income of residents and land-use types) also had the same contribution approximately. Compared with that for individual driving factors, the interaction between most pairs of driving factors enhanced their explanatory power. The high-risk areas for soil As pollution were primarily distributed in the valley areas of the upper reaches of the Longzi River Basin. Therefore, to guarantee the health of residents and the security and sustainability of agricultural production in the study area, regular monitoring and soil remediation should be used to reduce the migration and transformation of As in the local biogeochemical cycle. This study provides new ideas for the regional prediction of high-risk areas for soil pollution, which has guiding importance and reference value for the control and management of large-scale soil pollution.

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Heavy metals in soil are a great threat to ecosystems and human health. The rapid development of industrialization has created a serious risk of heavy metal pollution in soil. The study took the industrial-intensive Dahetan subbasin as the typical area. The factors and interactions that affected the distribution of soil heavy metals (Cd, Hg, As, Pb and Cr) in the typical area were explored based on the Geodetector model. The analysis results were extended to predict high-risk areas of heavy metal pollution in the soil in the Xiangjiang River basin. The results showed that Cd, As and Pb were significantly affected by local industrial and mining activities, and Hg and Cr were primarily affected by natural factors, such as pH and soil type. Compared to a single factor, the interaction between factors had a greater impact on the concentration of heavy metals. The high-risk areas of soil heavy metal pollution in the Xiangjiang River basin were primarily concentrated in the upper reaches and middle reaches.Significant overlapping of high-risk areas of multiple heavy metals occurred in the west, middle and south of the basin. The spatial visualization of the high-risk areas was realized, and the influence of several factors was integrated via layer superposition. This study proposes a new idea to predict the high-risk areas of soil pollution in large-scale areas to provide a reference for the regional prevention and control of soil pollution.

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RESUMEN En Ecuador las especies exóticas invasoras (EEI) provocan consecuencias negativas en los aspectos ecológicos, económicos y de seguridad alimentaria. Los agroecosistemas hacen parte de los sectores productivos a nivel mundial, pero son vulnerables a sufrir invasiones biológicas por la constante actividad humana y por el traslado de vegetación, tierra y semillas, por lo que deben ser constantemente monitoreados, pues desempeñan un papel importante en la economía al ser fuente de empleo. El objetivo de esta investigación fue evaluar la influencia potencial de las EEI sobre los agroecosistemas de Ecuador continental a través del modelado del nicho ecológico. Se usó como método de modelación el algoritmo de máxima entropía y se emplearon los registros de presencia de seis especies de plantas, tres insectos y un molusco en sus regiones nativas y en zonas invadidas a nivel mundial. Los registros provienen de Global Biodiversity Information Facility y de Tropicos. Como variables explicativas se emplearon 19 variables bioclimáticas y seis variables de vegetación. Se obtuvieron los mapas de distribución geográfica potencial, las áreas de superposición de la distribución de las especies y la delimitación de las zonas de mayor riesgo. Se determinó que las condiciones ambientales de las regiones Sierra y Amazónica son idóneas para una posible invasión de seis y siete especies. Además, más del 50 % de la cobertura agropecuaria del país podría ser afectada por las especies Wasmannia rochai, Spondias purpurea L., Lissachatina fúlica y Conium maculatum L., siendo los cultivos de ciclo corto los más vulnerables a la invasión por estas especies.

