2.Temporal-spatial analysis of bacillary dysentery in the Three Gorges Area of China, 2005-2016.
P ZHANG ; J ZHANG ; Z R CHANG ; Z J LI
Chinese Journal of Epidemiology 2018;39(1):47-53
Objective: To analyze the spatial and temporal distributions of bacillary dysentery in Chongqing, Yichang and Enshi (the Three Gorges Area) from 2005 to 2016, and provide evidence for the disease prevention and control. Methods: The incidence data of bacillary dysentery in the Three Gorges Area during this period were collected from National Notifiable Infectious Disease Reporting System. The spatial-temporal scan statistic was conducted with software SaTScan 9.4 and bacillary dysentery clusters were visualized with software ArcGIS 10.3. Results: A total of 126 196 cases were reported in the Three Gorges Area during 2005-2016, with an average incidence rate of 29.67/100 000. The overall incidence was in a downward trend, with an average annual decline rate of 4.74%. Cases occurred all the year round but with an obvious seasonal increase between May and October. Among the reported cases, 44.71% (56 421/126 196) were children under 5-year-old, the cases in children outside child care settings accounted for 41.93% (52 918/126 196) of the total. The incidence rates in districts of Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nanan, Yubei, Chengkou of Chongqing and districts of Xiling and Wujiagang of Yichang city of Hubei province were high, ranging from 60.20/100 000 to 114.81/100 000. Spatial-temporal scan statistic for the spatial and temporal distributions of bacillary dysentery during this period revealed that the temporal distribution was during May-October, and there were 12 class Ⅰ clusters, 35 class Ⅱ clusters, and 9 clusters without statistical significance in counties with high incidence. All the class Ⅰ clusters were in urban area of Chongqing (Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nanan, Beibei, Yubei, Banan) and surrounding counties, and the class Ⅱ clusters transformed from concentrated distribution to scattered distribution. Conclusions: Temporal and spatial cluster of bacillary dysentery incidence existed in the three gorges area during 2005-2016. It is necessary to strengthen the bacillary dysentery prevention and control in urban areas of Chongqing and Yichang.
Adolescent
;
Adult
;
Child
;
Child, Preschool
;
China/epidemiology*
;
Cities
;
Dysentery, Bacillary/epidemiology*
;
Environment
;
Female
;
Humans
;
Incidence
;
Male
;
Seasons
;
Spatio-Temporal Analysis
;
Young Adult
3.Association between distribution of bacillary dysentery and meteorological factors in Beijing, 2004-2015.
Z DU ; J ZHANG ; J X LU ; L P LU
Chinese Journal of Epidemiology 2018;39(5):656-660
Objective: To analyze the distribution characteristics of bacillary dysentery in Beijing during 2004-2015 and evaluate the influence of meteorological factors on the temporal and spatial distribution of bacillary dysentery. Methods: The incidence data of bacterial dysentery and meteorological data in Beijing from 2004 to 2015 were collected. Descriptive epidemiological analysis was conducted to study the distribution characteristics of bacterial dysentery. Linear correlation analysis and multiple linear regression analysis were carried out to investigate the relationship between the incidence of bacillary dysentery and average precipitation, average air temperature, sunshine hours, average wind speed, average air pressure, gale and rain days. Results: A total of 280 704 cases of bacterial dysentery, including 36 deaths, were reported from 2004 to 2015 in Beijing, the average annual incidence was 130.15/100 000. The annual incidence peak was mainly between May and October, the cases occurred during this period accounted for 80.75% of the total, and the incidence was highest in age group 0 year. The population distribution showed that most cases were children outside child care settings and students, and the sex ratio of the cases was 1.22∶1. The reported incidence of bacillary dysentery was positively associated with average precipitation, average air temperature and rain days with the correlation coefficients of 0.931, 0.878 and 0.888, but it was negatively associated with the average pressure, the correlation coefficient was -0.820. Multiple linear regression equation for fitting analysis of bacillary dysentery and meteorological factors was Y=3.792+0.162X(1). Conclusion: The reported incidence of bacillary dysentery in Beijing was much higher than national level. The annual incidence peak was during July to August, and the average precipitation was an important meteorological factor influencing the incidence of bacillary dysentery.
