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Topic:Disease Prevalence

Disease prevalence in horses refers to the frequency and distribution of various diseases within equine populations. Understanding disease prevalence is essential for identifying health trends, assessing risk factors, and implementing effective disease management and prevention strategies. Common diseases affecting horses include equine influenza, equine herpesvirus, strangles, and equine infectious anemia. The study of disease prevalence involves collecting and analyzing data from veterinary reports, field studies, and laboratory diagnostics. This page compiles peer-reviewed research studies and scholarly articles that investigate the patterns, causes, and implications of disease prevalence in horses, providing insights into equine health management and epidemiology.
A Pilot Serosurvey for Selected Pathogens in Feral Donkeys (Equus asinus).
Animals : an open access journal from MDPI    October 2, 2020   Volume 10, Issue 10 1796 doi: 10.3390/ani10101796
Goodrich EL, McLean A, Guarino C.Recent removal and relocation of feral donkeys from vast public lands to more concentrated holding pens, training facilities, and offsite adoption locations raises several health and welfare concerns. Very little is known regarding the common equid pathogens that are circulating within the feral donkey population in and around Death Valley National Park, California, USA. The aim of this study was to utilize serologic assays to assess previous exposure of these donkeys to equine herpesvirus 1 (EHV-1), equine influenza (EIV), West Nile virus (WNV), and (the causative agent of Lyme disease). The...
Sero-molecular survey and risk factors of equine piroplasmosis in horses in Spain.
Equine veterinary journal    October 2, 2020   Volume 53, Issue 4 771-779 doi: 10.1111/evj.13348
Camino E, Buendia A, Dorrego A, Pozo P, de Juan L, Dominguez L, Cruz-Lopez F.Theileria equi and Babesia caballi cause equine piroplasmosis (EP), one of the most important tick-borne diseases of horses due to its high negative impact to the equine industry. Although infections with these parasites have been reported for decades in Spain, epidemiological studies have only been carried out in certain regions. Objective: To determine the (sero)prevalence of these parasites in asymptomatic horses nationwide in Spain and to identify potential individual and environmental factors associated with seropositivity to EP. Methods: Sample size was calculated according to the horses...
Occurrence of Trypanosoma spp. and piroplasm infections of horses at Obollo-Afor southeastern Nigeria and resistance profiles of trypanosomes to isometamidium and diminazene salts.
Tropical animal health and production    September 30, 2020   Volume 52, Issue 6 3745-3753 doi: 10.1007/s11250-020-02412-5
Emeto UE, Okolo CC, Nweze NE.Epidemiological data on trypanosomosis and piroplasmosis of horses are lacking in southeastern Nigeria. The prevalence of trypanosome and piroplasm infections in horses and resistance profile of isolated trypanosomes to diminazene and isometamidium salts were investigated. For the cross-sectional study of horses billed for slaughter, 304 horses were randomly sampled. Approximately 2 ml of blood was collected into anticoagulant-treated bottles for haematocrit (HCT) determination, direct microscopic examinations, and rat inoculation. Gender, body condition scores (BCS), age groups, and body wei...
Exposure of Horses in Israel to West Nile Virus and Usutu Virus.
Viruses    September 28, 2020   Volume 12, Issue 10 1099 doi: 10.3390/v12101099
Schvartz G, Tirosh-Levy S, Erester O, Shenhar R, Levy H, Bazanow B, Gelman B, Steinman A.West Nile virus (WNV) and Usutu virus (USUV) are arboviruses transmitted by mosquito vectors. Whereas WNV is endemic in Israel, the Middle East, Europe, and in the Americas, data regarding the prevalence of USUV in the Middle East is limited. While both viruses share similar reservoirs and vectors, exposure of horses in the area to USUV have never been assessed. The aim of this study was to estimate the seroprevalence and co-exposure of WNV and USUV in horses in Israel. A total of 327 serum samples from healthy unvaccinated horses in Israel collected in 2018 were tested for neutralizing antibo...
The prevalence and risk factors associated with Leptospira in donkeys in Ngaka Modiri Molema District, North West Province, South Africa.
Veterinary world    September 28, 2020   Volume 13, Issue 9 2020-2027 doi: 10.14202/vetworld.2020.2020-2027
Daddy KK, Mwanza M, Oguttu JW, Ngoma L.Leptospirosis is one of the major emerging global economic and health problems affecting donkeys, thereby reducing their work output. Furthermore, the disease has public health importance because of its zoonotic nature. Despite the significant contribution donkeys make to the national economy, less attention is given to diseases that afflict donkeys and reduce their productivity and performance. A cross-sectional study was conducted to investigate the seroprevalence of Leptospira and identify risk factors associated with the occurrence of the disease among donkeys in the study area. Methods: A...
Leptospira spp. in horses in southern Brazil: Seroprevalence, infection risk factors, and influence on reproduction.
Comparative immunology, microbiology and infectious diseases    September 19, 2020   Volume 73 101552 doi: 10.1016/j.cimid.2020.101552
Da Silva AS, Jaguezeski AM, Laber IF, von Laer AE, Lovato LT, da Silva MO, de Moura AB.Leptospirosis in horses is often associated with reproductive disorders. In the southern states of Brazil, horses are used for various jobs and cultural practices; nevertheless, serological surveillance for Leptospira is rare. Therefore, the objective of this study was to determine the seroprevalence of Leptospira spp. in horses in southern Brazil, as well as to identify the risk factors for infection and its impacts on reproduction. We performed microscopic agglutination tests for 12 serovars that corresponding 9 serogroup (Sejroe, Icterohaemorrhagiae, Australis, Pyrogenes, Pomona, Canicola, ...
Molecular detection and identification of spotted fever group rickettsiae in ticks collected from horses in Cuba.
Medical and veterinary entomology    September 16, 2020   Volume 35, Issue 2 207-212 doi: 10.1111/mve.12480
Díaz-Sánchez AA, Chilton NB, Roblejo-Arias L, Fonseca-Rodríguez O, Marrero-Perera R, Diyes CP, Yunik MEM, Lobo-Rivero E, Corona-González B.Spotted fever group (SFG) rickettsiae are obligatory intracellular bacteria that cause disease in humans and other animals. Ixodid ticks are the principal vectors of SFG rickettsiae. The present study aimed to determine the prevalence and species identity of SFG rickettsiae in ticks and horses from urban and rural areas of western Cuba using PCR assays. Tick samples, collected from 79 horses, consisted of 14 Amblyomma mixtum adults, 111 Dermacentor nitens adults and 19 pools of D. nitens nymphs (2-5 individuals/pool). The PCR results revealed the presence of Rickettsia spp. in 64% of the A. mi...
Seroprevalence and risk factors associated with Equine piroplasmosis in North Egypt.
Comparative immunology, microbiology and infectious diseases    September 13, 2020   Volume 73 101549 doi: 10.1016/j.cimid.2020.101549
Selim A, Khater H.Equine piroplasmosis (EP) is caused by Theileria equi and/or Babesia caballi and has economic importance particularly in equines reared in poor management systems. This study is based on cELISA test to study the seroprevalence of EP among 370 horses and 150 donkeys in four Governorates north Egypt. Additionally, its risk factors were studied for the first time. The seroprevalence rates 36.5 %, 20 %, and 5.6 % for T. equi, B. caballi, and mixed infections, respectively. The highest antibody levels against T. equi were detected in Kafr ElSheikh (40 %) and Giza (40.1 %) Governorates, whereas thos...
Investigations on the occurrence of tapeworm infections in German horse populations with comparison of different antibody detection methods based on saliva and serum samples.
Parasites & vectors    September 10, 2020   Volume 13, Issue 1 462 doi: 10.1186/s13071-020-04318-5
Jürgenschellert L, Krücken J, Austin CJ, Lightbody KL, Bousquet E, von Samson-Himmelstjerna G.Effective and sustainable worm control in horses would benefit from detailed information about the current regional occurrence of tapeworms. Different diagnostic methods are currently available to detect Anoplocephala spp. infections in horses. However, the format as well as the sensitivity and specificity of the methods vary considerably. Methods: A coprological, serological and questionnaire study was conducted to investigate the prevalence and risk factors of tapeworm infections on 48 horse farms in the region of Berlin and Brandenburg, Germany. In total, faecal samples of 484 horses were a...
Neospora caninum infection in Iran (2004-2020): A review.
Journal of parasitic diseases : official organ of the Indian Society for Parasitology    September 10, 2020   Volume 44, Issue 4 671-686 doi: 10.1007/s12639-020-01266-w
Gharekhani J, Yakhchali M, Berahmat R.Knowledge on neosporosis and associated risk factors in different species of animals are so important for designing the control programs and reduce the economic losses globally. This literature review targeted for evaluating the infection rate of in animals in Iran. Until April 2020, all of published documents in the main English and Persian-language databases were searched. A total number of 110 documents (English = 85 and Persian = 25) were extracted. Most of reports were sero-epidemiological studies using ELISA in Iranian cattle population. The range of infection was 3.8-76.2% in ...
Equine disease surveillance: quarterly update.
The Veterinary record    September 7, 2020   Volume 187, Issue 6 e41 doi: 10.1136/vr.m3492
No abstract available
Disease surveillance in England and Wales, August 2020.
The Veterinary record    September 6, 2020   Volume 187, Issue 5 178-182 doi: 10.1136/vr.m3450
No abstract available
Serological evidence of West Nile virus infection among birds and horses in some geographical locations of Iran.
Veterinary medicine and science    August 28, 2020   Volume 7, Issue 1 204-209 doi: 10.1002/vms3.342
Bakhshi H, Beck C, Lecollinet S, Monier M, Mousson L, Zakeri S, Raz A, Arzamani K, Nourani L, Dinparast-Djadid N, Failloux AB.Recent expansion of arboviruses such as West Nile (WNV), Usutu (USUV), and tick-borne encephalitis (TBEV) over their natural range of distribution needs strengthening their surveillance. As common viral vertebrate hosts, birds and horses deserve special attention with routine serological surveillance. Here, we estimated the seroprevalence of WNV, USUV and TBEV in 160 migrating/resident birds and 60 horses sampled in Mazandaran, Golestan, North Khorasan, Kordestan provinces and Golestan province of Iran respectively. ELISA results showed that of 220 collected samples, 32 samples (14.54%), inclu...
Clinical and Serological Findings of Madariaga and Venezuelan Equine Encephalitis Viral Infections: A Follow-up Study 5 Years After an Outbreak in Panama.
Open forum infectious diseases    August 20, 2020   Volume 7, Issue 9 ofaa359 doi: 10.1093/ofid/ofaa359
Carrera JP, Pittí Y, Molares-Martínez JC, Casal E, Pereyra-Elias R, Saenz L, Guerrero I, Galué J, Rodriguez-Alvarez F, Jackman C, Pascale JM....Human cases of Madariaga virus (MADV) infection were first detected during an outbreak in 2010 in eastern Panama, where Venezuelan equine encephalitis virus (VEEV) also circulates. Little is known about the long-term consequences of either alphavirus infection. Methods: A follow-up study of the 2010 outbreak was undertaken in 2015. An additional survey was carried out 2 weeks after a separate 2017 alphavirus outbreak in a neighboring population in eastern Panama. Serological studies and statistical analyses were undertaken in both populations. Results: Among the originally alphavirus-seronegat...
Prevalence of Equus caballus Papillomavirus Type-2 Infection and Seropositivity in Asymptomatic Western Canadian Horses.
Veterinary pathology    August 19, 2020   Volume 57, Issue 5 632-641 doi: 10.1177/0300985820941270
Greenwood S, Chow-Lockerbie B, Ramsauer S, Wachoski-Dark G, Knight C, Wobeser B. papillomavirus type 2 (EcPV-2) has been recognized as a potential cause of a subset of genital squamous cell carcinomas (SCCs) in horses. In the current study, we measured EcPV-2 seropositivity in 50 healthy horses from Western Canada, and these were compared to a herd of horses with known EcPV-2 exposure. Second, the presence of EcPV-2 DNA was measured using EcPV-2-specific PCR (polymerase chain reaction), performed on a variety of tissues collected at necropsy from 70 horses that lacked any history, gross, or histologic evidence of neoplasia or papillomavirus-associated disease. EcPV-2-spec...
Fatal multiple outbreaks of equine influenza H3N8 in Nigeria, 2019: The first introduction of Florida clade 1 to West Africa.
Veterinary microbiology    August 13, 2020   Volume 248 108820 doi: 10.1016/j.vetmic.2020.108820
Shittu I, Meseko CA, Sulaiman LP, Inuwa B, Mustapha M, Zakariya PS, Muhammad AA, Muhammad U, Atuman YJ, Barde IJ, Zecchin B, Quaranta EG, Shamaki D....In December 2018, suspected outbreaks of equine influenza (EI) were observed in donkeys in Sokoto State, in the extreme northwest of Nigeria bordering the Republic of the Niger. Equine influenza virus (EIV) subtype H3N8 was the etiologic agent identified in the outbreaks using real-time RT-qPCR and sequencing of both the partial haemagglutinin (HA) gene and the complete genome. Since then the H3N8 virus spread to 7 of the 19 northern states of Nigeria, where it affected both donkeys and horses. Phylogenetic analysis of the partial and complete HA gene revealed the closest nucleotide similarity...
An epidemiological survey of Theileria equi parasite in donkeys (Equus asinus) in Egypt.
Veterinary parasitology, regional studies and reports    August 13, 2020   Volume 21 100449 doi: 10.1016/j.vprsr.2020.100449
El-Sayed SAE, AbouLaila M, ElKhatam A, Abdel-Wahab A, Rizk MA.In the present study, we conducted an epidemiological survey of Theileria equi, with sequencing analysis of the PCR product using blood-DNA samples collected from donkeys (n = 149) reared in different Egyptian provinces in Lower Egypt (Menoufia and Mersa Matruh) and middle Egypt (Giza). All animals were tested for the presence of T. equi parasite using species-specific PCR assay targeting the Equi merozoite antigen-1 (EMA-1). Nine- (6.04%) samples were positive for T. equi. The highest positive rate for infection was detected in Giza zoological garden (10.16%). Egyptian EMA-1 gene sequence e...
Prevalence of gastrointestinal nematodes, parasite control practices and anthelmintic resistance patterns in a working horse population in Egypt.
Equine veterinary journal    August 11, 2020   Volume 53, Issue 2 339-348 doi: 10.1111/evj.13325
Salem SE, Abd El-Ghany AM, Hamad MH, Abdelaal AM, Elsheikh HA, Hamid AA, Saud MA, Daniels SP, Ras R.Anthelmintic resistance is commonly reported in horse populations in developed countries, but evidence in some working horse populations is either lacking or inconclusive. Objective: To estimate prevalence of GI nematode infections in working horses in Egypt and to evaluate strongyle resistance to ivermectin, doramectin and fenbendazole. Methods: Cross-sectional study. Methods: Faecal egg count was performed on 644 working horses from 2 provinces in Egypt. A short questionnaire about horse signalment and worming history was completed for each horse. Horses identified with ≥50 strongyle type ...
Equine piroplasmosis: an insight into global exposure of equids from 1990 to 2019 by systematic review and meta-analysis.
Parasitology    August 3, 2020   Volume 147, Issue 13 1411-1424 doi: 10.1017/S0031182020001407
Onyiche TE, Taioe MO, Molefe NI, Biu AA, Luka J, Omeh IJ, Yokoyama N, Thekisoe O.Equine piroplasmosis (EP) is a tick-borne disease of economic importance, relevant in the international movement of equids. The causative agents are at least two apicomplexan protozoan parasites Babesia caballi and Theileria equi. To date, there is no study that estimates global and regional exposure of equids to EP. We therefore conducted a systematic review and meta-analysis to estimate the pooled prevalence and heterogeneity of EP using random-effects model. Six electronic databases were searched for publications on EP and assessed according to Preferred Reporting Items for Systematic Revie...
Bovine and equine trypanosomosis in Northwest Ethiopia: Prevalence, density of vectors and control measures.
Parasite epidemiology and control    July 31, 2020   Volume 11 e00170 doi: 10.1016/j.parepi.2020.e00170
Dagnachew S, Mohammed S, Dessie B, Tilahun M, Ayele A, Kefyalew H.A cross-sectional study was carried out from November 2016 to May 2017 in selected districts of Northwest Ethiopia (Jawi, South Achefer, Dembecha and Jabitehenan) with the aim of determining the prevalence of bovine and equine trypanosomosis, estimating the apparent density of vectors and assessing the effectiveness of control measures of the disease. A total of 1257 animals of which 803 bovine and 454 equine were examined for the determination of prevalence using blood sample collected from ear vein of animals. The buffy coat technique was employed to determine the prevalence and the packed c...
Clinical dental finding in Iranian horses.
Veterinary medicine and science    July 31, 2020   Volume 6, Issue 4 679-685 doi: 10.1002/vms3.329
Samad L, Tavanaeimanesh H, Mehr Azin H, Moadab SH, Vajhi AR.A horse's well-being is directly related to the management of its dental health. A good knowledge of the epidemiology and aetiology of dental disorders could help the owners and clinicians to prevent not only dental problems but also severe gastrointestinal diseases. In this study we report the prevalence of dental disorders in horses in Iran. We examined 317 horses randomly in eight provinces in Iran and 21 diseases were characterized in the examined horses. The observed diseases were compared among different breeds, genders and ages of the examined horses. The factor of age among the other t...
Molecular detection of 7SL-derived small RNA is a promising alternative for trypanosomosis diagnosis.
Transboundary and emerging diseases    July 31, 2020   Volume 67, Issue 6 3061-3068 doi: 10.1111/tbed.13744
Verney M, Grey F, Lemans C, Géraud T, Berthier D, Thévenon S, Rincé A, Hans A, Morrison L, Hébert L.Equine trypanosomosis comprises different parasitic diseases caused by protozoa of the subgenus Trypanozoon: Trypanosoma equiperdum (causative agent of dourine), Trypanosoma brucei (nagana) and Trypanosoma evansi (surra). Due to the absence of a vaccine and the lack of efficacy of the few available drugs, these diseases represent a major health and economic problem for international equine trade. Development of affordable, sensitive and specific diagnostic tests is therefore crucial to ensure the control of these diseases. Recently, it has been shown that a small RNA derived from the 7SL gene ...
Seroprevalence and evaluation of risk factors associated with seropositivity for Borrelia burgdorferi in Ontario horses.
Equine veterinary journal    July 29, 2020   Volume 53, Issue 2 331-338 doi: 10.1111/evj.13317
Neely M, Arroyo LG, Jardine C, Moore A, Hazlett M, Clow K, Archer H, Weese JS.Recently, the blacklegged tick (Ixodes scapularis), which is the vector of Borrelia burgdorferi, has undergone a range expansion from the northeastern and mid-west United States to areas of southeastern Canada, including parts of Ontario. Understanding the seroprevalence of antibodies against B. burgdorferi in horses and risk factors for exposure is important for monitoring and preventing this emerging disease. Methods: Cross-sectional study of 551 horses in southern, central, and eastern Ontario, Canada. Objective: To assess the seroprevalence of B. burgdorferi in horses in Ontario, Canada; ...
Molecular detection of Coxiella burnetii in horse sera in Iran.
Comparative immunology, microbiology and infectious diseases    July 23, 2020   Volume 72 101521 doi: 10.1016/j.cimid.2020.101521
Khademi P, Ownagh A, Ataei B, Kazemnia A, Eydi J, Khalili M, M M, Mardani K.Coxiella burnetii is a zoonotic bacterium that can infect a wide range of animals including horses. However, its circulation dynamics in and through horses are still unclear. The aim of this study was to evaluate prevalence of C. burnetii and its genomic characteristics in horse sera samples in the North of Iran (Golestan Province). The samples were collected in 2018 and the age, sex, and breed of each animal were recorded. Nested-PCR was used to detect C. burnetii based on the presence of the transposable gene IS1111. The results showed that 7.50 % (P < 0.05; 95 % CI: 0.5 %-0.12 %) of the ...
Prevalence of Radiographic Signs of Osteoarthritis in Lusitano Purebred Horses.
Journal of equine veterinary science    July 23, 2020   Volume 94 103196 doi: 10.1016/j.jevs.2020.103196
Ramos S, Pinto A, Cardoso M, Alexandre N, Bettencourt E, Monteiro S, Gama LT.Radiographic prevalence and correlation of radiographic findings has not been performed in Lusitano Purebred horses. The aim of this study was to (1) evaluate the prevalence of primary osteoarthritis radiographic findings in Lusitano Purebred horses; (2) to assess correlations between radiographic findings in different joints of the same limb and different limbs; and (3) elucidate the effect of age in the radiographic findings. A radiographic protocol of the stifle, tarsi, fetlocks and distal limbs was done in 98 Lusitanos and the classification of the radiographs was performed using a 0-4 sc...
West Nile Virus: An Update on Pathobiology, Epidemiology, Diagnostics, Control and “One Health” Implications.
Pathogens (Basel, Switzerland)    July 19, 2020   Volume 9, Issue 7 589 doi: 10.3390/pathogens9070589
Habarugira G, Suen WW, Hobson-Peters J, Hall RA, Bielefeldt-Ohmann H.West Nile virus (WNV) is an important zoonotic flavivirus responsible for mild fever to severe, lethal neuroinvasive disease in humans, horses, birds, and other wildlife species. Since its discovery, WNV has caused multiple human and animal disease outbreaks in all continents, except Antarctica. Infections are associated with economic losses, mainly due to the cost of treatment of infected patients, control programmes, and loss of animals and animal products. The pathogenesis of WNV has been extensively investigated in natural hosts as well as in several animal models, including rodents, lagom...
Seroprevalence of Antibodies Against Anaplasma Phagocytophilum and Borrelia Burgdorferi in Horses (Equus Caballus) from Northern Algeria.
Journal of veterinary research    July 14, 2020   Volume 64, Issue 3 413-419 doi: 10.2478/jvetres-2020-0045
Laamari A, Azzag N, Tennah S, Derdour SY, China B, Boꯚllah R, Ghalmi F.Horses (Equus caballus) are susceptible to tick-borne diseases. Two of them, Lyme borreliosis due to Borrelia burgdorferi and granulocytic anaplasmosis due to Anaplasma phagocytophilum were investigated in Algerian horses. The diseases have been less extensively studied in horses and results pertinent to Algeria have not been published. Methods: Blood samples were obtained from 128 horses. IgG antibodies directed against Anaplasma phagocytophilum and Borrelia burgdorferi were detected by an indirect immunofluorescence antibody test (IFAT) and ELISA. The potential effects of age, gender, breed,...
Infection dynamics of Theileria equi in carrier horses is associated with management and tick exposure.
Ticks and tick-borne diseases    July 11, 2020   Volume 11, Issue 6 101508 doi: 10.1016/j.ttbdis.2020.101508
Tirosh-Levy S, Gottlieb Y, Mazuz ML, Savitsky I, Steinman A.The tick-borne equine hemoparasite, Theileria equi, is endemic in many parts of the world where prevalence may be high, and most infected horses are apparently healthy but serve as life-long carriers. To determine the factors that affect T. equi dynamics, we followed parasitic loads in apparently healthy horses at four time points during one year. A total of 1094 blood samples were collected from 395 horses, along with ticks and demographic and clinical data. Infection and load of T. equi were tested by PCR and qPCR, and for the spring dataset, infection was also tested serologically by IFAT (...
Molecular detection of Theileria species and Babesia caballi from horses in Nigeria.
Parasitology research    July 10, 2020   Volume 119, Issue 9 2955-2963 doi: 10.1007/s00436-020-06797-y
Mshelia PW, Kappmeyer L, Johnson WC, Kudi CA, Oluyinka OO, Balogun EO, Richard EE, Onoja E, Sears KP, Ueti MW.Equine piroplasmosis (EP) is an infectious, tick-borne disease caused by the hemoprotozoan parasites, Theileria equi, Babesia caballi, and a recently reported new species, T. haneyi. Infections by these apicomplexan parasites limit performance and cause economic losses for the horse industry. Equine piroplasmosis is widespread in the northern regions of Nigeria, where an increasing portion of the animal population is composed of horses. This disease has remained epidemiologically challenging, especially as the movement of horses increases across Nigeria. In this study, blood samples from 300 h...
Prevalence of endo- and ecto-parasites of equines in Iran: A systematic review.
Veterinary medicine and science    July 9, 2020   Volume 7, Issue 1 25-34 doi: 10.1002/vms3.321
Khamesipour F, Taktaz-Hafshejani T, Tebit KE, Razavi SM, Hosseini SR.Equines are subject to infection with many parasites, which threaten their health. In the present study, we systematically reviewed existing literature on the prevalence of endo- and ectoparasites of equines in Iran. Major electronic databases, including PubMed, PubMed Central, Google Scholar, Science Direct and Scientific Information Database (SID), were searched (Last updated 11/05/2018) for relevant literature of parasites that have been identified from equines in Iran. Of the 1809 titles produced by bibliographic search, 38 were included in the review. Twenty-seven of the studies were on h...
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