江苏省部分城市男男性行为者HIV/STD感染情况研究

目的 了解男男性行为者（MSM）群体的艾滋病病毒/性病（HIV/STD）感染水平.方法 在MSM聚集的酒吧,在知情同意下,匿名填写问卷,自愿选择检查项目,在现场开展体检和实验室标本采集,标本按要求冷藏转送至实验室.结果 共检测了144人,平均年龄32.68岁,未婚者占59.03%,各种文化层次和职业者均有.他们中只有同性性行为者占38.64%,其他人均与异性有性行为.首次性行为的平均年龄为20.82岁.近3个月内被调查者有与异性的性行为及各种方式的性行为,且每次使用安全套者仅13.77%.其中11.11%的人报告曾被诊断有性病.现场体检发现尖锐湿疣患病率13.21%（14/106）.尿道分泌物检查淋球菌阳性率2.68%（3/112）,沙眼衣原体8.04%（9/112）,解脲脲原体25.00%（28/112）,生殖支原体4.46%（5/112）.血清学检查HIV抗体全部阴性,梅毒螺旋体明胶凝集试验（TPPA）阳性率18.75%（27/144）,快速血浆反应素试验（RPR）阳性率9.72%（14/144）,疱疹病毒抗体（HSV-2-IgG）阳性率7.78%（7/90）,乙型肝炎病毒表面抗原（HBsAg）阳性率9.68%（9/93）,丙型肝炎病毒抗体（抗-HCV）阳性率0（0/93）,戊型肝炎病毒抗体（抗-HEV）阳性率16.13%（15/93）.结论 MSM人群的性生活状态复杂并且缺乏安全性意识,成为HIV/STD传播的桥梁人群.他们中STD的感染水平较一般人群高,个别感染甚至接近性病门诊的感染水平,应该引起关注.     

Impaired cardiac work and oxygen uptake after reperfusion of regionally ischaemic myocardium.

Transient regional left ventricular ischaemia was produced in the isolated working perfused rat heart by ligation of the left main coronary artery and subsequent release of ligature after 15 min of acute regional myocardial ischaemia. Reperfusion restored coronary flow and the oxygen uptake to preligation values but cardiac output and peak left ventricular pressures remained impaired and tissue contents of ATP did not recover. Reperfusion also failed to restore the efficiency of the heart to pre-ligation values.     

From the Cover: Exploitative leaders incite intergroup warfare in a social mammal

Collective conflicts among humans are widespread, although often highly destructive. A classic explanation for the prevalence of such warfare in some human societies is leadership by self-serving individuals that reap the benefits of conflict while other members of society pay the costs. Here, we show that leadership of this kind can also explain the evolution of collective violence in certain animal societies. We first extend the classic hawk−dove model of the evolution of animal aggression to consider cases in which a subset of individuals within each group may initiate fights in which all group members become involved. We show that leadership of this kind, when combined with inequalities in the payoffs of fighting, can lead to the evolution of severe intergroup aggression, with negative consequences for population mean fitness. We test our model using long-term data from wild banded mongooses, a species characterized by frequent intergroup conflicts that have very different fitness consequences for male and female group members. The data show that aggressive encounters between groups are initiated by females, who gain fitness benefits from mating with extragroup males in the midst of battle, whereas the costs of fighting are borne chiefly by males. In line with the model predictions, the result is unusually severe levels of intergroup violence. Our findings suggest that the decoupling of leaders from the costs that they incite amplifies the destructive nature of intergroup conflict.

Humans are capable of astonishing feats of altruism and cooperation (1–3), but, at the same time, of violent and destructive conflicts (4–8). A key factor contributing to the latter may be that wars are often waged at the behest of leaders who do not share fully in the immediate risks of conflict, and stand to gain benefits in terms of resources and status that are not enjoyed by the majority of combatants (4, 9–11). Could such “warmongering” be a feature of animal conflicts too? Only recently have models of animal aggression begun to explore the impact of inequalities among combatants in collective conflict (12, 13), and the usual assumption of existing theory is that individuals who initiate intergroup conflicts also contribute most to group conflict effort and thereby confer fitness benefits on the rest of their group (a positive or “heroic” model of leadership) (14–17). Here, we explore the more sinister possibility that those who initiate conflict may actually harm their fellows in pursuit of their own interests by exposing them to the risks of conflict while contributing little to fighting themselves (a negative or “exploitative” model of leadership).     