Beijing/epidemiology*
;
Child
;
China/epidemiology*
;
Dysentery, Bacillary/epidemiology*
;
Humans
;
Incidence
;
Linear Models
;
Meteorological Concepts
;
Multivariate Analysis
;
Regression Analysis
;
Sex Ratio
;
Temperature
4.Prevalence of thyroid function in pregnant and lactating women in areas with different iodine levels of Shanxi province.
Y T REN ; Q Z JIA ; X D ZHANG ; B S GUO ; F F ZHANG ; X T CHENG ; Y P WANG
Chinese Journal of Epidemiology 2018;39(5):609-613
Objective: To investigate the effects of high iodine intake on thyroid function in pregnant and lactating women. Methods: A cross sectional epidemiological study was conducted among 130 pregnant women and 220 lactating women aged 19-40 years in areas with high environment iodine level (>300 μg/L) or proper environment iodine level (50-100 μg/L) in Shanxi in 2014. The general information, urine samples and blood samples of the women surveyed and water samples were collected. The water and urine iodine levels were detected with arsenic and cerium catalysis spectrophotometric method, the blood TSH level was detected with electrochemiluminescence immunoassay, and thyroid stimulating hormone (FT(4)), antithyroid peroxidase autoantibody (TPOAb) and anti-thyroglobulin antibodies (TGAb) were detected with chemiluminescence immunoassay. Results: The median urine iodine levels of the four groups were 221.9, 282.5, 814.1 and 818.6 μg/L, respectively. The median serum FT(4) of lactating women in high iodine area and proper iodine area were 12.96 and 13.22 pmol/L, and the median serum TSH was 2.45 and 2.17 mIU/L, respectively. The median serum FT(4) of pregnant women in high iodine area and proper iodine area were 14.66 and 16.16 pmol/L, and the median serum TSH was 2.13 and 1.82 mIU/L, respectively. The serum FT(4) levels were lower and the abnormal rates of serum TSH were higher in lactating women than in pregnant women in both high iodine area and proper iodine area, the difference was statistically significant (FT(4): Z=-6.677, -4.041, P<0.01; TSH: Z=8.797, 8.910, P<0.01). In high iodine area, the abnormal rate of serum FT(4) in lactating women was higher than that in pregnant women, the difference was statistically significant (Z=7.338, P=0.007). The serum FT(4) level of lactating women in high iodine area was lower than that in proper iodine area, the difference was statistically significant (Z=-4.687, P=0.000). In high iodine area, the median serum FT(4) in early pregnancy, mid-pregnancy and late pregnancy was 16.26, 14.22 and 14.80 pmol/L, respectively, and the median serum TSH was 1.74, 1.91 and 2.38 mIU/L, respectively. In high iodine area, the serum FT(4) level in early pregnancy was higher than that in mid-pregnancy and late pregnancy, and the serum TSH level was lower than that in mid-pregnancy and late pregnancy, the difference was statistically significant (FT(4): Z=-2.174, -2.238, P<0.05; TSH: Z=-2.985, -1.978, P<0.05). There were no significant differences in the positive rates of serum thyroid autoantibodies among the four groups of women and women in different periods of pregnancy (P>0.05). The morbidity rates of subclinical hyperthyroidism in pregnant women and lactating women in high iodine area were obviously higher than those in proper iodine areas, the difference was statistically significant (χ(2)=5.363, 5.007, P<0.05). Conclusions: Excessive iodine intake might increase the risk of subclinical hypothyroidism in pregnant women and lactating women. It is suggested to strengthen the iodine nutrition and thyroid function monitoring in women, pregnant women and lactating women in areas with high environmental iodine.
