High-risk Population Groups Research Articles

Current State and Challenges in Developing Respiratory Syncytial Virus Vaccines.

Respiratory syncytial virus (RSV) is the main cause of acute respiratory tract infections in infants and it also induces significant disease in the elderly. The clinical course may be severe, especially in high-risk populations (infants and elderly), with a large number of deaths in developing countries and of intensive care hospitalizations worldwide. To date, prevention strategies against RSV infection is based on hygienic measures and passive immunization with humanized monoclonal antibodies, limited to selected high-risk children due to their high costs. The development of a safe and effective vaccine is a global health need and an important objective of research in this field. A growing number of RSV vaccine candidates in different formats (particle-based vaccines, vector-based vaccines, subunit vaccines and live-attenuated vaccines) are being developed and are now at different stages, many of them already being in the clinical stage. While waiting for commercially available safe and effective vaccines, immune prophylaxis in selected groups of high-risk populations is still mandatory. This review summarizes the state-of-the-art of the RSV vaccine research and its implications for clinical practice, focusing on the characteristics of the vaccines that reached the clinical stage of development.

Antenatal Care During the COVID-19 Pandemic

Aim: COVID-19 pandemic has affected the daily living globally. It has added to the stress of day to day life. COVID-19 is associated with severe disease in high-risk population groups with increased mortality risk.COVID-19 and it’s impact on pregnancy needs extensive research. Early research data does not suggest any increased risk in the pregnant population and Vertical transmission is yet to be confirmed. As of now no standard protocol is available for management of COVID-19. Social distancing is the best possible mechanism available to protect patients and health care personnel from COVID-19. The aim of this study is know the effectiveness of protocol based Antenatal care during COVID-19 pandemic. Material and Method: This study was conducted at Antenatal clinic of Naval Hospital. 40 antenatal cases who satisfied inclusion and exclusion criteria were selected for the above study. They were assessed at the antenatal clinic following a modified protocol. Conclusion: Antenatal care in COVID-19 pandemic is challenging yet essential. Following a protocol based approach is the key to management of Antenatal care amidst the pandemic. It is cost-effective and has an easy learning curve.Funding Statement: None declared.Declaration of Interests: None declared.Ethics Approval Statement: The study was approved by the INHS Asvini ethical committee.

Prevalence and molecular genetic features of epidermolysis bullosa in Krasnodar Krai

Background. Epidermolysis bullosa defi nes a clinically and genetically heterogeneous group of severe orphan disorders manifested with a congenital propensity for bullae (blisters) propagation on skin and mucous membranes of oesophagus, intestine, respiratory and urogenital systems. In the Russian Federation, its incidence rate is 1 per 50 –300 thousand of people. The actual disease prevalence in Krasnodar Krai is undefi ned. The genetic basis of this hereditary pathology has been studied insuffi ciently.Objectives. Epidemiological description of epidermolysis bullosa in Krasnodar Krai and detection of its chemical DNA signatures.Мethods. The prevalence of epidermolysis bullosa in Krasnodar Krai was studied with a relevant patient sample selected in an electronic archive of primary physician visits during 2010–2018. Chemical DNA signatures were detected as levels of blood serum 8-oxoguanine, a common marker of oxidative lesion. The 8-oxoguanine concentration was determined in ELISA assays with monoclonal antibodies. Statistical signifi cance was estimated with the chi-square and Mann–Whitney U test criteria for small samples.Results. A retrospective study revealed the total incidence rate of epidermolysis bullosa in Krasnodar Krai as 0.96 per 100,000 population, with prevalence in people aged under 30 years (75.5% of all patients, p < 0.01). In Krasnodar Krai, epidermolysis bullosa simplex accounts for 54.7% of total observed cases. Lethal form was diagnosed in 13.2%, and dystrophic type — in 5.7%. Diagnosis was incomplete as per type in 26.4% of patients. Serum 8-oxoguanine concentration in pathology comprised 14.8 ± 1.9 ng/mL, which exceeds 1.9-fold the control values of 7.7 ± 1.3 ng/mL (p < 0.01).Conclusion. The epidemiological profi le of epidermolysis bullosa in Krasnodar Krai was described. The disease prevalence, areal occurrence, predominant types and high-risk population groups were determined. A quarter of all patients had incomplete diagnosis as per the disease type. Elevated levels of 8-oxoguanine, the main product of DNA oxidation, indicate both genomic lesion and oxidative stress associated with epidermolysis bullosa.

