Triangulating Truth and Reaching Consensus on Population Size, Prevalence, and More: Modeling Study.

BACKGROUND: Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE: This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS: In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS: The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS: The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges.

HIV prevalence in transgender populations and cisgender men who have sex with men in sub-Saharan Africa 2010-2022: a meta-analysis.

Introduction: The Global AIDS Strategy 2021-2026 calls for equitable and equal access to HIV prevention and treatment programmes for all populations to reduce HIV incidence and end HIV/AIDS as a public health threat by 2030. Transgender populations (TGP), including transmen (TGM) and transwomen (TGW) are populations that have been marginalised and are at high risk of HIV infection in sub-Saharan Africa (SSA). Limited surveillance data on HIV among TGP are available in the region to guide programmatic responses and policymaking. Surveillance data on cisgender men who have sex with men (cis-MSM) are comparatively abundant and may be used to infer TGP HIV prevalence. Methods: Data from key population surveys conducted in SSA between 2010-2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both TGP and cis-MSM populations were analysed in a random effect meta-analysis to estimate the ratio of cis-MSM:TGW HIV prevalence. Results: Eighteen studies were identified encompassing 8,052 TGW and 19,492 cis-MSM. TGW HIV prevalence ranged from 0-71.6% and cis-MSM HIV prevalence from 0.14-55.7%. HIV prevalence in TGW was 50% higher than in cis-MSM (prevalence ratio (PR) 1.50 95% CI 1.26-1.79). TGW HIV prevalence was highly correlated with year/province-matched cis-MSM HIV prevalence (R2 = 0.62), but poorly correlated with year/province-matched total population HIV prevalence (R2 = 0.1). Five TGM HIV prevalence estimates were identified ranging from 1-24%. Insufficient TGM data were available to estimate cis-MSM:TGM HIV prevalence ratios. Conclusion: Transgender women experience a significantly greater HIV burden than cis-MSM in SSA. Bio-behavioural surveys designed and powered to measure determinants of HIV infection, treatment coverage, and risk behaviours among transgender populations, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities among TGP and support improved programmes.

Key Population Size Estimation to Guide HIV Epidemic Responses in Nigeria: Bayesian Analysis of 3-Source Capture-Recapture Data.

BACKGROUND: Nigeria has the fourth largest burden of HIV globally. Key populations, including female sex workers, men who have sex with men, and people who inject drugs, are more vulnerable to HIV than the general population due to stigmatized and criminalized behaviors. Reliable key population size estimates are needed to guide HIV epidemic response efforts. OBJECTIVE: The objective of our study was to use empirical methods for sampling and analysis to improve the quality of population size estimates of female sex workers, men who have sex with men, and people who inject drugs in 7 states (Akwa Ibom, Benue, Cross River, Lagos, Nasarawa, Rivers, and the Federal Capital Territory) of Nigeria for program planning and to demonstrate improved statistical estimation methods. METHODS: From October to December 2018, we used 3-source capture-recapture to produce population size estimates in 7 states in Nigeria. Hotspots were mapped before 3-source capture-recapture started. We sampled female sex workers, men who have sex with men, and people who inject drugs during 3 independent captures about one week apart. During hotspot encounters, key population members were offered inexpensive, memorable objects unique to each capture round. In subsequent rounds, key population members were offered an object and asked to identify objects received during previous rounds (if any). Correct responses were tallied and recorded on tablets. Data were aggregated by key population and state for analysis. Median population size estimates were derived using Bayesian nonparametric latent-class models with 80% highest density intervals. RESULTS: Overall, we sampled approximately 310,000 persons at 9015 hotspots during 3 independent captures. Population size estimates for female sex workers ranged from 14,500 to 64,300; population size estimates for men who have sex with men ranged from 3200 to 41,400; and population size estimates for people who inject drugs ranged from 3400 to 30,400. CONCLUSIONS: This was the first implementation of these 3-source capture-recapture methods in Nigeria. Our population size estimates were larger than previously documented for each key population in all states. The Bayesian models account for factors, such as social visibility, that influence heterogeneous capture probabilities, resulting in more reliable population size estimates. The larger population size estimates suggest a need for programmatic scale-up to reach these populations, which are at highest risk for HIV.