Adult
;
China/epidemiology*
;
Cross-Sectional Studies
;
Female
;
Humans
;
Hypothyroidism/epidemiology*
;
Iodides/administration & dosage*
;
Iodine/urine*
;
Lactation
;
Nutritional Status
;
Pregnancy
;
Prevalence
;
Thyroid Diseases/epidemiology*
;
Thyroid Function Tests
;
Thyroid Gland/physiology*
;
Young Adult
5.Polymorphisms of four STRs and their associations with IDDM in Chinese Han population.
Z A ; S ZHANG ; C XIAO ; W LI ; Y HOU ; J ZHU ; J WANG
Chinese Journal of Medical Genetics 2000;17(4):248-251
<p>OBJECTIVETo obtain the polymorphic data of short tandem repeat(STR) loci of D15S657, D11S1369, D6S2420 and D6S503 in Chinese Han population and to study the association of these four STR loci with insulin-dependent diabetes mellitus(IDDM).p><p>METHODSThe polymorphisms of the four STRs were studied by polymerase chain reaction-polyacrylamide gel electrophoresis(PCR-PAGE) followed by direct sequencing of PCR products in 105 normal Chinese Hans and 48 patients with IDDM.p><p>RESULTSSeven alleles at D15S657 locus, 5 alleles at D11S1369 locus, 7 alleles at D6S2420 locus and 4 alleles at D6S503 locus were found. No deviation from Hardy-Weinberg equilibrium was observed. The heterozygosities of these loci were 0. 7524, 0.6000, 0.6286, 0.6571 and the polymorphic information contents(PIC) 0.7616, 0.4430, 0.5345 and 0.5932, respectively. The allele frequencies of allele A(5) at D15S657 locus, allele A(5) at D11S1369 locus and allele A(4) at D6S2420 locus were increased significantly in patients with IDDM, compared to those in the control group.p><p>CONCLUSIONThe four STRs, used as genetic markers, were suitable for case-control study, forensic medicine identification and population genetic study. There is an association between the polymorphisms of D15S657, D11S1369, D6S2420 and IDDM.p>
Adult
;
Aged
;
China
;
ethnology
;
Diabetes Mellitus, Type 1
;
genetics
;
Female
;
Humans
;
Male
;
Middle Aged
;
Polymorphism, Genetic
;
Tandem Repeat Sequences
6.Genetic characteristics of hemagglutinin and neuraminidase of avian influenza A (H7N9) virus in Guizhou province, 2014-2017.
Y H WAN ; L ZHUANG ; Q N ZHENG ; L J REN ; L FU ; W J JIANG ; G P TANG ; D Z ZHANG ; S J LI
Chinese Journal of Epidemiology 2018;39(11):1465-1471
Objective: To understand the molecular characteristics of hemagglutinin (HA) and neuraminidase (NA) as well as the disease risk of influenza virus A H7N9 in Guizhou province. Methods: RNAs were extracted and sequenced from HA and NA genes of H7N9 virus strains obtained from 18 cases of human infection with H7N9 virus and 6 environmental swabs in Guizhou province during 2014-2017. Then the variation and the genetic evolution of the virus were analyzed by using a series of bioinformatics software package. Results: Homology analysis of HA and NA genes revealed that 2 strains detected during 2014-2015 shared 98.8%-99.2% and 99.2% similarities with vaccine strains A/Shanghai/2/2013 and A/Anhui/1/2013 recommended by WHO, respectively. Two strains detected in 2016 and 14 strains detected in 2017 shared 98.2%-99.3% and 97.6%-98.8% similarities with vaccine strain A/Hunan/02650/2016, respectively. Other 6 stains detected in 2017 shared 99.1%-99.4% and 98.9%-99.3% similarities with strain A/Guangdong/17SF003/2016, respectively. Phylogenetic analysis showed that all the strains were directly evolved in the Yangtze River Delta evolution branch, but they were derived from different small branch. PEVPKRKRTAR↓GLF was found in 6 of 24 strains cleavage site sequences of HA protein, indicating the characteristic of highly pathogenic avian influenza virus. Mutations A134V, G186V and Q226L at the receptor binding sites were found in the HA. All the strains had a stalk deletion of 5 amino acid residue "QISNT" in NA protein, and drug resistance mutation R294K occurred in strain A/Guizhou-Danzhai/18980/2017. In addition, potential glycosylation motifs mutations NCS42NCT were found in the NA of 9 of 24 strains. Conclusions: HA and NA genes of avian influenza A (H7N9) virus showed genetic divergence in Guizhou province during 2014-2017. The mutations of key sites might enhance the virulence of the virus, human beings are more susceptible to it. Hence, the risk of infection is increasing.