ABSTRACT In Ecuador, invasive alien species (IAS) cause negative consequences in ecology, economy, and food security. Agroecosystems belong to one of the productive sectors worldwide but are vulnerable to biological invasions by constant human activity and the transfer of vegetation, soil, and seeds, so they must be constantly monitored because of their important role in the economy to be a source of employment. The objective of this research was to evaluate the potential influence of IAS on the agroecosystems of continental Ecuador through the modeling of the ecological niche. The maximum entropy algorithm was used as a modeling method, and the presence register in the native region and invaded areas at a global level of six plant species, three insect species and one mollusc species were used. Data were obtained from the Global Biodiversity Information Facility and Tropicos. As explanatory variables, 19 bioclimatic variables, and six vegetation variables were used. Maps of potential geographical distribution, the overlap areas of the distribution of the species, and the delimitation of the zones of greater risk were obtained. It was determined that the environmental conditions of the Sierra and the Amazonian regions are ideal for a possible invasion of most species. Moreover, more than 50 % of the agricultural coverage of the country could be affected by Wasmannia rochai, Spondias purpurea L., Lissachatina fulica, and Conium maculatum L., with short cycle crops being the most vulnerable to invasion.

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The content of Cd, Cu, Pb, Zn, Cr, Ni and As from 250 soil samples was measured in agricultural soil of Ningxia section of the Yellow River. Positive matrix factorization (PMF) was to identify the main sources of these heavy metals; Sequential Gaussian Simulation (SGS) was to identify their spatial distribution and high-risk areas; and Human Health risk (HHR) model was to measure the health risk. Results showed that the average content of Cd and As exceeds the risk screening value of "Soil Environmental Quality-Agricultural Land Soil Pollution Risk Control Standard" (GB 15618-2018), which belongs to slight-level pollution. Although the content of other types of HMs (Cu, Pb, Zn, Cr, Ni) is below the risk screening value, they are still included heavily in the soil (except Cr). PMF indicated that mixed sources of agriculture and industry accounted for 27.06%, natural sources accounted for 14.12%, industrial sources accounted for 23.04%, traffic sources accounted for 21.50%, and Yellow River sedimentary sources accounted for 14.28%. PMF-HHR showed that the mixed sources of agriculture and industry are the most important factor causing non-carcinogenic risk (HI) to children (accounting for 55.75%). Industrial sources and traffic sources were the two main factors that cause HI to adults (industrial sources accounted for 25.16%, and traffic sources accounted for 28.78%). Mixed sources of agriculture and industry and natural sources were the two main factors that cause carcinogenic risk (CR) (mixed sources of agriculture and industry account for 35.34%, and natural sources account for 33.23%). SGS indicated that 0.64% and 9.32% of the total areas were posing as higher HI areas to children and adults respectively; in particular, 0.68% and 1.12% of the areas were identified as higher HI of As and Cr areas at a critical probability of 0.9.

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BACKGROUND: Diagnosis of endometriosis and evaluation of incidence data are complex tasks because the disease is identified laparoscopically and confirmed histologically. Incidence estimates reported in literature are widely inconsistent, presumably reflecting geographical variability of risk and the difficulty of obtaining reliable data. METHODS: We retrieved incident cases of endometriosis in women aged 15-50 years using hospital discharge records and pathology databases of the Friuli Venezia Giulia region in the calendar period 2004-2017. We studied the spatial pattern of endometriosis incidence applying Bayesian approaches to Disease Mapping, and profiled municipalities at higher risk controlling for multiple comparisons using both q-values and a fully Bayesian approach. RESULTS: 4125 new cases of endometriosis were identified in the age range 15 to 50 years in the period 2004-2017. The incidence rate (x100 000) is 111 (95% CI 110-112), with a maximum of 160 in the age group 31-35 years. The geographical distribution of endometriosis incidence showed a very strong north-south spatial gradient. We consistently identified a group of five neighboring municipalities at higher risk (RR 1.31 95% CI 1.13; 1.52), even accounting for ascertainment bias. CONCLUSIONS: The cluster of 5 municipalities in the industrialized and polluted south-east part of the region is suggestive. However, due to the ecologic nature of the present study, information on the patients' characteristics and exposure histories are limited. Individual studies, including biomonitoring, and life-course studies are necessary to better evaluate our findings.

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Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 µg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 µg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- (n = 126) or low-risk (n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.

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BACKGROUND: It has been shown there is an upward trend for strontium (Sr) and antimony (Sb) levels from low-risk (LR) to high-risk (HR) areas of etiology of esophageal cancer in water, soil, and grains grown in Golestan province. In the present study, the serum levels of Sr and Sb were determined in healthy individuals living in these areas. METHODS: This cross-sectional study was performed on fasting blood serum of adult healthy individuals collected by cluster sampling. Subjects were divided into two groups, those living in either HR or LR areas. Strontium and antimony serum levels were measured using a graphite furnace atomic absorption spectroscopy. RESULTS: A total of 200 volunteers were enrolled from which 96 persons (48%) and 104 persons (52%) were from either HR or LR areas, respectively. The sex distribution was 40.9% male and 59.1% female, and the average age of enrolled people was 50.9 years. The average strontium levels were 30.44 ± 4.05 and 30.29 ± 3.74 µg/L in LR and HR, respectively. It also has been shown the average antimony levels were 15.21 ± 3.40, 14.81 ± 3.17, 15.13 ± 3.62, and 15.07 ± 3.62 µg/L in LR, HR, urban, and rural populations, respectively. CONCLUSION: The serum levels of strontium and antimony were not significantly different in healthy adults living in high- and low-risk areas of esophageal cancer. However, the average antimony serum levels in Golestan Province were above the reference interval in different countries.

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OBJECTIVES: To describe the epidemiology of human brucellosis in the past decade and provide evidence of disease control in Tongliao city, which is one of the highest-risk areas of human brucellosis in Inner Mongolia province, China. DESIGN: Cross-sectional study. PARTICIPANTS: Clinically and bacteriologically confirmed human brucellosis cases. PRIMARY AND SECONDARY OUTCOME MEASURES: An analysis of the reported cases of human brucellosis during 2007-2017 was carried out to describe the age, sex and occupational distributions of the cases. The time series analysis model and the geographical information system were explored to describe the seasonality and spatiotemporal distribution, respectively, at the county level. RESULTS: A total of 13 938 cases of human brucellosis was collected in Tongliao from 2007 to 2017; the majority was aged 25 years to 59 years (85.4%) and the male-to-female ratio was 2.64:1; most of them were agriculturalists (81.9%) and pastoralists (12.4%). The incidence rates increased dramatically from 9.22/100 000 in 2007 to 69.16/100 000 in 2011 with an annual increase of 14.99%. They decreased during 2012-2016 (annual decrease of 8.37%) and rose again in 2017 (44.32/100 000). The disease peaked during March-July, with a clear periodicity and trend of monthly anterior displacement since 2012. Jarud Banner, the region located in the north-west of Tongliao, had the highest accumulated incidence rate (130.1/100 000) compared with other counties. The high-risk regions were spread from the north-west to the south and east of Tongliao during the past decade. CONCLUSIONS: The prevalence of human brucellosis in Tongliao was aggravated during the past decade and peaked during March-July. High-risk areas were mainly concentrated in the counties with extensive prairies and livestock.

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In past years, communication activities have become increasingly important in the environment and health domain, considering the concurrent developments of social media and scientific citizenship that contributed changes in legislation and culture. Communication is particularly crucial where an environmental hazard is present, as in the case of high risk environmental and health risk areas. The project "International Center of Advanced Study in Environment, Ecosystem and Human Health" (CISAS), carried out by the Italian National Research Council, covers multiple research activities, from ecology to biology and medical sciences, from epidemiology to social sciences and communication. Three different studies based on human biomonitoring and a birth cohort study are currently in progress in the project locations, together with studies on the environmental fate of pollutants. A clear, accurate and respectful communication of study protocols and results represents a priority to produce comprehensible information available for policy makers, citizens, and stakeholders. This paper describes the multiple external and internal communication activities planned in the framework of the CISAS project as an example of promotion of knowledge in the society at large and improvement of risk management in the environmental health domain.

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BACKGROUND: This study aimed to analyze the epidemiological and spatiotemporal characteristics of bacillary dysentery in Zhejiang Province and to provide the basis for its monitoring, prevention and control. METHODS: This study included cases registered in China Information System for Diseases Control and Prevention from 1 January 2005 to 31 December 2017 in Zhejiang. Descriptive methods were employed to investigate the long trend of this disease: gender distribution, high-risk population, seasonality, and circular distribution was explored to detect the peak period; incidence maps were made to show the incidence trend of disease at county level; spatial autocorrelation was explored and the regions with autocorrelation were detected; and spatiotemporal scan was conducted to map out the high-risk regions of disease and how long they lasted. Statistical significance was assumed at p value of <0.05. RESULTS: A total of 105,577 cases of bacillary dysentery were included, the incidence declining sharply from 45.84/100,000 to 3.44/100,000 with an obvious seasonal peak from July to October. Males were more predisposed to the infection than females. Pre-education children had the highest proportion among all occupation categories. Incidence in all age groups were negatively correlated with the year (p < 0.001), and the incidences were negatively correlated with the age groups in 2005⁻2008 (p = 0.022, 0.025, 0.044, and 0.047, respectively). Local autocorrelation showed that counties in Hangzhou were high-risk regions of bacillary dysentery. The spatiotemporal scan indicated that all clusters occurred before 2011, and the most likely cluster for disease was found in Hangzhou, Jiaxing and Huzhou. CONCLUSIONS: The incidence of bacillary dysentery in Zhejiang from 2005 to 2017 featured spatiotemporal clustering, and remained high in some areas and among the young population. Findings in this study serve as a panorama of bacillary dysentery in Zhejiang and provide useful information for better interventions and public health planning.

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BACKGROUND: Brucellosis, one of the world's most important zoonosis, has been re-emerging in China. Shanxi Province, located in northern China, where husbandry development has been accelerated in recent years, has a rather high incidence of human brucellosis but drew little attention from the researchers. This study aimed to describe the changing epidemiology of human brucellosis in Shanxi Province from 2005 to 2014 and explore high-risk towns and space-time clusters for elucidating the necessity of decentralizing disease control resource to township level in epidemic regions, particularly in hotspot areas. METHODS: We extracted data from the Chinese National Notifiable Infectious Disease Reporting System to describe the incidence and spatiotemporal distribution of human brucellosis in Shanxi Province. Geographic information system was used to identify townships at high risk for the disease. Space-Time Scan Statistic was applied to detect the space-time clusters of human brucellosis during the past decade. RESULTS: From 2005 to 2014, a total of 50,002 cases of human brucellosis were recorded in Shanxi, with a male-to-female ratio of 3.9:1. The reported incidence rate increased dramatically from 7.0/100,000 in 2005 to 23.5/100,000 in 2014, with an average annual increase of 14.5%. There were still 33.8% cases delaying diagnosis in 2014. The proportion of the affected towns increased from 31.5% in 2005 to 82.5% in 2014. High-risk towns spread from the north to the center and then south of Shanxi Province, which were basins and adjacent highlands suitable for livestock cultivation. During the past decade, there were 55 space-time clusters of human brucellosis detected in high risk towns; the clusters could happen in any season. Some clusters' location maintained stable over time. CONCLUSIONS: During the last decade, Shanxi province's human brucellosis epidemic had been aggravated and high-risk areas concentrated in some towns located in basins and adjacent highlands. Space-time clusters existed and some located steadily over time. Quite a few cases still missed timely diagnosis. Greater resources should be allocated and decentralized to mitigate the momentum of rise and improve the accessibility of prompt diagnosis treatment in the high-risk townships.

