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Diabet. Med. 29, 893–904 (2012) Abstract Background Diabetes risk assessment has been proposed as part of the National Health Service Health Checks programme, and HbA1c has recently been recommended as a diagnostic test for diabetes at a threshold of 48 mmol/mol (6.5%). We estimated the potential population impact of different stepwise screening strategies to identify individuals at high risk who might be offered preventive interventions. Methods Using data from 5910 participants in the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort with HbA1c measurements, we modelled different stepwise screening strategies for identifying and treating individuals at high risk of Type 2 diabetes using different HbA1c cut-off points with and without a stage of prestratification. For each strategy, we estimated the number needed to have a diagnostic test, the number needed to treat to prevent one new case of Type 2 diabetes, and the number of new cases that could be prevented in the population over 3 years. Relative risk reductions for estimated effects of intensive lifestyle intervention were derived from the US Diabetes Prevention Program. Results Compared with inviting all individuals in an average primary care trust for a diagnostic test, a stepwise screening approach using simple routine data such as age and anthropometric indices could prevent a slightly lower number (lower-upper estimates) of new cases of Type 2 diabetes over 3 years (224 [130–359] and 193 [109–315] cases respectively) but would only require half the population to be invited for a diagnostic blood test. A total of 162 (88–274) cases could be prevented by inviting individuals with a Cambridge risk score of ≥ 0.15, with only 40% of the total population requiring diagnostic blood tests. Using a participant completed questionnaire for risk assessment (FINDRISC) was less effective, mainly relating to the questionnaire response rate. Providing preventive interventions to those with a lower HbA1c of 37–

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

This study determined the frequency and impact of symptoms on quality of life (QoL) in patients diagnosed with limb girdle muscular dystrophy (LGMD). Participants with a diagnosis of LGMD in registries based at the Coalition to Cure Calpain-3, the Jain foundation, and the Global FKRP Registry competed a survey to report the frequency and relative impact of themes and symptoms of LGMD. Frequency, mean impact, and population impact scores were calculated, and responses were categorized by age, symptom duration, gender, employment status, use of assistive devices, and LGMD subtypes. 134 participants completed the survey. The most prevalent themes included an inability to do activities (100%), limitation with mobility (99.3%), and lower extremity weakness (97.0%). Themes with the greatest impact were: limitations with mobility, lower extremity weakness, and an inability to do activities. Symptom duration and the use of assistive devices were associated with the presence of multiple themes. Employment was associated with the impact of several themes with no differences in frequency. The prevalence and impact of these themes vary in the LMGD population. The most prevalent and impactful themes were related to weakness, but additional concerns related to emotional challenges should also be considered in clinical and research settings.

BackgroundKey components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV preexposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and healthcare access across the U.S. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage.MethodsWe used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and two counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percent of infections averted (PIA) over the next decade and efficiency with the number needed to treat (NNT) by PrEP required to avert one HIV infection.ResultsIn our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage with the PIA ranging from 61% in the lowest baseline ART coverage population to 75% in the highest ART coverage. The efficiency declined with increasing ART (NNT range from 41 to 113).ConclusionsImproving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city like San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.

PURPOSE: To determine the population-based rate of emergency surgery performed in Ghana, categorized by hospital level. METHODS: Data on operations performed from June 2014 to May 2015 were obtained from a nationally representative sample of hospitals and scaled up to nationwide estimates. Operations were categorized as to: “emergency” or “elective” and as to “essential” (most cost-effective, highest population impact) or “other” according to the World Bank’s Disease Control Priorities project. RESULTS: Of 232,776 (95% UI 178,004–287,549) total operations performed nationally, 48% were emergencies. 112,036 emergency operations (95% UI: 92,105–131,967) were performed and the annual national rate was 416 per 100,000 population (95% UI: 342–489). Most emergency operations (87%) were in the essential category. Of essential emergency procedures, 47% were obstetric and gynecologic, 22% were general surgery, and 31% were trauma. District (first-level) hospitals performed 54%, regional hospitals 10%, and tertiary hospitals 36% of all emergency operations. About half (54%) of district hospitals did not have a fully-trained surgeon, however these hospitals performed 36% of district hospital emergency operations and 20% of all emergency operations. CONCLUSIONS: Emergency operations make up nearly half of all operations performed in Ghana. Most are performed at district hospitals, many of which do not have fully-trained surgeons. Obstetric procedures make up a large portion of emergency operations, indicating a need for improved provision of non-obstetric emergency surgical care. These data are useful for future benchmarking efforts to improve availability of emergency surgical care in Ghana and other low- and middle-income countries.

Objectives Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care. Methods We retrospectively reviewed all early glottic (T1-T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans' Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence-free survival (RFS), and overall survival (OS). Results One hundred seventeen patients with a primary diagnosis of T1-T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation-based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period. Conclusion At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long-term surveillance and monitoring. Level of evidence 4 Laryngoscope, 130:1733-1739, 2020.

SARS-CoV-2 variants of concern exhibit varying degrees of transmissibility and, in some cases, escape from acquired immunity. Much effort has been devoted to measuring these phenotypes, but understanding their impact on the course of the pandemic – especially that of immune escape – has remained a challenge. Here, we use a mathematical model to simulate the dynamics of wildtype and variant strains of SARS-CoV-2 in the context of vaccine rollout and nonpharmaceutical interventions. We show that variants with enhanced transmissibility frequently increase epidemic severity, whereas those with partial immune escape either fail to spread widely, or primarily cause reinfections and breakthrough infections. However, when these phenotypes are combined, a variant can continue spreading even as immunity builds up in the population, limiting the impact of vaccination and exacerbating the epidemic. These findings help explain the trajectories of past and present SARS-CoV-2 variants and may inform variant assessment and response in the future., A modeling approach looking at the impact of SARS-CoV-2 variants based on escape from immunity or different degrees of transmissibility in the context of vaccination as well as pharmaceutical interventions suggests that epidemic severity is linked more strongly to variants with enhanced transmissibility.