Prevalence and age patterns of depression in the United Kingdom. A population-based study

MethodsA representative sample of the UK population (n=17,152) from the European Health Interview Survey of 2014 was included in the analyses. The Patient Health Questionnaire (PHQ-8) was used to assess the prevalence of depressive symptoms and of probable depressive disorder. Prevalence estimates (95%CI) were calculated. The association between prevalence and age was assessed using multivariable multinomial logistic and logistic regression models. All analyses were carried out for the total sample and stratified by sex. ResultsThe prevalence of depressive symptoms ranged from 11.3% (10.6-11.9) for mild, to 3.3% (3.0-3.7) for severe symptoms. The prevalence of probable depressive disorder was 7.5% (95%CI: 7.0-8.0). A significantly higher prevalence of probable depressive disorder was found in those aged 45 to 59 years old compared with those aged 16 to 29. For the prevalence of severe depressive symptoms those age differences were even higher: 2.55 times higher (5.38 for men and 1.75 for women). LimitationsThe cross-sectional design precludes stablishing the direction of the relationship between age and the prevalence. ConclusionsThe prevalence and age patterns of depression in the UK were described. A peak in the prevalence was identified during middle adulthood. These results could serve as a reference for the monitoring of depression in the UK and the development of preventive strategies, particularly in the high-risk population groups identified.

Yenilikçi yaklaşımlarla HIV testi hizmetlerinin güçlendirilmesi: Dünya Sağlık Örgütü

Human Immunodeficiency Virus (HIV) infection has been regarded as one of the major public health concerns affecting the general population worldwide. Even though, many people are getting appropriate treatment, many more have not been able to access the same due to not being diagnosed. In other words, diagnosis is the crucial step to ensure that all the infected people are benefited and for averting all the adverse consequences. The World Health Organization has advocated for HIV self-testing in various population groups based on the evidence that most of the high-risk population groups are more comfortable with self-testing instead of going to the health care establishments. In conclusion, it is important to acknowledge that the process to save lives from the infection actually starts with detecting the infection at the earliest. The newly proposed recommendations will be of immense utility for the policy makers to expedite their battle against the infection.

Gains in life expectancy in the Australian population due to reductions in smoking: comparisons between interventions targeting the population versus interventions in a specific high risk group

BackgroundFour decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively.MethodsUsing the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014–15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011–13 Australian Health Survey.ResultsThe results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation.ConclusionsTargeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.

Hepatitis C Virus Treatment in Children: A Challenge for Hepatitis C Virus Elimination.

Hepatitis C is a global public health threat. The introduction of direct-acting antivirals (DAAs) brings the prospect of curing the 71 million people living with the disease, dramatically changing the landscape of hepatitis C. The World Health Organization developed a roadmap for the elimination and cure of hepatitis C by 2030 with a clear goal with measurable targets. However, there is a lack of a well-defined strategy to tackle the hepatitis C virus (HCV) problem in children and adolescents vis-à-vis the adult population. Hepatitis C in children and adolescents can be addressed as part of a national policy for elimination in the whole population, namely macroelimination, or could be fragmented into a microelimination approach targeting the high-risk population groups. Children born to HCV-infected mothers, adolescents who are injecting drugs, migrants, and those suffering from inherited blood diseases are important target populations. After the U.S. Food and Drug Administration approval for the use of DAAs in children aged 3 years and above, evidence from clinical trials and real-world experience was accumulated using brand and generic medicines, with sustained virological response rates exceeding 95%. The evidence created should guide policies on the management of hepatitis C in children and adolescents. There are many challenges in managing HCV in this left-behind marginalized population. The lack of awareness and epidemiological data, consent age, prohibitive prices of medicines, and absence of policies on access to diagnostics, treatment, and linkage to care are among the many barriers to service delivery that should be addressed to achieve the elimination goal by 2030.

Genetic polymorphisms in the cag pathogenicity island of Helicobacter pylori and risk of stomach cancer and high-grade premalignant gastric lesions.