A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study.

BACKGROUND: Disease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards. OBJECTIVE: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources. METHODS: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems-a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds. RESULTS: Data from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. CONCLUSIONS: We described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance.

Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface.

BACKGROUND: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis. OBJECTIVE: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE. METHODS: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine. RESULTS: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided. CONCLUSIONS: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa.

Key Population Hotspots in Nigeria for Targeted HIV Program Planning: Mapping, Validation, and Reconciliation.

BACKGROUND: With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. OBJECTIVE: We aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort. METHODS: In August 2018, 261 trained data collectors from 36 key population-led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President's Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population-defining behaviors. Hotspots were visited by data collectors, and each hotspot's name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots. RESULTS: A total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals. CONCLUSIONS: The number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population-led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.

Identification of Presymptomatic and Asymptomatic Cases Using Cohort-Based Testing Approaches at a Large Correctional Facility-Chicago, Illinois, USA, May 2020.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained persons exposed to laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to identify presymptomatic and asymptomatic cases. METHODS: During 1-19 May 2020, 2 testing strategies were implemented in 12 tiers or housing units of the Cook County Jail, Chicago, Illinois. Detained persons were approached to participate in serial testing (n = 137) and offered tests at 3 time points over 14 days (day 1, days 3-5, and days 13-14). The second group was offered a single test and interview at the end of a 14-day quarantine period (day 14 group) (n = 87). RESULTS: 224 detained persons were approached for participation and, of these, 194 (87%) participated in ≥1 interview and 172 (77%) had ≥1 test. Of the 172 tested, 19 were positive for SARS-CoV-2. In the serial testing group, 17 (89%) new cases were detected, 16 (84%) on day 1, 1 (5%) on days 3-5, and none on days 13-14; in the day 14 group, 2 (11%) cases were identified. More than half (12/19; 63%) of the newly identified cases were presymptomatic or asymptomatic. CONCLUSIONS: Our findings highlight the utility of cohort-based testing promptly after initiating quarantine within a housing tier. Cohort-based testing efforts identified new SARS-CoV-2 asymptomatic and presymptomatic infections that may have been missed by symptom screening alone.

Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study.

[This corrects the article DOI: 10.2196/12118.].

Living with Ménière's disease: an interpretative phenomenological analysis.

Purpose: To explore the meanings of Ménière's disease from the perspective of people living with this condition and to understand what was considered significant and important in participants' everyday lives.Materials and methods: Four women with Ménière's disease participated in face-to-face semi-structured interviews. Accounts were recorded, transcribed, and analysed using an iterative process integral to Interpretative Phenomenological Analysis.Results: Three interconnected themes were identified. "You have no control whatsoever" conveys participants' perceptions of vertigo as having a disruptive and ongoing impact on physical and psychosocial function in everyday life. "Ménière's takes away your life completely" describes Ménière's as impinging on participants' most meaningful activities and relationships, and as restricting their ability to live their lives on their own terms. "You get on with life" recounts participants' efforts to refashion their lives whilst living with this condition and manage its most harmful effects. The psychosocial impact of living with Ménière's disease and its relevance to rehabilitation is discussed.Conclusions: Ménière's disease has an enduring physical and psychosocial impact. Clinicians who acknowledge and respond to an individual's subjective experience of their condition may be key to their engagement in therapy. Service users should have a voice in health service design and delivery.Implications for rehabilitationMénière's disease is a long-term disabling condition that not only impacts on physical and psychosocial functioning but also restricts quality of life through stigmatisation.Fear of triggering an attack of vertigo may prevent people with Ménière's disease from engaging with rehabilitation.Therapists who adopt a biopsychosocial approach and who recognise patients' efforts to control their symptoms as a positive form of resistance may be better equipped to empathetically support patients to engage in new activities that may be vital to improving their lives.

Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study.

BACKGROUND: Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. OBJECTIVE: The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. METHODS: Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). RESULTS: We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). CONCLUSIONS: Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.

How Do General Practitioners (GPs) Engage in Falls Prevention With Older People? A Pilot Survey of GPs in NHS England Suggests a Gap in Routine Practice to Address Falls Prevention.

Falls are highly prevalent amongst older people and have substantial financial and social costs for health services and the community. Prevention of falls is the key to managing this threat to older people. General practitioners can identify older people at risk of falls on their caseloads. Once identified, actions can be taken to reduce the risk of falls by referring to appropriate services available in the community, such as allied health practitioners. However, the level of engagement in evidence based falls prevention by GPs is unknown. This study aimed to explore how British general practitioners (GPs) address falls prevention with older people, and to determine if there are any gaps in practice. As a pilot study, another aim was to test the feasibility of methods to survey GPs, if a larger survey was warranted from the findings. An on-line cross-sectional survey was distributed by email to all the Clinical Commissioning Groups in NHS England (n = 213) and individual general practices listed on the NHS Choices website, supplemented by invitations distributed to CCGs through Twitter and LinkedIn sites. Thirty-seven responses were received. Most GPs were unfamiliar with the 2013 NICE guidelines on assessment and prevention of falls in older people (51.4%, n = 19), and only 29.7% (n = 11) asked older people if they had fallen during consultations. If falls risk was identified, 81.1% (n = 30) frequently made referrals to physiotherapy (PT) and 56.8% (n = 21) to occupational therapy (OT). Most GPs did not identify older people on their caseloads as being at risk of falls unless they presented with a fall, and referral rates to relevant AHPs or falls prevention programs were low. Barriers to implementation of falls prevention best practice were identified. Alternative methods are needed to capture the falls prevention practice of a wider sample of GPs.

Health and social care practitioners' understanding of the problems of people with dementia-related visual processing impairment.

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia-related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners' opinions of the needs of people with dementia-related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one-to-one semi-structured interviews. All participants were shown video clips of people with dementia-related visual impairment to facilitate discussion. Sixty-one participants took part in focus groups or interviews between November 2014 and December 2015. Participants' experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants' understanding of dementia-related visual impairments. Theme 2 recounts how participants address and support people with dementia-related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients' difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well-recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence-based assessment and intervention.

Outcomes of infants born to women with influenza A(H1N1)pdm09.

BACKGROUND: Pregnant women with influenza are more likely to have complications, but information on infant outcomes is limited. METHODS: Five state/local health departments collected data on outcomes of infants born to pregnant women with 2009 H1N1 influenza reported to the Centers for Disease Control and Prevention from April to December 2009. Collaborating sites linked information on pregnant women with confirmed 2009 H1N1 influenza, many who were severely ill, to their infants' birth certificates. Collaborators also collected birth certificate data from two comparison groups that were matched with H1N1-affected pregnancies on month of conception, sex, and county of residence. RESULTS: 490 pregnant women with influenza, 1,451 women without reported influenza with pregnancies in the same year, and 1,446 pregnant women without reported influenza with prior year pregnancies were included. Women with 2009 H1N1 influenza admitted to an intensive care unit (ICU; n = 64) were more likely to deliver preterm infants (<37 weeks), low birth weight infants, and infants with Apgar scores <=6 at 5 min than women in comparison groups (adjusted relative risk, aRR = 3.9 [2.7, 5.6], aRR = 4.6 [2.9, 7.5], and aRR = 8.7 [3.6, 21.2], for same year comparisons, respectively). Women with influenza who were not hospitalized and hospitalized women not admitted to the ICU did not have significantly elevated risks for adverse infant outcomes. CONCLUSIONS: Severely ill women with 2009 H1N1 influenza during pregnancy were more likely to have adverse birth outcomes than women without influenza, providing more support for influenza vaccination during pregnancy.

Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda.

BACKGROUND: We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS: Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS: The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS: HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.

'Because my brain isn't as active as it should be, my eyes don't always see': a qualitative exploration of the stress process for those living with posterior cortical atrophy.

OBJECTIVES: To explore the stress process for individuals living with posterior cortical atrophy (PCA) and their families. DESIGN: A qualitative study using in-depth semi-structured dyadic and individual interviews with people living with a diagnosis of PCA and a family carer. Interview transcripts were thematically analysed. SETTING: Participants' homes. PARTICIPANTS: 20 individuals in the mild to moderate stages of PCA and 20 family carers. FINDINGS: Three major themes were identified: (1) the diagnostic journey: mostly an unsettling and convoluted process, owing to the early age of onset, rarity and atypical symptom profile of PCA. (2) Interactions with the physical environment: profound difficulties with functional and leisure activities were usually compensated for with adaptations maximising familiarity or simplicity. (3) Implications within the psychosocial environment: symptoms impacted individuals' sense of independence and identity and required reallocations of roles and responsibilities. Ongoing uncertainties and the progressive nature of PCA caused most dyads to take a 'one day at a time' approach to coping. Relatively well-preserved insight and memory were a benefit and burden, as individuals shared the illness experience with family members and also compared their current situation to pre-diagnosis. The experience was framed by background and contextual factors and understood within an ever-changing temporal context. CONCLUSION: The stress process in PCA is characterised by uncertainty and unpredictability from diagnosis through to ongoing management. The provision of tailored information about cortical visual problems and associated functional difficulties, time-sensitive environmental adaptations to help those with PCA to identify what and where things are and psychosocial interventions for the marital/family unit as a whole would be useful to improve both functional status and psychological well-being. Future research exploring (1) stress and coping in the later stages of PCA and (2) the nature and impact of visual impairment(s) in typical Alzheimer's disease would be worthwhile.

The use of evidence-based guidance to enable reliable and accurate measurements of the home environment.

INTRODUCTION: High quality guidance in home strategies is needed to enable older people to measure their home environment and become involved in the provision of assistive devices and to promote consistency among professionals. This study aims to investigate the reliability of such guidance and its ability to promote accuracy of results when measurements are taken by both older people and professionals. METHOD: Twenty-five health professionals and 26 older people participated in a within-group design to test the accuracy of measurements taken (that is, person's popliteal height, baths, toilets, beds, stairs and chairs). Data were analysed with descriptive analysis and the Wilcoxon test. The intra-rater reliability was assessed by correlating measurements taken at two different times with guidance use. RESULTS: The intra-rater reliability analysis revealed statistical significance (P < 0.05) for all measurements except for the bath internal width. The guidance enabled participants to take 90% of measurements that they were not able to complete otherwise, 80.55% of which lay within the acceptable suggested margin of variation. Accuracy was supported by the significant reduction in the standard deviation of the actual measurements and accuracy scores. CONCLUSION: This evidence-based guidance can be used in its current format by older people and professionals to facilitate appropriate measurements. Yet, some users might need help from carers or specialists depending on their impairments.

How are service users instructed to measure home furniture for provision of minor assistive devices?

PURPOSE: Measurements play a vital role in providing devices that meet the individual needs of users. There is increasing evidence of devices being abandoned. The reasons for this are complex but one key factor that plays a role in non-use of equipment is the lack of fit between the device, environment and person. In addition, the abandonment of devices can be seen as a waste of public money. The aim of this paper is to examine the type, the readability, and the content of existing guidance in relation to measuring home furniture. METHOD: An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated. RESULTS: From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9-11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths. CONCLUSION: There is a need to standardize guidance to ensure that measurements are reliable. Implications for Rehabilitation Our research has highlighted the need to confirm and agree measurement techniques for home furniture in the provision of assistive devices. Inaccurate guidance can lead to abandonment of devices. Inaccurate guidance could prevent service users from not participating within the self-assessment process for devices.