Brief report: Risk factors for pneumococcal vaccine refusal in adults

Background: Invasive pneumococcal disease is a significant cause of morbidity and mortality in the United States. Despite availability of an effective vaccine, many patients refuse vaccination.
Objective: To investigate patient characteristics and features of the patient–provider relationship associated with pneumococcal vaccine refusal.
Design: Case–control study using chart review.
Patients: Five hundred adults from the medical clinics of a 1,000-bed inner-city teaching hospital.
Measurements and Main Results: Independent risk factors for pneumococcal vaccine refusal included patient–provider gender discordance (odds ratio (OR)=2.09, 95% confidence interval (CI) 1.07 to 4.09); a visit to a not-usual provider at the time of vaccine offering (OR=2.26, 95% CI 1.13 to 4.49); never having received influenza vaccination (OR=7.44, 95% CI 3.76 to 14.76); prior pneumococcal vaccine refusals (OR=3.45, 95% CI 1.60 to 7.43); and a history of ever having refused health maintenance tests (OR=2.86, 95% CI 1.40 to 5.84).
Conclusions: We have identified both patient factors and factors related to the patient–provider relationship that are risk factors for pneumococcal vaccine refusal. By identifying patients at risk for pneumococcal vaccine refusal, efforts to increase vaccination rates can be better targeted.     

Exposure density and neighborhood disparities in COVID-19 infection risk

Although there is increasing awareness of disparities in COVID-19 infection risk among vulnerable communities, the effect of behavioral interventions at the scale of individual neighborhoods has not been fully studied. We develop a method to quantify neighborhood activity behaviors at high spatial and temporal resolutions and test whether, and to what extent, behavioral responses to social-distancing policies vary with socioeconomic and demographic characteristics. We define exposure density (Exρ) as a measure of both the localized volume of activity in a defined area and the proportion of activity occurring in distinct land-use types. Using detailed neighborhood data for New York City, we quantify neighborhood exposure density using anonymized smartphone geolocation data over a 3-mo period covering more than 12 million unique devices and rasterize granular land-use information to contextualize observed activity. Next, we analyze disparities in community social distancing by estimating variations in neighborhood activity by land-use type before and after a mandated stay-at-home order. Finally, we evaluate the effects of localized demographic, socioeconomic, and built-environment density characteristics on infection rates and deaths in order to identify disparities in health outcomes related to exposure risk. Our findings demonstrate distinct behavioral patterns across neighborhoods after the stay-at-home order and that these variations in exposure density had a direct and measurable impact on the risk of infection. Notably, we find that an additional 10% reduction in exposure density city-wide could have saved between 1,849 and 4,068 lives during the study period, predominantly in lower-income and minority communities.

As of December 17, 2020, there have been 73 million cases of COVID-19 in more than 200 countries, and 1.6 million people have lost their lives to the disease (1). The COVID-19 pandemic is considered the most severe public health crisis since the 1918 flu pandemic due to its transmission and infection characteristics (2–5). Social distancing (also referred to as physical distancing) has been shown to be an effective behavioral nonpharmaceutical intervention to reduce the transmission rate of COVID-19 (3–7). Social distancing reduces the probability of contacts between individuals who might be infected, resulting in reduced exposure risk (7, 8). Governments have implemented a range of social-distancing policies, including travel bans, restrictions on gatherings, school closures, nonessential business closures, and restaurant restrictions. In particularly hard-hit locations, mandatory “stay-at-home” orders have been issued to limit or avoid unnecessary close contacts outside of the home (7–9).Studies have found that social-distancing measures help to prevent transmission of the virus and reduce the reproduction (R₀) number (5–7, 10–14). These practices help to avoid overwhelming hospital intensive care units and healthcare systems, control doubling time of infections, and ultimately save lives (5, 8, 14, 15). Although not without potentially significant hardship to individuals and communities, social distancing is an important public health tool to flatten the epidemic curve and support longer-term economic and public health benefits (3, 15–17).However, the impact of, and response to, stay-at-home orders and social-distancing guidelines is not uniform across neighborhoods and communities (18, 19). In order to maximize the positive effects of social distancing, individuals need to change their typical behavior, often dramatically (3, 20). Despite government-mandated social-distancing policies (such as New York State’s PAUSE order), socio-behavioral responses vary across neighborhoods, further contributing to disparities in risk of infection (4, 7, 21). Disparities in social-distancing practices—namely, geographic or population subgroup differences in adopting behavior changes in response to the same policy context—may stem from varying levels of awareness, perception, or belief in the severity of the virus threat; differences in social and cultural norms; or the ability of households and communities to alter normal activity patterns given economic constraints or other existing responsibilities (7, 20–23). For example, lower-income households typically do not have the option to work from home, and going to a place of work (often in essential services) is unavoidable, meaning higher risk of exposure to COVID-19 for themselves, as well as their families and communities (7, 24). Within specific neighborhoods, norms can also be reinforcing; if large numbers of residents are essential workers and not socially distancing, other residents may have similar behavioral responses (20).A growing number of outbreaks are occurring in densely populated areas (25), with disproportionate impacts on lower-income and predominantly minority communities (18, 26–28). Measuring and understanding social distancing and behavior change across neighborhoods can provide critical insight into the design and implementation of more effective—and equitable—public health policy. Given the potential heterogeneity in localized responses to social-distancing recommendations, quantifying local patterns of activity represents an emerging tool to understand and eventually reduce local exposure risk and limit community outbreaks (7, 29, 30). Although there has been increasing awareness of the troubling disparities in infection rates and outcomes in vulnerable communities, the effectiveness of behavioral interventions at the scale of individual neighborhoods has not been fully studied. Often, studies that do attempt to observe effects at higher spatial resolutions rely on simulations or are limited to relatively coarse areal units (e.g., county or state) due to data availability and computational constraints (31–34). Absent a more complete understanding of neighborhood activity patterns in response to nonpharmaceutical interventions, disaggregating built-environment, behavioral, and social determinants of health in the context of COVID-19 remains a challenge.We develop a method to quantify neighborhood activity at high spatial and temporal resolutions to test whether—and to what extent—behavioral responses to social-distancing policies vary with socioeconomic, demographic, and built-environment characteristics. We define exposure density (Exρ) as a measure of both the localized volume of activity in a defined area and the proportion of activity occurring in nonresidential and outdoor land uses, areas that can be associated with an increased risk of exposure to others that may be infected. We utilize this approach to capture community inflows/outflows of people as a result of the pandemic and changes in mobility behavior for those that remain.Our focus is on New York City (NYC), the first epicenter of the pandemic in the United States, where a statewide stay-at-home order (NY on PAUSE) was introduced on March 22, 2020. By June 30, 2020, NYC had more than 212,000 confirmed cases of COVID-19, accounting for 8% of the nationwide total, resulting in at least 18,492 confirmed deaths and 4,604 probable deaths (35). Our methodology proceeds in three steps. First, we develop a generalizable method for assessing neighborhood activity levels using smartphone geolocation data over a 3-mo period (February, March, and April) covering more than 12 million unique devices within the Greater New York area, together with land-use classifications at 1-m grid resolution. Second, we measure and analyze disparities in community social distancing by estimating variations in neighborhood activity and associated patterns in community characteristics before and after the stay-at-home order. Finally, we evaluate the effect of exposure density on COVID-19 infection rates associated with localized demographic, socioeconomic, and built-environment characteristics in order to identify disparities in health outcomes related to mobility behavior. Our findings provide insight into the timely evaluation of the effectiveness of social distancing at the scale of individual neighborhoods and support a more equitable allocation of resources to vulnerable and at-risk communities.     

Hepatitis B and C among women with illegal social behavior in Isfahan, Iran: Seroprevalence and associated factors

Background

In Iran, there is limited evidence on the prevalence of hepatitis B and C viruses (HBV and HCV) among females who engage in illegal sexual behavior.

Objectives

To determine the prevalence of HBV and HCV infections and their associated factors in this population in Isfahan-Iran.

Patients and Methods

In this cross-sectional study, 100 females who engaged in illegal sexual behavior during 2009-2010 in Isfahan were recruited from welfare to the DIC for women, and referrals were made among those who knew others who engaged in prostitution. Markers for HBV and HCV-Ab were measured by ELISA, and recombinant immunoblot assay was used for confirmation of HCV infection. Also, a questionnaire on demographics and prostitution-associated risk data in a face-to-face interview was completed for each participant. Chi-square and multivariate logistic regression models were used for data analysis.