Helicobacter pylori (Hp) infects the stomach of about half of the human population and is strongly associated with the risk of gastric cancer (GC) and its premalignant precursors. The cag pathogenicity island (cagPAI) is a region of the Hp genome encoding for key molecular machinery involved in the infection process. Following a sequencing study, we selected 50 genetic polymorphisms located in seven cagPAI genes and tested their associations with the risk of advanced gastric premalignant lesions and GC in 1220 subjects from various Latin American populations showing the whole spectrum of phenotypes from gastritis to GC. We found that three polymorphisms of cagA are associated with the risk of advanced gastric premalignant lesions (incomplete intestinal metaplasia [ie, Type 2 and 3] or dysplasia), and that six polymorphisms located in cagA, cagL and cagI were associated with risk of GC. When corrected for multiple testing none of the associations were statistically significant. However, scores built by integrating the individual polymorphisms were significantly associated with the risk of advanced gastric premalignant lesions and GC. These results have the potential of establishing markers for risk stratification in the general population, in view of targeting Hp eradication to high-risk population groups.

Identification of candidate lncRNAs and circRNAs regulating WNT3/β-catenin signaling in essential hypertension.

Mounting evidence suggests that noncoding RNAs (ncRNAs) contribute to the pathogenesis of cardiovascular diseases. However, their role in essential hypertension (EH) is still unclear. We therefore identified differentially expressed long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs) in EH patients from a high-risk population group and constructed a competing endogenous RNA regulatory network that predicts interactions of potential diagnostic and therapeutic relevance between specific lncRNA/circRNA-microRNA-mRNA triplets. Our analysis identified two lncRNAs, transmembrane protein 183A pseudogene (LOC646616) and leucine aminopeptidase 3 pseudogene 2 (LAP3P2), and two circRNAs, hsa_circ_0039388 and hsa_circ_0038648, that are highly co-expressed with both wingless-type MMTV integration site family member 3 (WNT3) and calcium/calmodulin-dependent protein kinase II inhibitor 2 (CAMK2N2) mRNAs and also share common microRNA binding sites with these two transcripts. We also confirmed that a mutually regulated network composed of LOC646616/microRNA-637/WNT3 controls WNT3 expression and influences viability and invasive properties in human arterial smooth muscle cells in vitro. These findings highlight a novel ncRNA-based regulatory mechanism potentially driving WNT/β-catenin activation in EH, and suggest that the identified ncRNAs may represent useful biomarkers and therapeutic targets for this condition.

A systematic review and meta-analysis of the clinical outcomes of TAVI versus SAVR in the octogenarian population.

Surgical aortic valve replacement (SAVR) has shown safe, robust results in elderly populations, and up until recently, was the gold standard for management of severe aortic stenosis. The approach to severe aortic stenosis in high-risk populations, such as octogenarians, has been challenged with the development of transcatheter-based strategies. We sought to systematically analyse outcomes between surgical and transcatheter aortic valve replacement (TAVI) in octogenarians. Electronic databases were searched from their inception until November 2018 for studies comparing SAVR to TAVI in octogenarians, according to a predefined search criterion. The primary end point was mortality, and secondary end points included post-procedural complications. The review yielded four observational studies. The total number of patients included was 1221 including 395 who underwent TAVI and 826 SAVR. On average, patients from both subgroups carried a high number of cardiac risk factors, and STS-PROM scoring yielded mean values equating to high-risk population groups, with significantly higher values for TAVI patients across the board. The presence of post-procedural moderate aortic regurgitation was noted only in the TAVI population (OR = 8.88; 95% CI (1.47-53.64), χ2 = 1.22; p = 0.02; I 2= 0%). Otherwise, there were no significant differences when accounting for mortality (OR = 0.68; 95% CI (0.44-1.05), χ2 = 1.88; p = 0.60; I 2= 0%), permanent pacemaker implantation groups (OR = 0.45; 95% CI (0.44-1.49), χ2 = 0.11; p = 0.19; I 2= 0%), and neurological events (OR = 0.72; 95% CI (0.42-1.23), χ2 = 2.57; p = 0.23; I 2= 22%). The analysed data on TAVI versus SAVR in the octogenarian population show that TAVI shows similar outcomes with relation to mortality and inpatient admission times, in a population with significantly higher risk profiles than their SAVR counterparts. TAVI has higher occurrences of post-procedural AR. TAVI still does not have robust long-term data to ensure its efficacy and rate of complications, but is showing promising results nonetheless.