Place of influenza vaccination among children--United States, 2010-11 through 2013-14 influenza seasons.

BACKGROUND: Studies are published on settings adults receive influenza vaccination but few have reported on settings children are vaccinated and how this might be changing over time or vary by socio-demographics. METHODS: Data from the National Immunization Survey-Flu were analyzed to assess place of influenza vaccination among vaccinated children 6 months-17 years during the 2010-11, 2011-12, 2012-13, and 2013-14 influenza seasons. The percentage of children vaccinated at each place was calculated overall and by age, race/ethnicity, income, and Metropolitan Statistical Area (MSA). RESULTS: The places children received influenza vaccination varied little over four recent influenza seasons. From the 2010-11 through 2013-14 influenza seasons the percentage of vaccinated children receiving influenza vaccination at a doctor's office was 64.1%, 65.1%, 65.3%, and 65.3%, respectively with no differences from one season to the next. Likewise, for vaccination at clinics or health centers (17.8%, 17.5%, 17.0%. 18.0%), health departments (3.2%, 3.6%, 3.0%, 2.8%), and other non-medical places (1.6%, 1.4%, 1.2%, 1.1%), there were no differences from one season to the next. There were some differences for vaccinations at hospitals, pharmacies, and schools. There was considerable variability in the place of influenza vaccination by age, race/ethnicity, income, and MSA. Fewer Hispanic children were vaccinated at a doctor's office than black, white, and other or multiple race children and fewer black children and children of other or multiple races were vaccinated at a doctor's office than white children. More children at or below the poverty level were vaccinated at a clinic or health center than all of the other income groups. CONCLUSION: Most vaccinated children receive their influenza vaccination at a doctor's office. Place of vaccination changed little over four recent influenza seasons. Large variability in place of vaccination exists by age, race/ethnicity, income, and MSA. Monitoring place of vaccination can help shape future immunization programs.

Factors influencing occupational therapy home visit practice: a qualitative study.

BACKGROUND: Home visits prior to discharge from hospital are an integral part of both occupational therapy practice and the discharge process. However, there is remarkably little understanding as to why they occur in practice and who is thought to best benefit from a home visit. The aims of this research were to explore occupational therapists' perceptions of home visits and to ascertain their clinical reasoning in respect of conducting home visits. Thematic analysis was used to analyse the data. RESULTS: The research revealed two different types of home visits: one with the patient and one without the patient. Both types aimed to enhance the discharge process. The key deciding factors for the chosen type of home visit were time issues and available resources. The therapist's justification for a home visit was also associated with the patient's living arrangements, impairments, and level of functioning. Occupational therapists rarely consulted patients about their preferred type of visit. CONCLUSION: This study is the first to identify therapists' reasoning between two types of home visits that occur in practice. Future trials are imperative to ascertain which visit is more effective in terms of both patient outcomes and cost effectiveness.

CDC Pregnancy Flu Line: monitoring severe illness among pregnant women with influenza.

The Centers for Disease Control and Prevention implemented the Pregnancy Flu Line (PFL) during the influenza A(H1N1)pdm09 (pH1N1) pandemic and continued operation through the 2010-2011 influenza season to collect reports of intensive care unit (ICU) admissions and deaths among pregnant women with influenza. The system documented the severe impact of influenza on pregnant women during both seasons with 181 ICU/survivals and 37 deaths reported during the 2009 fall pandemic wave and 69 ICU/survivals and ten deaths reported in the subsequent influenza season (2010-2011). A health department survey suggests PFL participants perceived public health benefits and minimum time burdens.