Animals
;
Base Sequence
;
Birds
;
China/epidemiology*
;
Genome, Viral
;
Hemagglutinin Glycoproteins, Influenza Virus/immunology*
;
Hemagglutinins/genetics*
;
Humans
;
Influenza A Virus, H7N9 Subtype/isolation & purification*
;
Influenza in Birds
;
Influenza, Human/virology*
;
Neuraminidase/genetics*
;
Phylogeny
;
RNA, Viral/genetics*
;
Sequence Analysis, DNA
7.Effects of PNPLA3, TM6SF2 gene polymorphisms and its interactions with smoking and alcohol drinking on hepatitis B virus-associated hepatocellular carcinoma.
L Q WANG ; W H GUO ; Z W GUO ; P QIN ; R ZHANG ; X M ZHU ; D W LIU
Chinese Journal of Epidemiology 2018;39(12):1611-1616
Objective: To explore the SNP effects of patatin-like phospholipase domain which containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2) gene, environmental effects of smoking, alcohol drinking and interaction between gene-gene, gene-environment and drinking-smoking on hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC). Methods: We collected anticoagulant peripheral blood from patients of HBV-HCC, chronic hepatitis B (CHB), liver cirrhosis (LC) and from healthy controls to detect the single nucleotide polymorphism (SNP) of patatin-like phospholipase domain containing 3 (PNPLA3) gene loci rs738409 and transmembrane 6 superfamily member 2 (TM6SF2) gene loci rs58542926, using the flight mass spectrometry method. The optimal assignment value of gene polymorphisms was defined by using the online SNP stats. Hardy-Weinberg (H-W) balance was tested for SNP. Effects of the genetic and environmental factors to HBV-HCC were analyzed by using the multiple classification logistic regression method. The gene-gene, gene-smoking and alcohol drinking interaction effects were investigated by Fork-Life analysis and binary logistic regression methods. Results: The frequency distribution of CHB group rs738409 loci seemed not in conformity with the H-W balance (χ(2)=11.980, P<0.005). Two loci frequency distributions in the other groups were all in accordandce with the H-W balance. After adjusting for influences on age and sex and comparing to the healthy group, the rs58542926 mutation appeared as OR=1.659, 95%CI: 1.026-2.684, P=0.039, in the HBV-HCC group. When comparing to CHB group, the HBV-HCC group presented that drinking as OR=1.680, 95%CI: 1.121-2.519, P=0.012. When comparing to the LC group, the ORs of drinking and smoking were 1.539 (1.071-2.213) and 1.453 (1.005-2.099) respectively, in the HBV-HCC group. When comparing to the CHB+LC group, interactions between the HBV-HCC group were found rs738409 and rs58542926 on additive model OR=1.548 (U=1.885, P=0.029) and OR=1.658 (P=0.024) on logistic regression model while drinking was rs738409 on interaction additive model with OR=1.811(U=1.965, P=0.024). As for drinking and mutation of rs738409, the multiplication model of logistic regression showed no statistically significant differences. Interaction between smoking and drinking appeared as OR=1.756 (P<0.001) in the logistics regression multiplication model. Conclusions: Factors as mutation of TM6SF2, smoking and drinking all appeared as risk factors for HBV-HCC. Mutations of both PNPLA3 and TM6SF2, together with smoking and drinking all served as risk factors for HBV-HCC. However, the mutation of single PNPLA3 appeared as a protective factor on HBV-HCC.
Alcohol Drinking/adverse effects*
;
Carcinoma, Hepatocellular/virology*
;
Case-Control Studies
;
Epistasis, Genetic
;
Gene-Environment Interaction
;
Genetic Predisposition to Disease
;
Genotype
;
Hepatitis B virus
;
Hepatitis B, Chronic
;
Humans
;
Lipase/genetics*
;
Liver Cirrhosis, Alcoholic/complications*
;
Liver Neoplasms/virology*
;
Membrane Proteins/genetics*
;
Polymorphism, Single Nucleotide
;
Smoking/adverse effects*
8.Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases.
J ZHANG ; R R JIN ; J J LI ; J L LI ; X W SU ; G J DENG ; S MA ; J ZHAO ; Y P WANG ; F BIAN ; Y M QU ; Z Z SHEN ; Y JIANG ; Y L LIU
Chinese Journal of Epidemiology 2018;39(4):394-400
Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention (OR=6.591, 95%CI: 5.188-8.373), salt reduction (OR=1.352, 95%CI: 1.151-1.589), oil reduction (OR=1.477, 95%CI: 1.249-1.746) and recommendation on physical activities (OR=1.975, 95%CI: 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.
China/epidemiology*
;
Chronic Disease/epidemiology*
;
Delivery of Health Care
;
Health Promotion/organization & administration*
;
Humans
;
National Health Programs
;
Noncommunicable Diseases/prevention & control*
;
Outcome Assessment, Health Care
;
Population Surveillance
;
Preventive Health Services/organization & administration*
;
Program Evaluation
;
Public Health
9.Current status on prevalence, treatment and management of hypertension among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases.
R R JIN ; J ZHANG ; J L LI ; J J LI ; S MA ; F BIAN ; G J DENG ; X W SU ; Z Z SHEN ; Y P WANG ; Y JIANG
Chinese Journal of Epidemiology 2018;39(4):401-406
Objective: To investigate the current status of prevalence, treatment, and management on hypertension among Chinese adults from the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: We selected a total of 4 000 residents aged ≥18 years for this questionnaire-based survey by multi-stage clustering sampling in 10 National Demonstration Areas between November and December, 2016. Results: There were 3 891 effective questionnaires. The self-reported prevalence of hypertension among aged ≥35 years was 31.47% (1 011/3 213). For the past two weeks, the self-reported treatment of hypertension was 86.75%(877/1 011), with the rates of guidance as 56.87% (575/1 011) on physical activity, 40.95% (414/1 011) on diet, 38.33% (385/1 011) on weight management, and 22.75% (228/1 011) on smoking cessation. For the past 12 months, 74.68% (755/1 011) of the residents aged ≥35 years were under the proper management and 62.12% (628/1 011) of them were under the standardized management programs. The follow-up program lasted for 4 (P(25)-P(75): 4-12) times per year, with 15 (P(25)-P(75): 10-20) minutes per each visit. Hypertensive patients would mainly visit the outpatient clinics (53.51%), followed by home visits (22.91%) and telephone calls (13.64%). Rate of satisfaction on management services was 94.83% (716/755) from the hypertensive patients. Multivariate analysis showed that the rate of self-reported treatment (OR=1.986, 95%CI: 1.222-3.228) and self-reported standardized management (OR=2.204, 95%CI: 1.519-3.199) on hypertension were higher in the Demonstration Areas with higher implementation scores of self-reported non-communicable diseases management. Conclusions: Prevention and management on hypertension in the Demonstration Areas had met the requirement set for the Demonstration Areas during the "12th Five-Year Plan" . Projects on setting up the National Non-communicable Diseases Demonstration Areas had played an active role in promoting the standardized management program on hypertension.