Accuracy of Smartphone Camera Applications for Detecting Atrial Fibrillation

Atrial fibrillation (AF) affects more than 6 million people in the United States; however, much AF remains undiagnosed. Given that more than 265 million people in the United States own smartphones (>80% of the population), smartphone applications have been proposed for detecting AF, but the accuracy of these applications remains unclear. To determine the accuracy of smartphone camera applications that diagnose AF. MEDLINE and Embase were searched until January 2019 for studies that assessed the accuracy of any smartphone applications that use the smartphone's camera to measure the amplitude and frequency of the user's fingertip pulse to diagnose AF. Bivariate random-effects meta-analyses were constructed to synthesize data. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) of Diagnostic Test Accuracy Studies reporting guideline. Sensitivity and specificity were measured with bivariate random-effects meta-analysis. To simulate the use of these applications as a screening tool, the positive predictive value (PPV) and negative predictive value (NPV) for different population groups (ie, age ≥65 years and age ≥65 years with hypertension) were modeled. Lastly, the association of methodological limitations with outcomes were analyzed with sensitivity analyses and metaregressions. A total of 10 primary diagnostic accuracy studies, with 3852 participants and 4 applications, were included. The oldest studies were published in 2016 (2 studies [20.0%]), while most studies (4 [40.0%]) were published in 2018. The applications analyzed the pulsewave signal for a mean (range) of 2 (1-5) minutes. The meta-analyzed sensitivity and specificity for all applications combined were 94.2% (95% CI, 92.2%-95.7%) and 95.8% (95% CI, 92.4%-97.7%), respectively. The PPV for smartphone camera applications detecting AF in an asymptomatic population aged 65 years and older was between 19.3% (95% CI, 19.2%-19.4%) and 37.5% (95% CI, 37.4%-37.6%), and the NPV was between 99.8% (95% CI, 99.83%-99.84%) and 99.9% (95% CI, 99.94%-99.95%). The PPV and NPV increased for individuals aged 65 years and older with hypertension (PPV, 20.5% [95% CI, 20.4%-20.6%] to 39.2% [95% CI, 39.1%-39.3%]; NPV, 99.8% [95% CI, 99.8%-99.8%] to 99.9% [95% CI, 99.9%-99.9%]). There were methodological limitations in a number of studies that did not appear to be associated with diagnostic performance, but this could not be definitively excluded given the sparsity of the data. In this study, all smartphone camera applications had relatively high sensitivity and specificity. The modeled NPV was high for all analyses, but the PPV was modest, suggesting that using these applications in an asymptomatic population may generate a higher number of false-positive than true-positive results. Future research should address the accuracy of these applications when screening other high-risk population groups, their ability to help monitor chronic AF, and, ultimately, their associations with patient-important outcomes.

Domestic Pigeons As A Potential Hazzard For Transmission Of Some Human Protozoan Parasites

Domestic pigeons (Columba liviadomestica) of the order Columbiformes are ubiquitous birds and can be found in virtually every town and city around the globe. Their interaction with humans and domestic animals and wild birds makes them a potential carrier of zoonotic parasites. The present study aimed to detect the prevalence of different zoonotic protozoans that affect different-aged domestic pigeons in different localities in Assiut Governorate, Egypt. A total of 50 fecal samples from 20 young and 30 adult pigeons were collected and examined for identification and estimation of prevalence of Cryptosporidium sp. and Microsporidium sp. using modified Kinyoun acid-fast stain. For detection of the prevalence of Toxoplasma gondii, serum samples from 50 pigeons were examined serologically for the presence of Toxoplasma antibodies by using Latex Agglutination test. The prevalence of Cryptosporidium sp. infection was 20%; 6.7% in adult pigeons and 40 % in young pigeons while that of Microsporidium sp. was 40% both in adult and young pigeons. Mixed infection was detected in only two young pigeons (10%). Regarding Toxoplasma gondii detection, the number of seropositive cases detected by LAT was 29 out of 50 (58%). The positive agglutination titers, among 14 (48.27%) seropositive pigeons ranged between 1:2 -1:128. It was concluded that domestic pigeons may be considered as a reservoir host for Cryptosporidium, Microsporidium, and Toxoplasmagondii human infection which represents a serious human public health problem especially for high risk groups of population living in the same dwellings with pigeons. Moreover, the present pilot results provide a baseline data for planning future researches and control strategies against domestic pigeon's parasites.

