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Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection Observational studies reporting on risk factor-outcome combinations of interest in participants with influenza. Outcomes included death, ventilator support, admission to hospital, admission to an intensive care unit, pneumonia, and composite outcomes. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 63 537 articles were identified of which 234 with a total of 610 782 participants met the inclusion criteria. The evidence supporting risk factors for severe outcomes of influenza ranged from being limited to absent. This was particularly relevant for the relative lack of data for non-2009 H1N1 pandemics and for seasonal influenza studies. Limitations in the published literature included lack of power and lack of adjustment for confounders was widespread: adjusted risk estimates were provided for only 5% of risk factor-outcome comparisons in 39 of 260 (15%) studies. The level of evidence was low for “any risk factor” (odds ratio for mortality 2.77, 95% confidence interval 1.90 to 4.05 for pandemic influenza and 2.04, 1.74 to 2.39 for seasonal influenza), obesity (2.74, 1.56 to 4.80 and 30.1, 1.74 to 2.39), cardiovascular diseases (2.92, 1.76 to 4.86 and 1.97, 1.06 to 3.67), and neuromuscular disease (2.68, 1.91 to 3.75 and 3.21, 1.84 to 5.58). The level of evidence was very low for all other risk factors. Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza (4.43, 1.24 to 15.81). Conclusion The level of evidence to support risk factors for influenza related complications is low and some well accepted risk factors, including pregnancy and ethnicity, could not be confirmed as risks. Rigorous and adequately powered studies are needed.

In this study, we conducted a review of reading intervention research (1988–2019) for upper elementary struggling readers and examined intervention area (e.g., foundational, comprehension, or multicomponent) and intensity (e.g., hours of intervention, group size, and individualization) as possible moderators of effects. We located 33 studies containing 49 treatment-comparison contrasts, found small effects for foundational reading skills (g = 0.22) and comprehension (g = 0.21), and decreased effects when considering standardized measures only. For intervention area, only multicomponent interventions predicted significant effects for both comprehension and foundational outcomes. For intensity, we did not find systematic evidence that longer or individualized interventions were associated with larger effects. However, interventions implemented in very small groups predicted larger comprehension outcomes. Overall, more research examining the quality of school provided reading instruction and how the severity of reading difficulties may impact effects of more intensive interventions is needed.

In recent years, it has increasingly been recognized that due to the uncertain geographic context problem caused by daily human mobility, the residential population is too static to serve as a valid measure of the population at risk for criminal victimization. Various alternative measures have been suggested instead. Guided by the routine activity approach, this study furthers the concept of crime risk population and its measurement across space and time. Using exceptionally comprehensive data sets on population mobility and on theft from the person in a large city in China, we select the best indicator of the risk population from the following four candidates: residential population, subway ridership, taxi ridership, and mobile phone users. Controlling for the potentially confounding effects of offender and guardian presence, we show that on both weekdays and weekends, the best indicators of risk population vary over the course of the day. In the morning, residential population outperforms other measures. In the afternoon and evening, taxi ridership and phone users are better indicators. Although the mobile phone user base forms an arguably more representative measure of ambient population, during some periods taxi ridership is superior because it provides a better indicator of outdoor (as opposed to indoor) activities. In terms of practical applications to security policy and law enforcement, these findings can help identify crime hot spots by calculating accurate crime risks.

Background Family genetic testing of patients newly diagnosed with a rare genetic disease can improve early diagnosis of family members, allowing patients to receive disease‐specific therapies when available. Fabry disease, an X‐linked lysosomal storage disorder caused by pathogenic variants in GLA, can lead to end‐stage renal disease, cardiac arrhythmias, and stroke. Diagnostic delays are common due to the rarity of the disease and non‐specificity of early symptoms. Newborn screening and screening of at‐risk populations, (e.g., patients with hypertrophic cardiomyopathy or undiagnosed nephropathies) can identify individuals with Fabry disease. Subsequent cascade genotyping of family members may disclose a greater number of affected individuals, often at younger age than they would have been diagnosed otherwise. Methods We conducted a literature search to identify all published data on family genetic testing for Fabry disease, and discussed these data, experts’ own experiences with family genetic testing, and the barriers to this type of screening that are present in their respective countries. Results There are potential barriers that make implementation of family genetic testing challenging in some countries. These include associated costs and low awareness of its importance, and cultural and societal issues. Regionally, there are barriers associated with population educational levels, national geography and infrastructures, and a lack of medical geneticists. Conclusion In this review, the worldwide experience of an international group of experts of Fabry disease highlights the issues faced in the family genetic testing of patients affected with rare genetic diseases. This review article discusses the literature published on family genetic testing for Fabry disease and the experiences of 19 Fabry experts from 15 countries regarding family screening in their countries and the barriers they are facing. Together, this literature overview and combined global experience provides valuable insights to medical geneticists working to improve the diagnosis of rare diseases within their countries and globally.

Our study aimed to conduct a comparative evaluation of various noninvasive tests (NITs) for risk stratification in at-risk population for non-alcoholic fatty liver disease (NAFLD), focusing on cardiovascular and liver-related mortality. A total of 21,715 adults aged 40 years and older were enrolled at baseline. The mean follow-up period was 12.39 years. Three types of NITs (fibrosis-4 index [FIB-4], NAFLD fibrosis score [NFS], and steatosis-associated fibrosis estimator [SAFE] score) were used. When using the low cut-off as a 'rule-out' strategy, there were no significant differences in cardiovascular mortality between the 'rule-out' (low-risk) group and the 'rule-in' (intermediate- or high-risk) group based on FIB-4 (aHR = 1.029, P  = 0.845) or NFS (aHR = 0.839, P  = 0.271) classification. However, the SAFE score exhibited higher sensitivity in predicting cardiovascular mortality compared to FIB-4 or NFS (73.3% in SAFE score vs. 29.6% in FIB-4 or 21.3% in NFS). Only the SAFE score could effectively differentiate the risk between low- and intermediate- or high-risk groups for all types of mortality (all P values for aHR < 0.001). The low cutoff value of the SAFE score discriminated not only liver-related mortality but also identified the cardiovascular high-risk group in the community cohort.

Background A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. Aims To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. Methods A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. Findings Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. Conclusion While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.

Significance & Background: How an individual with a life-limiting disorder such as cancer responds to adverse health outcomes can be varied depending upon their beliefs and values. However, providing timely resources can be difficult if the individual is wary of what palliative care entails, if they have barriers to receiving palliative care, and how to best identify if palliative care is needed. NIH states that vulnerable populations are people who have a high incidence of health care disparities which can compound health issues. Social determinants of health such as socioeconomic factors and physical environment, have a direct effect on an individual's well-being which in turn compounds the barriers in receiving timely care. Understanding the barriers and identifying solutions has the propensity of improving patient outcomes in vulnerable populations. Purpose: This project will identify the barriers facing vulnerable populations to receive palliative care, what solutions have been found, and how to best reach individuals who show a need for a palliative care consultation. Interventions: A literature review was conducted utilizing a comprehensive search of Pubmed and Gale databases; the keywords of 'palliative care', 'barriers', 'solutions', 'vulnerable', 'underserved, and 'minority' were used. Studies were assessed for key topics regarding barriers and solutions regarding palliative care accessibility for the specific populations of vulnerable individuals as categorized by NIH. Fourteen qualitative studies were utilized, barriers and solutions, and population were delineated and compiled into common themes. Results: Several barriers were identified such as indifference to linguistic differences, stigmatization of individuals who used substances, and discrimination against individuals who were unhoused. Several solutions were identified such as increased care coordination, technology integration into care, and increased education regarding patient's diverse cultural and belief systems. Limitations were noted such as study sample sizes and accessibility of study participants. Discussion: Based on these results, individuals categorized as vulnerable populations are lacking access to adequate palliative care due to barriers of logistics, linguistics, and unconscious biases. Practical implications for healthcare providers are improving the education of the multidisciplinary team and improving health literacy of vulnerable populations to view palliative as a viable option in the presence of a life-limiting illness.

To determine operational and analytical characteristics of respondent-driven sampling (RDS) in international settings and to explore factors that may affect recruitment of most-at-risk populations using RDS, we reviewed HIV biological and behavioral surveillance studies that used this method outside of the United States. We identified 123 eligible studies, 59 from Europe, 40 from Asia and the Pacific, 14 from Latin America, seven from Africa and three from Oceania. Studies collectively recruited 32,298 participants between 2003 and 2007; 53% of studies were conducted among injecting drug users, which generally had faster recruitment compared with studies among sex workers. All but 13 studies reached ≥90% of their intended sample size, and six studies failed to reach equilibrium for key variables. This review has shown that RDS is an effective technique, when designed and implemented appropriately, to sample most-at-risk populations for HIV biological and behavioral surveys.

In Singapore, influenza vaccination is recommended for persons at higher risk of complications of seasonal influenza, including those with chronic medical conditions and the elderly (individuals aged ⩾65 years). We investigated the factors associated with influenza vaccine uptake based on a nationally representative sample of community-dwelling adults aged >50 years. The data for this study were obtained from the National Health Surveillance Survey (NHSS) 2013. The association between influenza vaccine uptake and socio-demographic and health-related variables was analysed using univariable and multivariable logistic regression models. Of 3700 respondents aged ⩾50 years in the NHSS, 15·2% had received seasonal influenza vaccination in the past year. Older age, single marital status and economic inactivity were the socio-demographic variables independently associated with vaccine uptake. Health-related factors which were predictive of influenza vaccine uptake were sufficient total physical activity, better self-rated health, having at least one medical condition at risk of influenza complications and a regular family doctor/general practitioner. Influenza vaccine uptake in community-dwelling older adults was low. Our findings are of relevance in the formulation of public health policies and targeted health promotion strategies to increase vaccine uptake in this population group.