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Dobrava-Belgrade virus (DOBV) is the most pathogenic hantavirus in Europe with a case-fatality rate of up to 12%. To detect changes in risk for humans, the prevalence of antibodies to DOBV has been monitored in a population of Apodemus flavicollis in the province of Trento (northern Italy) since 2000, and a sudden increase was observed in 2010. In the 13-year period of this study, 2077 animals were live-trapped and mean hantavirus seroprevalence was 2·7% (s.e. = 0·3%), ranging from 0% (in 2000, 2002 and 2003) to 12·5% (in 2012). Climatic (temperature and precipitation) and host (rodent population density, rodent weight and sex, and larval tick burden) variables were analysed using Generalized Linear Models and multi-model inference to select the best model. Climatic changes (mean annual precipitation and maximum temperature) and individual body mass had a positive effect on hantavirus seroprevalence. Other possible drivers affecting the observed pattern need to be studied further.
Although headache is one of the most common complaints that patients bring to their clinicians, few physicians feel confident about its clinical evaluation and management. Is it a problem in its own right, or the presenting symptom of a serious medical condition? Loder, Rizzoli and Burch bring a practical case-based approach to this complex ailment, highlighting specific areas of diagnostic uncertainty in headache evaluation and treatment. Each case is taken from real-world clinical practice and reviews the diagnostic and treatment process in a systematic manner, identifying common challenges and pitfalls and describing newly issued treatment guidelines. Written in a question and answer format, this concise and useful guide in the Common Pitfalls series provides a step-by-step guide for everyday clinical practice, invaluable to anyone dealing with headache on a front-line basis.