Relevance of Calcium and Vitamin D in Supporting Bone Health: An Expert Panel Recommendation in Indonesia

Osteoporosis is a bone health related condition that weakens the bones, making individuals fragile and prone to breaks. Nutrients such as calcium and vitamin D are essential for bone health. Calcium helps in building and maintaining bone mass while vitamin D aids in the absorption and utilization of calcium. According to WHO, 28.8% men and 32.3% women in Indonesia have osteoporosis, and this is inspite of the international recommendations for the daily intake of calcium and vitamin D intake. This could be attributed to low community awareness on how to prevent and care for osteoporosis. Several high-risk population groups have been identified such as those with osteopenia, undergoing rehabilitation and pregnancy/lactation periods. Therefore, in this review, an expert panel comprising of specialties of dietetics, rehabilitation medicine, orthopaedic, obstetrics & gynaecology, pharmacology, and geriatrics, convened to provide an evidence-based guidance on the prevention and care for osteoporosis. The recommendations are as follows: (i) It is important to know that calcium and vitamin D work synergistically to maintain bone health. (ii) The intake of calcium and vitamin D must start early. (iii) We should be aware that our diet and lifestyle today does not allow us to meet the recommended daily intake of calcium and vitamin D required for optimal bone health. (iv) Supplementation can compensate for the deficits in both calcium and vitamin D intake, thereby strengthening bone health. This study could guide the primary health care team, who plays a critical role in community care, to encourage early bone health awareness and care in Indonesia.

Adoption of the population-based sero-epidemiological protocol to effectively respond to the coronavirus disease 2019 pandemic

The ongoing Coronavirus Disease-2019 (COVID-19) outbreak has been declared as a pandemic and has created a global public health concern. The primary reason due to which COVID-19 outbreak became a public health emergency of international concern was its novel nature. In order to enhance our understanding about the novel infection, five epidemiological protocols have been already developed and the World Health Organization has designed another protocol to conduct investigations pertaining to the disease on the basis of the population and age-stratification. It is expected that this protocol will aid in knowing about the magnitude of the infection in the community, age-specific incidence, infection attack rate, case fatality ratio, ratio of severe disease, detection of high-risk population groups, and the proportion of people having an asymptomatic infection. In conclusion, the adoption of the recently formulated epidemiological protocol by the nation's public health authorities will be a significant step in shaping the battle of mankind against the COVID-19 disease. The protocol will enable the standardized collection of information and thus will help us in understanding crucial clinical, virological and epidemiological attributes of the novel infection.

Risk factors for non-participation in a universal developmental surveillance program in a population in Australia.

Objectives This study examined the risk factors for non-participation in a developmental surveillance program in a population in south-west Sydney with a high proportion of culturally diverse and socioeconomically disadvantaged people. Methods Data from 850 and 625 12- and 18-month-old children respectively from the Watch Me Grow (WMG) birth cohort were used for this study. Logistic regression models were used to assess risk factors for 12- and 18-month non-attendance at Well Child Visits, as well as non-completion of the developmental surveillance questionnaire Parents' Evaluation of Developmental Status (PEDS) in the child's personal health record (PHR). Results Independent risk factors for non-attendance at Well Child Visits were female sex of the child (odds ratio (OR) 12 months 1.5; 95% confidence interval (CI) 1.0-2.3), mother's country of birth Australia (OR 18 months 1.8; 95% CI 1.2-2.7), annual household income less than A$25001 (OR 12 months 1.8; 95% CI 1.0-3.2) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 1.7; 95% CI 1.1-2.5). Independent risk factors for non-completion of PEDS in those who did not attend the Well Child Visit compared with those who did attend and did complete PEDS were household annual income at birth less than A$25001 (OR 12 months 3.9; 95% CI 1.9-8.1) and residing in a socioeconomically disadvantaged neighbourhood (OR 12 months 2.1 (95% CI 1.2-3.7) and OR 18 months 2.0 (95% CI 1.2-3.6)). Conclusions In this population, children exposed to socioeconomic disadvantage are less likely to have attended a Well Child Visit and to have a completed PEDS in their PHR at 12 and/or 18 months of age. What is known about the topic? Developmental problems are common in early childhood, and children from socioeconomically disadvantaged households are at higher risk. Universal developmental surveillance programs may be effective at early identification of children at risk of developmental problems. Early childhood interventions, when accessed, can lessen the effects of developmental problems in later years. What does this paper add? This paper highlights that children exposed to socioeconomic disadvantage in early childhood who are at higher risk of having developmental problems are also at higher risk of missing out on early identification by non-participation in universal developmental surveillance. What are the implications for practitioners? A more equitable model of developmental surveillance should include a framework of proportionate universalism to ensure optimal engagement of high-risk population groups.