Simple Summary Efficiently addressing human-large carnivore conflicts is a conservation issue of increasing relevance, especially in human-dominated landscapes where impact on rural economies generates negative attitudes towards large carnivores and their conservation. We quantified patterns of bear impact on farms and the costs of compensation from 2005 to 2015 in the Abruzzo Lazio and Molise National Park (central Italy), an historical stronghold of the relict and highly imperiled Apennine brown bear population, where the park authority has been adopting conflict management approaches since the 1960s. Although the compensation program is rather costly (1490 ± 589 €/bear/year), the park policy has been increasingly integrated with prevention incentives, managing to effectively avert further increases in bear damages during the study period. Concurrently, local residents generally share a positive attitude towards bears, and the number of illegally killed bears decreased in the last decade. Despite this, our findings indicate there is still room for improvement in local conflict management, and that a more efficient use of conservation funds would benefit from increased monitoring, integrated prevention, conditional compensation, and participatory processes. Lessons learned from areas of historical coexistence between humans and large carnivores provide critical insights to design successful management strategies in areas of recent and future recolonisation by large carnivores. Abstract Human-carnivore conflicts are a major conservation issue. As bears are expanding their range in Europe’s human-modified landscapes, it is increasingly important to understand, prevent, and address human-bear conflicts and evaluate mitigation strategies in areas of historical coexistence. Based on verified claims, we assessed costs, patterns, and drivers of bear damages in the relict Apennine brown bear population in the Abruzzo Lazio and Molise National Park (PNALM), central Italy. During 2005–2015, 203 ± 71 (SD) damage events were verified annually, equivalent to 75,987 ± 30,038 €/year paid for compensation. Most damages occurred in summer and fall, with livestock depredation, especially sheep and cattle calves, prevailing over other types of damages, with apiaries ranking second in costs of compensation. Transhumant livestock owners were less impacted than residential ones, and farms that adopted prevention measures loaned from the PNALM were less susceptible to bear damages. Livestock farms chronically damaged by bears represented 8 ± 3% of those annually impacted, corresponding to 24 ± 6% of compensation costs. Further improvements in the conflict mitigation policy adopted by the PNALM include integrated prevention, conditional compensation, and participatory processes. We discuss the implications of our study for Human-bear coexistence in broader contexts.

Emerging evidence suggests that emotion regulation (ER) impairment in those with ASD is associated with poor mental health. This study used the Emotion Dysregulation Inventory, a new norm-referenced ER measure with clinical cut-offs, developed and validated in ASD and non-ASD samples, to establish rates of ER impairment and understand its association with psychiatric service use in ASD. Parents of 6-17 year olds in three well-characterized samples (nationally representative US n = 1,000; community ASD n = 1,169; inpatient ASD n = 567) completed a battery of questionnaires about their child. The prevalence of ER impairment was significantly higher in the ASD groups compared to the nationally representative sample and highest in the psychiatric Inpatient ASD group. The community ASD and inpatient ASD samples were four and seven times more likely, respectively, to exceed clinical cutoffs for emotional reactivity than the general US sample. Similarly, history of psychiatric hospitalization, recent emergency services use (police contact, emergency room visits, or in-home crisis evaluations for emotional or behavioral concerns in the past 2 months), and psychotropic medication prescriptions were significantly higher in the ASD groups. ER impairment was significantly associated with all forms of psychiatric service use, after controlling for demographics (age, sex, race), co-occurring intellectual disability, and ADHD symptoms. This is the first large-scale study to document substantially higher rates of ER impairment in youth with ASD compared to the general population. The importance of ER impairment is underscored by its association with higher utilization of inpatient, emergency, and medication services in ASD, after accounting for demographics and ADHD-related symptoms.

Background The causal relevance of elevated blood pressure for several cardiovascular diseases (CVDs) is uncertain, as is the population impact of blood pressure lowering. This study systematically assesses evidence of causality for various CVDs in a 2‐sample Mendelian randomization framework, and estimates the potential reduction in the prevalence of these diseases attributable to long‐term population shifts in the distribution of systolic blood pressure (SBP). Methods and Results We investigated associations of genetically predicted SBP as predicted by 256 genetic variants with 21 CVDs in UK Biobank, a population‐based cohort of UK residents. The sample consisted of 376 703 participants of European ancestry, aged 40 to 69 years at recruitment. Genetically predicted SBP was positively associated with 14 of the outcomes ( P Conclusions Risk of many CVDs is influenced by long‐term differences in SBP. The burden of a broad range of CVDs could be substantially reduced by long‐term population‐wide reductions in the distribution of blood pressure.

BackgroundShort-term forecasts of infectious disease can aid situational awareness and planning for outbreak response. Here, we report on multi-model forecasts of Covid-19 in the UK that were generated at regular intervals starting at the end of March 2020, in order to monitor expected healthcare utilisation and population impacts in real time.MethodsWe evaluated the performance of individual model forecasts generated between 24 March and 14 July 2020, using a variety of metrics including the weighted interval score as well as metrics that assess the calibration, sharpness, bias and absolute error of forecasts separately. We further combined the predictions from individual models into ensemble forecasts using a simple mean as well as a quantile regression average that aimed to maximise performance. We compared model performance to a null model of no change.ResultsIn most cases, individual models performed better than the null model, and ensembles models were well calibrated and performed comparatively to the best individual models. The quantile regression average did not noticeably outperform the mean ensemble.ConclusionsEnsembles of multi-model forecasts can inform the policy response to the Covid-19 pandemic by assessing future resource needs and expected population impact of morbidity and mortality.

Neuroimaging has identified individual brain regions, but not yet whole-brain patterns, that correlate with the population impact of health messaging. We used neuroimaging to measure whole-brain responses to health news articles across two studies. Beyond activity in core reward value-related regions (ventral striatum, ventromedial prefrontal cortex), our approach leveraged whole-brain responses to each article, quantifying expression of a distributed pattern meta-analytically associated with reward valuation. The results indicated that expression of this whole-brain pattern was associated with population-level sharing of these articles beyond previously identified brain regions and self-report variables. Further, the efficacy of the meta-analytic pattern was not reducible to patterns within core reward value-related regions but rather depended on larger-scale patterns. Overall, this work shows that a reward-related pattern of whole-brain activity is related to health information sharing, advancing neuroscience models of the mechanisms underlying the spread of health information through a population.

It has been just over a decade since the release of the maize (Zea mays) Nested Association Mapping (NAM) population. The NAM population has been and continues to be an invaluable resource for the maize genetics community and has yielded insights into the genetic architecture of complex traits. The parental lines have become some of the most well-characterized maize germplasm, and their de novo assemblies were recently made publicly available. As we enter an exciting new stage in maize genomics, this retrospective will summarize the design and intentions behind the NAM population; its application, the discoveries it has enabled, and its influence in other systems; and use the past decade of hindsight to consider whether and how it will remain useful in a new age of genomics.

