BackgroundIntegrated vector management strategies depend on local eco-bio-social conditions, community participation, political will and inter-sectorial partnership. Previously identified risk factors for persistent Triatoma dimidiata infestation include the presence of rodents and chickens, tiled roofs, dirt floors, partial wall plastering and dog density.MethodsA community-based intervention was developed and implemented based on cyclical stakeholder and situational analyses. Intervention implementation and evaluation combined participatory action research and cluster randomized pre-test post-test experimental designs. The intervention included modified insecticide application, education regarding Chagas disease and risk factors, and participatory rodent control.ResultsAt final evaluation there was no significant difference in post-test triatomine infestation between intervention and control, keeping pre-test rodent and triatomine infestations constant. Knowledge levels regarding Chagas disease and prevention practices including rodent control, chicken management and health service access increased significantly only in intervention communities. The odds of nymph infection and rat infestation were 8.3 and 1.9-fold higher in control compared to intervention communities, respectively.ConclusionVector control measures without reservoir control are insufficient to reduce transmission risk in areas with persistent triatomine infestation. This integrated vector management program can complement house improvement initiatives by prioritizing households with risk factors such as tiled roofs. Requirement for active participation and multi-sectorial coordination poses implementation challenges.

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Background: This paper examined the gap between obesity and its diagnosis for cohorts of patients with overweight, obesity, and morbid obesity in the Veterans Administration (VA) population. Using the risk adjustment models, it also identified factors associated with the underdiagnosis of obesity. Methods: Analysis was performed on a VA data set. We identified diagnosed patients and undiag-nosed patients (identified through BMI but not diagnosed by ICD-10 codes). The groups’ de-mographics were compared using nonparametric chi-square tests. We used logistic regression analysis to predict the likelihood of the omission of diagnosis. Results: Of the 2,900,067 veterans with excess weight, 46% were overweight, 46% had obesity, and 8% of them had morbid obesity. The overweight patients were the most underdiagnosed (96%), followed by the obese (75%) and morbidly obese cohorts (69%). Older, male, and White patients were more likely to be undiagnosed as overweight and obese; younger males were more likely to be undiagnosed as morbidly obese. (p<.05) Comorbidities significantly contributed to diagnosis. Conclusion: Underdiagnosis of obesity continues to be a significant problem despite its prevalence. Diagnosing obesity accurately is necessary to provide effective management and treatment.

Background: Fe status determines intestinal Fe‐absorption and internal metabolism. Recently, sex‐associated effects on Fe handling have been suggested as well. These hold implications for prophylactic or therapeutic oral Fe supplementation. Objective: To determine whether sex and/or Fe‐status influence the NTBI response to oral Fe. Methods: 40 subjects ‐‐10 men (LM) and 10 women (LW) with low Fe stores (70 µg ferritin/L) ‐‐ provided blood samples at baseline and at 90, 180 and 270 min after ingesting 100 mg Fe as FeSO4. Fe and NTBI were quantified with ferrozine‐based assay and a fluorometric competitive‐binding assay, respectively. Responses in serum were estimated as cumulative 3‐h absolute concentrations. Results: The respective ∑ 3‐h absolute concentrations (in µg/dL) were 820±124, 560±115, 714±61, and 772±198 for serum Fe (p=0.004), and 12±3, 14±4, 16±4, and 11±6 for serum NTBI (p=0.218) for the LM, AM, LW, and AW groups. Two‐way ANOVA interaction‐terms for Fe status and sex were statistically significant for the serum Fe and NTBI responses (p=0.003 and p=0.05). Conclusion: Among males, the serum Fe uptake response was diminished with adequate Fe status as compared to low status, but a corresponding status‐related differential was not seen among women. The NTBI response was equally mitigated across the entire spectrum of subject groups. Grant Funding Source: Supported by the Hildegard Grunow Foundation