Oral cancer: a major and growing public health problem towards a national policy of prevention and early detection in Tunisia.

Oral cancer is a growing public health problem, it is increasing worldwide since it is the sixth most common cancer overall. The highest rates of oral cancer occur in the most disadvantaged sections of the population. Early detection and screening have been shown to be effective in reducing mortality and morbidity caused by oral cancers. To ensure early detection of oral cancer measures such as mass screening or screening of high-risk group population; reducing the delay from patients´ side by creating awareness about signs and symptoms of oral cancer. Today, no national population-based screening programs for oral cancer have been implemented yet. The objectives of this project are to evaluate and educate Tunisian Dentists as well as health professionals to perform oral screening and early detection of suspicious oral lesions in order to reduce morbidity and mortality associated with oral cancer.

Surveillance Data for Eight Consecutive Influenza Seasons in Sicily, Italy.

Influenza A and B outbreaks occur each year with different activity and molecular patterns. To date, knowledge of seasonal epidemiology remains a prerequisite not only to put in place the most effective immunization strategy against influenza but also to identify population groups at higher risk of developing serious complications. A retrospective analysis of influenza surveillance data from 2010 to 2018 aimed to explore the epidemiology of influenza in Sicily, at the primary care and hospital level. Overall, 6,740 patients with acute respiratory infection were tested, of which 3,032 (45.0%) were positive for influenza. The relative proportion of type A and B viruses markedly varied across seasons. Type A similarly spreads among children and adults, whereas type B was more commonly identified among pediatric population aged 5-9 years. The median age of confirmed influenza cases differed by health-care setting, increasing according to disease severity (range: 8-54 years). Among influenza-confirmed cases, more than 80% of hospitalized patients had an underlying medical condition. Cardiovascular disease, lung disease, diabetes, and obesity were some of the most frequent. Overall, patients admitted to an intensive care unit were more likely to have multiple comorbidities and being infected with influenza infection strongly increased the risk of severe clinical outcomes. Understanding of the epidemiology of influenza and the molecular features of circulating viruses is of paramount importance to optimize prevention and control strategies. Knowledge of predictors for the occurrence of severe forms of the disease may help to address adequate preventive measures to high-risk population groups.

Pollen exposure weakens innate defense against respiratory viruses.

Hundreds of plant species release their pollen into the air every year during early spring. During that period, pollen allergic as well as non-allergic patients frequently present to doctors with severe respiratory tract infections. Our objective was therefore to assess whether pollen may interfere with antiviral immunity. We combined data from real-life human exposure cohorts, a mouse model and human cell culture to test our hypothesis. Pollen significantly diminished interferon-λ and pro-inflammatory chemokine responses of airway epithelia to rhinovirus and viral mimics and decreased nuclear translocation of interferon regulatory factors. In mice infected with respiratory syncytial virus, co-exposure to pollen caused attenuated antiviral gene expression and increased pulmonary viral titers. In non-allergic human volunteers, nasal symptoms were positively correlated with airborne birch pollen abundance, and nasal birch pollen challenge led to downregulation of type I and -III interferons in nasal mucosa. In a large patient cohort, numbers of rhinoviruspositive cases were correlated with airborne birch pollen concentrations. The ability of pollen to suppress innate antiviral immunity, independent of allergy, suggests that high-risk population groups should avoid extensive outdoor activities when pollen and respiratory virus seasons coincide.