Adult
;
Asian People/statistics & numerical data*
;
Diet
;
Exercise
;
Humans
;
Hypertension/therapy*
;
Noncommunicable Diseases/prevention & control*
;
Population Surveillance
;
Prevalence
;
Risk Factors
;
Surveys and Questionnaires
10.Stratified sampling survey of major human parasitic diseases in Henan province.
B L XU ; H W ZHANG ; Y DENG ; Z L CHEN ; W Q CHEN ; D L LU ; Y L ZHANG ; Y L ZHAO ; X M LIN ; Q HUANG ; C Y YANG ; Y LIU ; R M ZHOU ; P LI ; J S CHEN ; L J HE ; D QIAN
Chinese Journal of Epidemiology 2018;39(3):322-328
Objective: To understand the prevalence of major human parasitic diseases and related factors in Henan province. Methods: This stratified sampling survey was carried out according to the requirement of national survey protocol of major human parasitic diseases, 2014-2015. The prevalence of soil-transmitted helminths infection, taeniasis and intestinal protozoiasis were surveyed in 104 sites selected from 35 counties (districts) and the prevalence of clonorchiasis was surveyed in 62 sites selected from 37 townships. In each survey spot, 250 persons were surveyed. A total of 26 866 persons and 15 893 persons were surveyed. Modified Kato-Katz thick smear was used to detect the eggs of intestinal helminthes. Tube fecal culture was used to identify the species of hookworm. The Enterobius eggs were detected in children aged 3 to 6 years by using adhesive tape. The cyst and trophozoite of intestinal protozoa were examined with physiological saline direct smear method and iodine stain method. Results: The overall infestation rate of intestinal parasites was2.02% in Henan, and the worm infection rate was higher than protozoa infection rate. Fourteen kinds of intestinal parasites were found, including nematode (5 species), trematode (2 species), and protozoan (7 species). The infection rate of Enterobius vermicularis was highest, and Qinba Mountain ecological area had the highest infestation rate of intestinal parasites in 4 ecological areas of Henan. There was no significant difference in intestinal parasite infection rate between males and females (χ(2)=3.630, P=0.057), and the differences in intestinal parasite infection rate among different age groups had significance (χ(2)=124.783, P=0.000 1). The infection rate reached the peak in age group ≤9 years and the major parasite was Enterobius vermicularis. Furthermore the overall human infection rate of parasite showed a downward trend with the increase of educational level of the people (χ(2)=70.969, P=0.000 1), the differences had significance (χ(2)=120.118, P=0.000 1). For different populations, the infection rate of intestinal parasites was highest among preschool children. The infection of intestinal helminth was mainly mild, only 2 severe cases were detected. The infection rate of Clonorchis sinensis in urban residents was only 0.006%. Logistic regression analysis showed that being preschool children (χ(2)=15.765, P=0.000 1) and drinking well water (χ(2)=45.589, P=0.000 1) were the risk factors for intestinal parasite infection, and annual income per capita of farmers was the protective factor against intestinal parasite infection. The infection rates of protozoa and intestinal parasites decreased sharply compared with the results of previous two surveys, and the rate of intestinal helminth infection also dropped sharply compared with the second survey. The numbers of protozoa, helminth and intestinal parasites detected in this survey were all less than the numbers found in the previous two surveys. Conclusions: Compared the results of three surveys in Henan, the infection rate of protozoa and intestinal parasites showed a downward trend. The prevention and treatment of Enterobius vermicularis infection in children should be the key point of parasitic disease control in the future.
Animals
;
Child
;
Child, Preschool
;
Clonorchiasis/epidemiology*
;
Farmers
;
Feces/parasitology*
;
Female
;
Helminthiasis/epidemiology*
;
Helminths
;
Humans
;
Intestinal Diseases, Parasitic/parasitology*
;
Male
;
Prevalence
;
Protective Factors
;
Risk Factors
;
Rural Population
;
Soil Microbiology
;
Surveys and Questionnaires
;
Taeniasis/epidemiology*
;
Trematode Infections/parasitology*
;
Urban Population
;
Water Wells