Using data collected from a 2012 - 2016 randomized trial, the effectiveness of enhanced collaborative care for PTSD and depression was evaluated using probable diagnostic status as the primary outcome. Exclusion criteria were then applied to a 2011 disease registry to examine the representativeness of the trial sample and estimate the potential reach of the intervention. Population impact was derived from the estimated effectiveness and reach of the intervention.Enhanced collaborative care was associated with a significantly greater probability of PTSD/depression remission by the end of the trial (conditional effect = -0.066, chisq = 51.1, p0.001). Based on the effectiveness and reach of the enhanced intervention, an estimated 250 (out of the 3,436) more Army soldiers with PTSD and/or depression would experience diagnostic remission during the preceding year if the enhanced model was available.The population framework permits the estimated differential impact of two collaborative care models to inform implementation considerations. These results highlight the value of applying public health models to identify front line treatments.

Gaming disorder (GD) is considered as a condition related to severe functional impairment, and its prevalence reaches meaningful proportions of the general population in many countries. Besides treatment and prevention, early interventions could play a major role to curb this rising public health concern. This review summarizes the available knowledge in this field. Among current systematic reviews on treatment approaches with respect to GD or Internet-related disorders (IDs), only two studies have been found that can be characterized as early interventions. However, findings from the substance abuse field foreshadow the prospects of such approaches for the arena of GD and ID. To date, nearly no evidence according to early interventions for GD or ID exists. Early intervention for GD or ID in settings like primary care or school needs to receive much more attention given the promising population impact that this approach could have. Sound studies testing the efficacy of brief interventions are highly needed.

Based on the large ensembles of the half a degree additional warming, prognosis, and projected impacts historical, +1.5 and +2 °C experiments, we quantify changes in the magnitude of water availability (i.e., precipitation minus actual evapotranspiration; a function of monthly precipitation flux, latent heat flux, and surface air temperature) below normal conditions (less than median, e.g., 20th percentile water availability). We found that, relative to the historical experiment, water availability below normal conditions of the +1.5 and +2 °C experiments would decrease in the midlatitudes and the tropics, indicating that hydrological drought is likely to increase in warmer worlds. These cause more (less) people in East Asia, Central Europe, South Asia, and Southeast Asia (West Africa and Alaska/Northwest Canada) to be exposed to water shortage. Stabilizing warming at 1.5 °C instead of 2 °C would limit population impact in most of the regions, less effective in Alaska/Northwest Canada, Southeast Asia, and Amazon. Globally, this reduced population impact is ~117 million people.

Introduction Tobacco price increases can generate increased public interest in smoking cessation, but it is not clear how long this interest lasts. Our objective was to evaluate the duration of the impact of cigarette price increase in Japan using Google search data. Methods Monthly or daily aggregated Google search volume for smoking cessation in Japan from 2004 to 2016 was collected in terms of relative search volume (RSV) ranging from 0 to 100. Using monthly RSV data, we evaluated possible relationships between the RSVs and tobacco control measures in Japan. Time periods within which the impact of search volume significantly increased were identified by cluster detection test, using daily RSV data. A spike in RSV preceding the enforcement of a cigarette price increase revealed an anticipation effect. Results Between 2004 and 2016, the three highest monthly RSV spikes were observed in July 2006 (RSV = 66), when cigarette prices increased by 11%, and in September (RSV = 90) and October 2010 (RSV = 100), when cigarette prices increased by 37%. Regarding daily RSV, the detected cluster size around the price increase in 2010 (52 days) was longer than that in 2006 (17 days). In 2010, a cluster period of 25 days before the date of the price increase was observed, suggesting an anticipation effect. After the onset of the price increase, a cluster of 27 days was detected. When the cigarette price increased due to consumption tax in April 2014, almost no anticipation effect was observed. Conclusions The population impact of tobacco price increases on smoking cessation may be assessed using Google Trends data. The cluster indicates that a higher cigarette price increase had a higher and longer lasting effect on population interest in cessation, but the impact may continue for a relatively short time. Implications To examine the duration of the impact of cigarette price increases on population interest in smoking cessation in Japan, Google search data for smoking cessation were analyzed. Between 2004 and 2016, the three highest spikes of monthly RSV were observed in October 2010, when cigarette prices increased by 37%. Analyzing daily RSV data, the detected cluster size around the price increase in 2010 was 52 days, and a cluster period of 25 days before the date of the price increase was observed, suggesting an anticipation effect. The cluster indicates that a higher cigarette price increase had a higher and longer lasting effect, but the population impact continues for a relatively short time. Further increases in the price of cigarettes are necessary.

Data on long-term consequences of non-hip non-vertebral (NHNV) fractures, accounting for approximately two-thirds of all fragility fractures, are scanty. Our study aimed to quantify the population-wide impact of NHNV fractures on mortality. The national population-based prospective cohort study (Canadian Multicentre Osteoporosis Study) included 5526 community dwelling women and 2163 men aged 50 years or older followed from July 1995 to September 2013. Population impact number was used to quantify the average number of people for whom one death would be attributable to fracture and case impact number to quantify the number of deaths out of which one would be attributable to a fracture. There were 1370 fragility fractures followed by 296 deaths in women (mortality rate: 3.49; 95% CI, 3.11 to 3.91), and 302 fractures with 92 deaths in men (5.05; 95% CI, 4.12 to 6.20). NHNV fractures accounted for three-quarters of fractures. In women, the population-wide impact of NHNV fractures on mortality was greater than that of hip and vertebral fractures because of the greater number of NHNV fractures. Out of 800 women, one death was estimated to be attributable to a NHNV fracture, compared with one death in 2000 women attributable to hip or vertebral fracture. Similarly, out of 15 deaths in women, one was estimated to be attributable to a NHNV fracture, compared with one in over 40 deaths for hip or vertebral fracture. The impact of forearm fractures (ie, one death in 2400 women and one out of 42 deaths in women attributable to forearm fracture) was similar to that of hip, vertebral, or rib fractures. Similar, albeit not significant, results were noted for men. The study highlights the important contribution of NHNV fractures on mortality because many NHNV fracture types, except for the most distal fractures, have serious adverse consequences that affect a significant proportion of the population. © 2017 American Society for Bone and Mineral Research.