Country Report: How do Greek municipalities currently promote health and health equity?

Abstract The establishment of municipalities in Greece is governed by Kallikratis Law (2011). There are 325 municipalities in Greece. The municipalities promote activities relating arts, education, health, sport and social services. In addition, there are a few national laws giving municipalities extra possibilities. Main financial sources of municipalities are municipal taxes, fees and duties, VAT tax. Central government finances major infrastructure projects in the municipalities, based on individual projects. Also, some NGOs are helping municipalities in their social role. Aim The investigation of the promotion of health and health equity in municipal level. Findings: Social determinants of health are the main causes for health inequalities at a municipal level. Due to that, some municipalities have developed programs to mitigate them. Municipalities have developed the National Intermunicipal Network of Healthy Cities - Health Promotion has as its sole purpose the prevention of diseases, health Promotion, the screening control of high-risk population groups and generally promote integrated policies in the field of Public Health. Today includes 218 (67%) KALLIKRATI Municipalities from all regions of the country. Municipal social capacities are: kindergartens, programs for migrants, daily care centres for elder people, health care centres (urban and rural), community nursing /home nursing care, mainly to elder and vulnerable groups. Environmental hygiene: The most important role is the collection of household waste and their appropriate disposal, as well as the protection of the environment. There are difficulties in promoting health and health equity by the municipalities: a) lack of financial & human recourses, b) lack of explicit responsibility of Municipalities c) lack of capacity about health issues and 4) bureaucracy. Conclusions There is place for action at the municipal allowing municipalities to implement various programs relating to healthy living environments.

The Accuracy of Smartphone Camera Apps to Detect Atrial Fibrillation: A Systematic Review, Meta-Analysis, Meta-Regression and Modeling Study

Background: Atrial Fibrillation (AF) affects more than 6 million people in the United States (US) and greatly increases one's risk of stroke. Despite its prevalence, much AF remains undiagnosed. Smartphone applications (apps) have been proposed to aid the detection of subclinical AF and to monitor chronic AF. However, the accuracy of these apps remains unclear. We set out to determine the accuracy of smartphone camera apps to diagnose AF and compare the accuracy of apps. Methods: We searched MEDLINE and EMBASE databases and grey literature for studies that assessed the accuracy of any smartphone camera app to diagnose AF. To synthesize data, we constructed bivariate random-effects meta-analyses to determine the meta-analyzed sensitivity and specificity. Furthermore, we modeled the positive predictive value (PPV) and negative predictive value (NPV) for different population groups (age ≥65 and age ≥65 with hypertension). Lastly, we explored the effect of methodological limitations with sensitivity analyses and meta-regressions. Findings: We analyzed data from 3852 participants across 10 primary diagnostic accuracy studies, which evaluated four different apps. The apps analyzed the pulsewave signal (PPG) for an average of 2 minutes (range: 1 to 5 mins). The meta-analyzed sensitivity and specificity for all apps combined was 94·2% (92·2% to 95·7%) and 95·8% (92·4% to 97·7%) respectively. We found the PPV and NPV for the detection of AF was between 19·3% to 37·5% and 99·8% to 99·9%, respectively, in an asymptomatic population aged ≥65. The PPV increased for people aged ≥65 year old and with hypertension (PPV: 20·5% to 39·2%, NPV: 99·8% to 99·9%)). We found methodological limitations in a number of studies that did not appear to impact diagnostic performance, but an effect could not be definitively excluded given data sparsity. Interpretation: All smartphone camera apps have a relatively high sensitivity and specificity. The modeled NPV was high for all analyses, but the PPV was modest, suggesting that using these apps in an asymptomatic population may generate more false, rather than true, positive results. Future research could address the accuracy of these apps to screen further highrisk population groups, and to monitor chronic AF. Funding Statement: The lead author (JOS) is supported by an unrestricted NIH Fellowship ( T32 post-doctoral Fellowship), however there was no specific funding for this study. Declaration of Interests: The authors stated: None declared. Ethics Approval Statement: The protocol for this systematic review was developed and registered a priori (PROSPERO: CRD42019125253). This systematic review and meta-analysis were conducted in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA).