Summary Imported dengue cases are thought to be important source for transmission of autochthonous dengue in Europe. We aimed to investigate the prevalence of dengue in Europe, its severity, and factors associated with it. Out of 5287 reports resulting from the search of nine electronic search engines, we included 174 reports. Meta‐analysis was performed by pooling the event rate and 95% confidence interval (CI). Subgroup meta‐analyses were performed to test the effect of the covariates. Among 20 284 reported cases, 130 autochthonous dengue cases were reported in eight countries with the highest number of cases reported in Israel (n = 41). The highest number of imported dengue cases was in Germany (n = 6638) then France (n = 6610). Most cases were imported from Southeast Asia (n = 2533) especially Thailand. Dengue infection cases increased with time, with 4157 cases reported in 2010. Second dengue infection and dengue serotype 2 were positively associated with dengue severity. The proportion of autochthonous dengue infection increased with time to reach 14.8% (95% CI, 7.6‐26.9) in 2015. The pooled proportion of severe dengue was 6.18% (95% CI, 2.7‐13.3). The United Kingdom and France had the highest rate of severe dengue (25%; 95% CI, 6.3‐62.3, and 21.4%; 95% CI, 24.5‐18.7, respectively). This change may be due to the surveillance efforts instead of true biological phenomenon; thus, the lack of surveillance is an obvious limitation. In conclusion, imported and autochthonous dengue has been increasing in Europe. Severe dengue began to increase recently in Europe. European health authorities should pay more attention for the diagnosis and control of dengue infection among returning travelers, especially the travelers with fever of unknown origin.

Background Awareness of individual risk may encourage improved prevention and early detection of melanoma. Methods We evaluated the accuracy of self-reported pigmentation and nevus phenotype compared to clinical assessment, and examined agreement between nevus counts from selected anatomical regions. The sample included 456 cases with invasive cutaneous melanoma diagnosed between ages 18-39 years and 538 controls from the population-based Australian Melanoma Family Study. Participants completed a questionnaire regarding their pigmentation and nevus phenotype, and attended a dermatologic skin examination. Results There was strong agreement between self-reported and clinical assessment of eye color (kappa, κ, =0.78, 95% confidence interval (CI) 0.74-0.81); and moderate agreement for hair color (κ =0.46, 95% CI 0.42-0.50). Agreement between self-reported skin color and spectrophotometer-derived measurements was poor (κ =0.12, 95% CI 0.08-0.16) to moderate (Spearman correlation rs=-0.37, 95% CI -0.32- to -0.42). Participants tended to under-estimate their nevus counts and pigmentation; men were more likely to under-report their skin color. The rs was 0.43 (95% CI 0.38-0.49) comparing clinical total body nevus counts with self-reported nevus categories. There was good agreement of quartile distributions of total body nevus counts with site-specific nevus counts, particularly on both arms. Conclusions Young adults have sub-optimal accuracy when assessing important risk characteristics including nevus numbers and pigmentation. Measuring nevus count on the arms is a good predictor of full body nevus count. Impact These results have implications for the likely success of targeted public health programs that rely on self-assessment of these factors.

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Objective: Few studies describe changes in students' class preparation, note-taking, and examination preparation over the course of professional school. This study aims to describe the use of these learning and study strategies by pharmacy students and to analyze changes during enrollment. Methods: We performed a prospective, observational cohort study of students at a single US pharmacy school between 2016-2019. Students completed an online survey on learning and study strategies at the beginning of each school year. Quantitative results were analyzed by level in pharmacy school during which the survey was completed as the primary predictor. Open-ended responses were thematically analyzed using an inductive approach. Results: We observed significant changes in strategies, including an increased use of audiovisual materials for course preparation, preference for electronic over manual notetaking, increasing use of lecture capture viewing, and increased use of peer materials in studying. Changes were generally largest between the first (P1) and second (P2) survey years, representing adjustments in student behaviors during P1 year. In some cases, changes from P1 to P2 survey years were followed by a gradual return towards P1 survey levels. Three themes described students' comments: Students' preferences shaped their learning strategies, experiences guided changes in learning strategies, and description of additional strategies beyond those included in the survey items. Conclusions: Significant changes in pharmacy student study strategies occur over the course of enrollment. This may represent an opportunity to promote use of more effective approaches for long-term learning.

Background: Emerging infectious diseases (EIDs) are among the widespread everchanging threats to public health. Web-based queries using information gathered from social media can enhance global syndromic surveillance to trace EIDs activity. This systematic review aimed to investigate the correlation of web-based queries to outbreak of EIDs. Methods: Nine electronic databases were systematically searched and updated in August 2018 including; PubMed, Virtual Health Library (VHL), WHO Global Health Library (GHL), Scopus, ISI, Google Scholar, POPLINE, and Systems for Information of Grey Literature in Europe (SIGLE), New York Academy of Medicine (NYAM Grey Literature Report). A prior protocol was registered at Prospero (CRD42016038104). In a total five included articles, 47 datasets were included for reviewing. The correlation was assessed through Spearman and Pearson tests using either google trends or number of tweets. Results: Meta-analysis of influenza-like illness data revealed that correlation was significant (0.784 (0.743-0.820, 0.964 (0.918-0.985) for both Spearman and Pearson tests respectively. Conclusions: Web-based surveillance systems could serve as a good method in predicting events of EIDs.