This article proposes that universal and targeted preventive interventions should be compared and evaluated in terms of their benefit-cost ratio in achieving population-wide impact on mental disorders and related outcomes. Universal approaches attempt to affect every individual in a population, whereas targeted approaches select candidates for intervention based on screening of demographic or behavioral characteristics. Unique assets and challenges of each approach in achieving population impact in a cost-efficient way are discussed, along with spillover effects, sensitivity and specificity, developmental processes, timing of intervention, and the relation between severity of risk and plasticity. A general targeted-efficiency framework is proposed as a heuristic to evaluate the collective merits of universal and targeted approaches in specific cases. A tiered approach that combines universal and targeted identification strategies is proposed, and examples are described. Issues for high-priority research are identified.

Background Adolescent girls and young women (AGYW) In South Africa are at high risk of HIV and early pregnancy. MTV-Shuga, a mass-media edu-drama, improved some sexual health outcomes in a randomised trial amongst young people in Nigeria. We used the national free-to-air TV screening of MTV-Shuga (the “Down South” series), concurrent with the roll-out of a large scale-up of combination HIV prevention for AGYW - to test the hypothesis that mass-media edu-drama can improve the sexual health of AGYW in a rural and resource-constrained area of KwaZulu-Natal. Methods We followed a representative population-based prospective cohort of females aged 13–23 between May 2017 and September 2018. We measured the relationship between exposure to MTV-Shuga (i.e., reporting seeing ≥1 of 24 episodes; able to recall any storyline) and: incident HSV-2; incident pregnancy; condom use at last sex; uptake of HIV-testing and contraception; and awareness of HIV Pre-Exposure Prophylaxis (PrEP). Results 2183 (85.5%) eligible participants were surveyed at baseline, of whom 1853 (86.5%) completed follow-up. MTV-Shuga exposure was low – 152 (8.2%) reported seeing ≥1 episode and 73 (3.9%) recalled any storyline – while teenage pregnancy and incident HSV-2 were high (6.4 and 11.3/100 person-years respectively). MTV-Shuga exposed AGYW were from wealthier households (p Conclusion AGYW exposure to the MTV-Shuga edu-drama was very low in a setting where AGYW remain at high risk for STI, HIV and early pregnancy. Nevertheless, there is a suggestion that those who were exposed to MTV-Shuga had better sexual health outcomes. There is a need for strategies to raise uptake of such edu-dramas, and to evaluate whether wider coverage leads to population impact. Disclosure No significant relationships.

Relatives of cancer patients are at an increased risk of the same (concordant) cancer but whether they are at a risk for different (discordant) cancers is largely unknown - beyond well characterized hereditary cancer syndromes - but would be of major scientific and clinical interest. We therefore decided to resolve the issue by analyzing familial risks when family members were diagnosed with any discordant cancers. We compared the population impact of concordant to discordant familial cancer. The Swedish Family-Cancer Database (FCD) was used to calculate familial relative risks (RRs) for family members of cancer patients, for the 27 most common cancers. Population attributable fractions (PAFs) were estimated for concordant and discordant family histories. Discordant cancers in the family were detected as significant risk factors for the majority of cancers, although the corresponding RRs were modest compared to RRs for concordant cancers. Risks increased with the number of affected family members with the highest RRs for pancreatic (2.31), lung (1.69), kidney (1.98), nervous system (1.79) and thyroid cancers (3.28), when 5 or more family members were diagnosed with discordant cancers. For most cancers, the PAF for discordant family history exceeded that for concordant family history. Our findings suggest that there is an unspecific genetic predisposition to cancer with clinical consequences. We consider it unlikely that shared environmental risk factors could essentially contribute to the risks for diverse discordant cancers, which are likely driven by genetic predisposition. The identification of genes that moderately increase the risk for many cancers will be a challenge.

Background. Rotavirus vaccines have been introduced in many low-income African countries including Malawi in 2012. Despite early evidence of vaccine impact, determining persistence of protection beyond infancy, the utility of the vaccine against specific rotavirus genotypes, and effectiveness in vulnerable subgroups is important. Methods. We compared rotavirus prevalence in diarrheal stool and hospitalization incidence before and following rotavirus vaccine introduction in Malawi. Using case-control analysis, we derived vaccine effectiveness (VE) in the second year of life and for human immunodeficiency virus (HIV)–exposed and stunted children. Results. Rotavirus prevalence declined concurrent with increasing vaccine coverage, and in 2015 was 24% compared with prevaccine mean baseline in 1997–2011 of 32%. Since vaccine introduction, population rotavirus hospitalization incidence declined in infants by 54.2% (95% confidence interval [CI], 32.8–68.8), but did not fall in older children. Comparing 241 rotavirus cases with 692 test-negative controls, VE was 70.6% (95% CI, 33.6%–87.0%) and 31.7% (95% CI, −140.6% to 80.6%) in the first and second year of life, respectively, whereas mean age of rotavirus cases increased from 9.3 to 11.8 months. Despite higher VE against G1P[8] than against other genotypes, no resurgence of nonvaccine genotypes has occurred. VE did not differ significantly by nutritional status (78.1% [95% CI, 5.6%–94.9%] in 257 well-nourished and 27.8% [95% CI, −99.5% to 73.9%] in 205 stunted children; P = .12), or by HIV exposure (60.5% [95% CI, 13.3%–82.0%] in 745 HIV-unexposed and 42.2% [95% CI, −106.9% to 83.8%] in 174 exposed children; P = .91). Conclusions. Rotavirus vaccination in Malawi has resulted in reductions in disease burden in infants

Introduction: Outdoor air pollution is classified as a carcinogen by IARC primarily on the basis of a relationship between PM2.5 and NO2 and lung cancer risk. This study evaluates the population at...

Background The 2017 ACC/AHA guidelines on hypertension management recommend the introduction of antihypertensive treatment for patients with new stage 1 hypertension thresholds (130–139/80–89 mm Hg) and with a cardiovascular disease or related condition. We compared the Swiss population and economic impact of antihypertensive treatment of the 2017 ACC/AHA guidelines with the 2013 European guidelines. Methods Analyses were based on 4438 participants (aged 45–85 years; 2448 women) of the CoLaus|PsyCoLaus study recruited between 2014-2017. Participants eligible for antihypertensive treatment according to the 2017 ACC/AHA and 2013 European guidelines were sex and age standardised using the Swiss population for 2016. In addition, we estimated the population-wide annual costs of antihypertensive treatment. Results Individuals eligible for antihypertensive treatment were 40.3% (95% confidence interval 38.5–42.1) and 31.3% (29.7–32.9) according to the 2017 ACC/AHA and 2013 European guidelines, respectively. That difference would translate into approximately 250,000 additional individuals eligible for antihypertensive treatment, corresponding to an additional annual cost of 72.5 million CHF (63.0 million EUR). Conclusion The 2017 ACC/AHA guidelines on the management of hypertension substantially increase the number of individuals eligible for antihypertensive treatment compared to the 2013 European guidelines. While implementation of the 2017 ACC/AHA guidelines is expected to lead to cost reduction by preventing cardiovascular diseases, that reduction might be mitigated by the costs incurred by antihypertensive treatments in a larger proportion of the population.