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Because (222)Rn is a progeny of (238)U, the relative abundance of uranium may be used to predict the areas that have the potential for high indoor radon concentration and therefore determine the best areas to conduct future surveys. Geographic Information System (GIS) mapping software was used to construct maps of South Dakota that included levels of uranium concentrations in soil and stream water and uranium deposits. Maps of existing populations and the types of land were also generated. Existing data about average indoor radon levels by county taken from a databank were included for consideration. Although the soil and stream data and existing recorded average indoor radon levels were sparse, it was determined that the most likely locations of elevated indoor radon would be in the northwest and southwest corners of the state. Indoor radon levels were only available for 9 out of 66 counties in South Dakota. This sparcity of data precluded a study of correlation of radon to geological features, but further motivates the need for more testing in the state. Only actual measurements should be used to determine levels of indoor radon because of the strong roles home construction and localized geology play in radon concentration. However, the data visualization method demonstrated here is potentially useful for directing resources relating to radon screening campaigns.

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BACKGROUND: Occupational science and therapy scholars have argued that research on inequality in health is needed. Simultaneously, a knowledge gap between how to understand and take action on health inequalities exists in occupational science and therapy. OBJECTIVE: To identify how inequality in health, high-risk areas of health, and engagement in health for low-income adult citizens have been described and conceptualized in contemporary occupational science and therapy literature. MATERIAL AND METHODS: A structured literature review of 37 publications in occupational science and therapy literature, published from 2004 to 2014. FINDINGS: The review revealed several descriptions and conceptualizations based on environmental, social, cultural, historical, and personal perspectives on occupation and already existing occupational science concepts. However, these descriptions were mainly based on assumptions regarding the relation between occupation and inequality in health, and statements on the need to explore this relation. CONCLUSION: Basic theory and reasoning, as well as empirical studies, on inequality in health are missing in occupational science and therapy. Based on the findings and theoretical trends, the authors suggest a transactional perspective on occupation is a possible frame for understanding inequality in health and related issues.

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BACKGROUND: Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. METHODS: Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group (0, 1-4, 5-9, 10-14…80+). Incidence and mortality rates were age-standardized to World Segi's population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. RESULTS: The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 (males, 42.18/100,000 and females, 24.31/100,000). The age-standardized rate by world standard population (ASRW) was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 (males, 31.40/100,000 and females, 18.45/100,000), ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 (ASRW =48.69/100,000) to 2004-2005 (ASRW =28.02/100,000), with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes (APC) of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. CONCLUSIONS: Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

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AIM: To investigate the incidence and mortality of gastric cancer (GC) in Zhuanghe region, northeast China and the influencing factors for their changing trends. METHODS: All new cancer cases and deaths registered from 2005 to 2010 in Zhuanghe County were reviewed. The annual GC cases, constituent ratio, crude rates, age-standardized rates, their sex and age distribution and temporal trends were assessed. The method of annual percentage change (APC) was used to estimate the trends of GC. RESULTS: Altogether 2634 new cases of GC and 1722 related deaths were registered, which accounted for 21.04% and 19.13% of all cancer-related incidence and deaths, respectively. The age-standardized incidence rate steadily decreased from 57.48 in 2005 to 44.53 in 2010 per 10(5) males, and from 18.13 to 14.70 per 10(5) females, resulting in a APC of -5.81% for males and -2.89% for females over the entire period. The magnitude of APC in GC mortality amounted to -11.09% and -15.23%, respectively, as the age-standardized mortality rate steadily decreased from 42.08 in 2005 to 23.71 in 2010 per 10(5) males, and from 23.86 to 10.78 per 10(5) females. Females had a significantly lower incidence (a male/female ratio 2.80, P < 0.001) and mortality (a male/female ratio 2.30, P < 0.001). In both genders, the peak incidence and mortality occurred in the 80-84 years age group. The age-standardized mortality/incidence ratio also decreased from the peak of 0.73 in 2005 to 0.53 in 2010 for males, and from 1.32 to 0.73 for females. CONCLUSION: Encouraging declines of incidence and mortality of GC were observed in Zhuanghe region between 2005 and 2010, possibly due to the economic development and efficient GC control strategies.

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