Background Effectiveness of interventions in pragmatic trials may not translate directly into population impact, because of limited uptake by clinicians and/or the public. Uptake of an intervention is influenced by a number of factors. Methods We propose a method for calculating population impact of clinical interventions that accounts for the intervention uptake. We suggest that population impact may be estimated by multiplying the two key components: (1) the effectiveness of the intervention in pragmatic trials (trial effect); and, (2) its uptake in clinical practice. We argue that participation rates in trials may be a valid proxy for uptake in clinical practice and, in combination with trial effectiveness estimates, be used to rank interventions by their likely population impact. We illustrate the method using the example of four interventions to decrease antibiotic prescription for acute respiratory infections in primary care: delayed prescribing, procalcitonin test, C-Reactive Protein, shared decision making. Results In order to estimate uptake of interventions from trial data we need detailed reporting on the recruitment processes used for clinician participation in the trials. In the antibiotic prescribing example, between 75 and 91% of the population would still be prescribed or consume antibiotics because effective interventions were not taken up. Of the four interventions considered, we found that delayed prescribing would have the highest population impact and shared decision making the lowest. Conclusion Estimates of uptake and population impact of an intervention may be possible from pragmatic RCTs, provided the recruitment processes for these trials are adequately reported (which currently few of them are). Further validation of this method using empirical data on intervention uptake in the real world would support use of this method to decide on public funding of interventions.

Background The article by Marryat, Thompson and Wilson (2017) in BMC Pediatrics presents an evaluation of the implementation of the Triple P system as a public health intervention conducted by the Glasgow City Council and NHS Greater Glasgow and Clyde. Discussion Unfortunately, the conclusions drawn are questionable for multiple reasons. The lack of a controlled design precludes defensible conclusions about intervention effects free from routine threats to internal validity. There was a substantial mismatch between the intervention sample and the population sample assessed. The article’s title and abstract leave readers with the mistaken impression that the children assessed for outcome were suitably representative of intervention families, when in fact many of the children in the intervention families were missing from the teacher-report outcome assessment (a single questionnaire), and many or most of the children in the teacher-report outcome assessment belonged to families who had never received the intervention. Although Triple P targets parent-child relations and child behavioural and emotional problems at home, Marryat et al. narrowly defined mental health impact as child difficulties in nursery or preschool, while not reporting data from practitioners and parents in the same evaluation that did not support the authors’ conclusion. The paper was further diminished by a number of misleading statements and factual errors related for example to other research on Triple P. Summary Studying the extent to which child mental health functioning at home can generalise to school settings is an important topic of inquiry in relation to parenting support interventions, but unfortunately the Marryat et al. article did not move this area forward.

The expense of new therapies for HCV infection may force health systems to prioritise the treatment of certain patient groups over others. Our objective was to forecast the population impact of possible prioritisation strategies for the resource-rich setting of Scotland.We created a dynamic Markov simulation model to reflect the HCV-infected population in Scotland. We determined trends in key outcomes (e.g., incident cases of chronic infection and severe liver morbidity (SLM)) until the year 2030, according to treatment strategies involving prioritising, either: (A) persons with moderate/advanced fibrosis or (B) persons who inject drugs (PWID).Continuing to treat the same number of patients with the same characteristics will give rise to a fall in incident infection (from 600 cases in 2015 to 440 in 2030) and a fall in SLM (from 195 cases in 2015 to 145 in 2030). Doubling treatment-uptake and prioritising PWID will reduce incident infection to negligible levels (50 cases per year) by 2025, while SLM will stabilise (at 70-75 cases per year) in 2028. Alternatively, doubling the number of patients treated, but, instead, prioritising persons with moderate/advanced fibrosis will reduce incident infection less favourably (only to 280 cases in 2030), but SLM will stabilise by 2023 (i.e., earlier than any competing strategy).Prioritising treatment uptake among PWID will substantially impact incident transmission, however, this approach foregoes the optimal impact on SLM. Conversely, targeting those with moderate/advanced fibrosis has the greatest impact on SLM but is suboptimal in terms of averting incident infection.

Trends in the populations of large herbivores in Niassa Reserve, Mozambique, have been monitored through biennial aerial surveys since 1998. The elephant Loxodonta africana population has been subjected to intensive illegal hunting since 2006. We used a simple population model to mimic the observed trends in the numbers of live and dead elephants to demonstrate the impact of poaching. The number of fresh or recent carcasses recorded was used in the model as an index of the annual mortality rate. A maximum likelihood analysis to compare population models revealed that the best fit to the survey estimates of both live elephants and old or very old carcasses was a model that started with 6,635 elephants in 1987. This number increased through births by 4.6% annually and decreased through deaths from natural and anthropogenic causes. In the best-fit model, the mean mortality rate in any year was 3.2 times the observed 1 + 2 carcass ratio (ratio for carcasses in age categories 1 and 2), and carcasses remained visible for a mean of 6 years. The model suggested that c. 900 elephants were poached during 2007–2010 and another c. 1,000 during 2011. Population estimates for live elephants and carcasses are now routine outcomes of aerial surveys conducted as part of the CITES programme for Monitoring the Illegal Killing of Elephants, and our method can be applied to any population with a time series of estimates for live and dead elephants.

How do large scale, involuntary migrations and population exchanges affect sending and receiving communities? We examine the case of the partition of India in which approximately 17 million people moved within four years, resulting in one of the largest and most rapid population exchanges in human history. We find large effects due to the migration on a district's educational, occupational, and gender composition. Due to higher education levels amongst migrants, districts with 10 per cent greater inflows saw their literacy rates increase by 3 percentage points, while a 10 per cent increase in outflows reduced literacy by 1.2 percentage points. Due to disparities in the amount of land vacated by migrants, Indian districts with 10 per cent greater inflows saw a decline of 11 per centin agricultural occupations. Districts that experienced high inflows and outflows also experienced changes in gender composition. While the partition, driven along religious lines, increased religious homogenization within communities, our results suggest that this was accompanied by increased educational and occupational differences within religious groups. We conclude that these compositional effects, in addition to an aggregate population impact, are probably features of involuntary migrations and population exchanges and, as in the case of India, Pakistan, and Bangladesh, can have important long-term consequences.

Society is concerned about the large presence of animals without owners that are observed in all cities and that can be transmitters of numerous diseases to other animals as well as humans, the so-called zoonoses. This is why the concern to promote population control of these animals has been increasingly discussed among public administrators, public bodies and organized civil society. In the city of João Pessoa-PB an estimated population of 75,000 dogs is estimated. In order to minimize the possibility of an increased growth of street animals, the Center for Environmental Monitoring and Zoonoses through Dogs and Cats Population Control Unit develops out a very important work in this sense that is the Performing of castrations surgeries in both dogs and cats. Using documentary research methodology in specific material to the said Institution and by performing statistical weightings in the data collected, well expressive results were obtained. In 2017, it was scientifically verified that there was a difference of 0.05% of significance in the observations made between male and female dogs that were submitted to castration this year. Over the 12-month analysis period, there was a monthly average of surgical procedures involving male canines of 14 animals/month and 19 animals/month for females, resulting in 166 male and 224 castrated females, totalizing 390 sterile canines in the municipality of João Pessoa - PB during the year. This number is very significant, as each female can generate an average of eight pups per gestation and get pregnant six times per year, which would have a high population impact on the total number of animals without owners in the city. It is concluded that castration presents methodologically, as a safe technique for the reduction of domestic animals, with and without tutors, contributing to the population control of the species involved and the Prevention of the spread of zoonoses.

The airport problem is concerned with sharing the cost of an airstrip among airlines who need airstrips of different lengths. We investigate the implications of various axioms specifying how a rule should respond to changes in the set of airlines for airport problems. Population fairness requires that upon the arrival of a new airline, the contributions of all airlines whose costs are not less than the cost of the new airline should be affected by equal amounts. Smallest-cost consistency requires that upon the departure of an airline with the smallest cost, if the problem is reevaluated from the viewpoint of the remaining airlines, then all the remaining airlines should contribute the same amounts as they did initially. Balanced population impact requires that the effect on the contribution from the departure of one airline to another should be the same between any two airlines. We show that each of these axioms together with other minor axioms characterizes the best-known rule for the problem, the sequential equal contributions rule.

Summary Objective Hearing loss is a complex multifactorial disorder caused by genetic and environmental factors. The 35delG mutation in the GJB2 gene is the most prevalent mutation in Caucasian patients with genetic sensorineural deafness. The A1555G mutation in the mitochondrial 12S rRNA is the main genetic alteration associated with aminoglycoside-induced deafness. The aim of this study was to evaluate the prevalence of both mutations in general population of Argentina. Methods A total of 712 samples of unrelated healthy blood donors and 330 newborn dried blood spots were studied by PCR–RFLP. Results The 35delG mutation was detected in 11/ 712 unrelated blood donors. The carrier frequency found in this sample (1/65) proved to be lower than that found in Southern European countries, mainly Spain and Italy, from where Argentina originally received its major immigration waves. When the populations of Southern Europe were considered altogether, this difference reached statistical significance. The A1555G mutation was not found in any of the 1042 samples tested. Conclusions Taking into account the 35delG carrier frequency found in this study, it could be estimated that 130–160 children with congenital deafness due to mutations in the connexin genes would be born per year in Argentina. In contrast, the mitochondrial mutation A1555G appears to be infrequent in general Argentinean population.

This review investigated the population impact of major modifiable type 2 diabetes (T2D) risk factors, with special focus on native Asian Indians, to estimate population attributable risks (PARs) and compare them with estimates from Chinese and Japanese populations.Information was obtained on risk factors in 21,041 Asian Indian, 17,774 Chinese and 17,986 Japanese populations from multiple, large, cross-sectional studies (the DECODA project) of T2D. Crude and adjusted PARs were estimated for the major T2D risk factors.Age had the highest crude and adjusted PARs among Asian Indians and Chinese in contrast to waist-hip ratio among Japanese. After adjusting for age, the PAR for body mass index (BMI) in Asian Indians (41.4% [95% CI: 37.2%; 45.4%]) was second only to triglycerides (46.4% [95% CI: 39.5%; 52.8%]) compared with 35.8% [95% CI: 29.9%; 41.4%] in Japanese and 38.4% [95% CI: 33.5%; 43.2%] in Chinese people. The PAR for BMI adjusted for age, LDL and triglycerides (39.7% [95% CI: 31.6%; 47.2%]) was higher than for any other factor in Asian Indians, and was much higher than in the Chinese (16.8% [95% CI: 3.0%; 30.9%]) and Japanese (30.4% [95% CI: 17.5%; 42.2%]) populations.This review provides estimates of the association between major risk factors and prevalences of T2D among Asian populations by examining their PARs from large population-based samples. From a public-health point of view, the importance of BMI in Asian Indians is especially highlighted in comparison to the other Asian populations. Given these results and other recent findings on the causality link between BMI and T2D, it can be postulated that obesity may be involved in the aetiology of T2D through interaction with ethnic-specific genetic factors, although ethnicity itself is not a direct risk factor for T2D as people of all ethnic backgrounds develop diabetes.

To present evidence and unmet needs in addressing the intention to change health risk behaviors (HRB) in public health intervention. Special emphasis is given to the population impact.Existing evidence was analyzed according to intention to change HRB and outcome. Evidence according to public health intervention approaches, that are focused on supporting the intention to change HRB, has revealed positive outcomes. These effects increase with time after the onset of the intervention. Interventions focused on the intention to change HRB are a promising but under-researched and under-practised contribution to improve public health.

An important consideration when assessing the public health impact of e-cigarettes is how far they contribute to, or detract from, smoking cessation in the population. There has been speculation about this (1), but without engaging appropriately with the relevant data and based on unreliable assumptions. England has data that can help to address this question, at least so far. Addiction's readers may be interested in the following analysis. It focuses on 2014, the most recent year for which full data are available. It leads to an estimate of 16K-22K as the number of additional long-term quitters generated by e-cigarettes in that year.

Introduction : Although antiretroviral therapy (ART) reduces individual tuberculosis (TB) risk by two-thirds, the population-level impact remains uncertain. Cape Town reports high TB notification rates associated with endemic HIV. We examined population trends in TB notification rates during a 10-year period of expanding ART. Methods : Annual Cape Town TB notifications were used as numerators and mid-year Cape Town populations as denominators. HIV-stratified population was calculated using overall HIV prevalence estimates from the Actuarial Society of South Africa AIDS and Demographic model. ART provision numbers from Western Cape government reports were used to calculate overall ART coverage. We calculated rates per 100,000 population over time, overall and stratified by HIV status. Rates per 100,000 total population were also calculated by ART use at treatment initiation. Absolute numbers of notifications were compared by age and sub-district. Changes over time were described related to ART provision in the city as a whole (ART coverage) and by sub-district (numbers on ART). Results : From 2003 to 2013, Cape Town’s population grew from 3.1 to 3.7 million inhabitants, and estimated HIV prevalence increased from 3.6 to 5.2%. ART coverage increased from 0 to 63% in 2013. TB notification rates declined by 16% (95% confidence interval (CI), 14–17%) from a 2008 peak (851/100,000) to a 2013 nadir (713/100,000). Decreases were higher among the HIV-positive (21% (95% CI, 19–23%)) than the HIV-negative (9% (95% CI, 7–11%)) population. The number of HIV-positive TB notifications decreased mainly among 0- to 4- and 20- to 34-year-olds. Total population rates on ART at TB treatment initiation increased over time but levelled off in 2013. Overall median CD4 counts increased from 146 cells/µl (interquartile range (IQR), 66, 264) to 178 cells/µl (IQR 75, 330; p

OBJECTIVE: To examine the association between meeting behavioural goals and diabetes incidence over 10years in a large, representative Swedish population. METHODS: Population-based prospective cohort study of 32,120 individuals aged 35 to 55years participating in a health promotion intervention in Västerbotten County, Sweden (1990 to 2013). Participants underwent an oral glucose tolerance test, clinical measures, and completed diet and activity questionnaires. Poisson regression quantified the association between achieving six behavioural goals at baseline - body mass index (BMI)

Background Recent changes in recommendations for mammography screening for women in their forties could have an impact on organized screening programs, as these require clear definition of target and eligible populations. Current status Internationally, a majority of programs target women fifty and over, and so the recent USPSTF age recommendations for screening are quite consistent with this practice. However, there is a good deal of variability in the availability of population-based screening programs to women in their forties should they choose to participate. Future impact Several programs are reviewing recommendations regarding the eligibility of women in their forties; as guidelines indicate women in this age group should be eligible for screening, even if not targeted, there is discussion as to whether they should be allowed in programs so that they benefit from the same programmatic quality assurance afforded to the target population of women over 50. Clear communication of the evidentiary basis for the eligibility criteria and target populations is required, so that the public is aware that programs are designed to deliver maximal population impact, while minimizing population risk.

Aims/hypothesis This study aimed to evaluate the association of types of sugar-sweetened beverages (SSB) (soft drinks, sweetened-milk beverages, sweetened tea/coffee), artificially sweetened beverages (ASB) and fruit juice with incident type 2 diabetes and determine the effects of substituting non-SSB for SSB and the population-attributable fraction of type 2 diabetes due to total sweet beverages. Methods Beverage consumption of 25,639 UK-resident adults without diabetes at baseline (1993–1997) in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study was assessed using 7-day food diaries. During 10.8 years of follow-up 847 incident type 2 diabetes cases were verified. Results In adjusted Cox regression analyses there were positive associations (HR [95% CI] per serving/day]) for soft drinks 1.21 (1.05, 1.39), sweetened-milk beverages 1.22 (1.05, 1.43) and ASB 1.22 (1.11, 1.33), but not for sweetened tea/coffee 0.98 (0.94, 1.02) or fruit juice 1.01 (0.88, 1.15). Further adjustment for adiposity attenuated the association of ASB, HR 1.06 (0.93, 1.20). There was a positive dose–response relationship with total sweet beverages: HR per 5% energy 1.18 (1.11, 1.26). Substituting ASB for any SSB did not reduce the incidence in analyses accounting for energy intake and adiposity. Substituting one serving/day of water or unsweetened tea/coffee for soft drinks and for sweetened-milk beverages reduced the incidence by 14%–25%. If sweet beverage consumers reduced intake to below 2% energy, 15% of incident diabetes might be prevented. Conclusions/interpretation The consumption of soft drinks, sweetened-milk beverages and energy from total sweet beverages was associated with higher type 2 diabetes risk independently of adiposity. Water or unsweetened tea/coffee appear to be suitable alternatives to SSB for diabetes prevention. These findings support the implementation of population-based interventions to reduce SSB consumption and increase the consumption of suitable alternatives. Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3572-1) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Introduction: Several investigations have evaluated the cost effectiveness of a low density lipoprotein (LDL) cholesterol “threshold” treatment strategy compared with a “risk-based” strategy based on a person’s 10-year risk of coronary heart disease (CHD). No studies to date have focused on adults 75 years and older. Methods: Based on the Cardiovascular Disease Policy Model, a Markov model of the U.S. population, we forecasted the population impact of statin therapy over 10 years in adults aged 75-94 years. We compared two strategies for statin therapy in adults 75-94 years free of prevalent CHD and stroke: 1) treatment in anyone with LDL cholesterol >100 mg/dL in diabetics, and >130 mg/dL in non-diabetics, and 2) high intensity statins for persons with a 10-year CHD risk of >20% and low intensity statin for persons with a risk of 10-20%, independent of LDL cholesterol level. We assumed the use of low-cost statins ($4 per month), 100% adherence, 3% discounting/year, and costs from a healthcare perspective. Results: The threshold strategy would treat an additional 50 million elders and prevent 99,000 incident myocardial infarctions and 55,000 CHD deaths at a cost of $ 1.4 billion, whereas the risk-based strategy would treat 103 million and prevent 143,000 incident myocardial infarctions and 97,000 CHD deaths at a cost of $ 7.8 billion. The threshold strategy is more cost-effective than the risk-based strategy ($4,300 vs. $18,000 per quality-adjusted life year gained). Conclusions: A risk-based strategy prevents more events compared with a threshold strategy due to the large proportion of older adults who have high 10-year CHD risk scores, but is less efficient than a threshold strategy in adults 75 years and older.

Influenza causes a significant burden of disease each year in England and Wales, with the young and the elderly suffering the greatest burden. Children are recognised as playing an important role in the dissemination of the influenza virus. This study examines the population impact of implementing a programme of paediatric vaccination. A dynamic transmission model was used to simulate the impact of vaccination programmes with varying levels of coverage across pre-school and school age children. These analyses suggest that vaccinating as few as 50% of 2–18 year olds could result in a substantial reduction in the annual incidence of influenza related morbidity and mortality across the population. Herd immunity may extend this protection to the young and the elderly. It is assumed that such programmes would be implemented in concert with the current strategy of vaccinating the elderly and younger at risk groups with an inactivated vaccine. In England and Wales, paediatric vaccination of two to eighteen year olds reduced the estimated number of general practice consultations, hospitalisations and deaths arising from influenza A and B infections by up to 95%. This translates into an annual average reduction of approximately 52,000, 1500 and 1200 events, respectively. A policy of paediatric vaccination could significantly reduce the clinical burden of influenza in England and Wales, in all age groups, with the added value of herd immunity helping to protect the young and the elderly who are at highest risk of complications. Highlights: ► Children play an important role in the dissemination of the influenza virus. ► Vaccinating 50% of 2–18 year olds could significantly reduce the influenza burden. ► Preventing 52,000 GP consultations, 1500 hospitalisations and 1200 deaths annually. ► Herd immunity can help to protect those at highest risk of complications.

Background The optimal vaccination strategy to mitigate the impact of influenza epidemics is unclear. In 2005, a countywide school-based influenza vaccination campaign was launched in Knox County, Tennessee (population 385,899). Approximately 41% and 48% of eligible county children aged 5–17 years were immunized with live attenuated influenza vaccine before the 2005–2006 and 2006–2007 influenza seasons, respectively. We sought to determine the population impact of this campaign. Methods Laboratory-confirmed influenza data defined influenza seasons. We calculated the incidence of medically attended acute respiratory illness attributable to influenza in Knox and Knox-surrounding counties (concurrent controls) during consecutive seasons (5 precampaign and 2 campaign seasons) using negative binomial regression and rate difference methods. Age-stratified analyses compared the incidence of emergency department (ED) visits and hospitalizations attributable to influenza. Results During precampaign seasons, estimated ED visit rates attributable to influenza were 12.39 (95% CI: 10.34–14.44) per 1000 Knox children aged 5–17 years and similar in Knox-surrounding counties. During the campaign seasons, annual Knox influenza-associated ED visit rates declined relative to rates in Knox-surrounding counties: rate ratios 0.55 (95% CI: 0.27–0.83) and 0.70 (95% CI: 0.56–0.84) for the first and second campaign seasons, respectively. Overall, there were about 35% or 4.86 per 1000 fewer influenza-associated ED visits among Knox County children aged 5–17 years attributable to the campaign. No significant declines in Knox compared to surrounding counties were detected for influenza associated ED visits in children aged

International audience; National Cattle Registers have been widely used to examine animal movements and their role in disease transmission, but less frequently for other epidemiological applications. Our study shows how routinely collected identification data can be used to evaluate the population impact of an epidemic in cattle and to derive an indirect estimate of the associated mortality. We adapted a method developed by Human health agencies, based on the modelling of historical mortality fluctuations, to analyze the evolution of mortality in a cattle population subjected to a Bluetongue serotype 8 (BT8) outbreak. Between 01/07/2007 and 01/07/2008, 21,017 cattle died in the considered population whereas 16,691 deaths were expected according to the model. 43% of the 4326 extra deaths were found in calves less than 7 days of age, but excess mortality was found in each age group. The temporal distribution of extra-deaths, described at a weekly scale, suggests that they were related to the BT8 epidemic. The presented method could be an appreciable tool for estimating the global burden of epidemics since it is based on data already routinely collected in each European Member State. This study was conducted retrospectively but considering the promptness of the notification system, the method could be used to monitor the evolution of epidemics in near-real time.

T HE OCULAR HYPERTENSION TREATMENT Study (OHTS) was designed to determine the effect of lowering intraocular pressure (IOP) on the conversion from ocular hypertension to identifiable glaucomatous damage in a high-risk population, namely, patients with ocular hypertension (OHTN). Ocular hypertension was defined as an IOP greater than 22 mm Hg. Before the OHTS, some investigators had found that patients with elevated IOPs but no other stigmata of glaucoma developed glaucoma at an annual rate of approximately 2%. However, the value of lowering IOP for patients with OHTN remained unknown. After an average of 5 years of follow-up, the OHTS found that IOP lowering of approximately 20% decreased the prevalence of glaucoma from 9.5% in the observation group to 4% in the treatment group. These findings clarified the natural history of OHTN and validated the protective effect of lowering IOP.

Large scale migrations, especially involuntary ones, can have a substantial impact on the demographics of both sending and receiving communities. We estimate the impact of the 1947 Indian subcontinent partition, one of the largest and most rapid population exchanges in human history. Comparing neighboring districts better isolates the effect of the migratory flows from secular changes. We find large effects on a districts' educational, occupational, and gender composition within four years. Due to higher education levels amongst migrants, districts with greater inflows saw their literacy rates increase by 16% more while outflows reduced literacy rates by as much as 20%. With less land vacated by those who left Indian Punjab, Indian districts with large inflows saw a decline of 70% in the growth of agricultural occupations. Affected districts also experienced large changes in gender composition with a relatively large drop in percentage men in Indian districts that experienced large outflows, and in Pakistani districts with large inflows. While the partition, driven along religious lines, increased religious homogenization within communities, our results suggest that this was accompanied by increased educational and occupational differences within religious groups. We hypothesize that these compositional effects, in addition to an aggregate population impact, are likely features of involuntary migrations and, as in the case of India, Pakistan, and Bangladesh, can have important long-term consequences.

The Willow Grove Naval Air Station Joint Reserve Base in Montgomery County, Pennsylvania, is scheduled to close by 2010. The Base closing is anticipated to have broad effects on the economy, population, and labor market of Montgomery County. This report contains a forecast of the potential impacts of the base closing on the economy, population, and workforce of Montgomery County and on assessing a variety of industrial development opportunities afforded Montgomery County by use of the surplus land that becomes available after the property is transferred from the U.S. Department of Defense to its new owners.