Results

Of the 100 samples collected, 91 were sufficient for testing. The mean age and time spent in sex work were 30.84 ± 9.34 years and 36 ± 28.5 months, respectively. HBsAg was detected in 1 (1.1%), anti-HBc in 4 (4.4%), anti-HBs in 60 (65.9%), and HCV Ab in 9 (9.9%) subjects. The evidence of vaccination was seen in 54 subjects (59.3%). There were no significant differences in the prevalence of HBV or HCV infection by estimated risk factors, and there was no independent risk factor for these infections.

Conclusions

The high prevalence of HCV infection in this study indicates the need to implement preventive interventions for female sex workers and, perhaps more importantly, to involve their male clients.     

Association of Help-seeking Behavior with Depression and Anxiety Disorders among Gastroenterological Patients in Saudi Arabia

Background/Aims:

There is a high prevalence of depression and anxiety disorders among gastroenterological outpatients. Relatively few studies have been done on the help-seeking behavior among those who suffer from gastrointestinal symptoms with or without psychiatric disorders. We aimed to characterize the help-seeking behavior of gastroenterological outpatients and to evaluate if this behavior is linked to the presence of depression and anxiety.

Patients and Methods:

A cross-sectional study was carried out in gastroenterology clinics in four hospitals in Riyadh between February and September 2013. A self-administrated questionnaire was developed and administered to patients. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to diagnose depression and anxiety, respectively.

Results:

A total of 440 patients completed the study questionnaire. The average age was 36.0 ± 12.8 years and 69% of the patients were males. Complaints included abdominal pain (58%), heartburn (29%), diarrhea or constipation (25%), appetite or weight changes (22%), and nausea or vomiting (16%). Depression was diagnosed in 36%, while anxiety was diagnosed in 28% of the patients. The first intervention was use of medications (68%) and undergoing endoscopy (16%), while few patients initially used herbs or Islamic incantation (7.5%). This first intervention was done primarily (59%) in private sector hospitals rather than government sector hospitals (36%). The rates of depression and anxiety in our patients were higher among those who suffered from multiple complaints for longer durations and with less satisfaction with the offered services.

Conclusion:

Depression and anxiety are common comorbidities in gastroenterological outpatient population, especially those who have a chronic course of multiple gastrointestinal complaints.     

Dendrites are dispensable for basic motoneuron function but essential for fine tuning of behavior

Dendrites are highly complex 3D structures that define neuronal morphology and connectivity and are the predominant sites for synaptic input. Defects in dendritic structure are highly consistent correlates of brain diseases. However, the precise consequences of dendritic structure defects for neuronal function and behavioral performance remain unknown. Here we probe dendritic function by using genetic tools to selectively abolish dendrites in identified Drosophila wing motoneurons without affecting other neuronal properties. We find that these motoneuron dendrites are unexpectedly dispensable for synaptic targeting, qualitatively normal neuronal activity patterns during behavior, and basic behavioral performance. However, significant performance deficits in sophisticated motor behaviors, such as flight altitude control and switching between discrete courtship song elements, scale with the degree of dendritic defect. To our knowledge, our observations provide the first direct evidence that complex dendrite architecture is critically required for fine-tuning and adaptability within robust, evolutionarily constrained behavioral programs that are vital for mating success and survival. We speculate that the observed scaling of performance deficits with the degree of structural defect is consistent with gradual increases in intellectual disability during continuously advancing structural deficiencies in progressive neurological disorders.Dendrites are structural ramifications of a neuron specialized for receiving and processing synaptic input (1). The estimated 100 billion neurons in the human brain (2) form approximately 100 trillion synapses onto a total of approximately 100,000 miles of dendritic cable. The functions of dendrites are proposed to range from simply providing enough surface for synaptic input (3) to highly compartmentalized units of molecular signaling and information processing (4–6). In addition to functioning as passive receivers, dendrites may be equipped with output synapses (7) and active membrane currents (8), which add tremendous computational power to a single neuron (6, 9, 10).Accordingly, dendritic abnormalities are highly consistent anatomical correlates of numerous brain disorders (11, 12), including autism spectrum disorders, Alzheimer’s disease, schizophrenia, Down syndrome, Fragile X syndrome, Rett syndrome, anxiety, and depression. However, in many cases it remains unclear whether dendritic defects are the cause or the consequence of impaired brain function. Trying to understand dendrite function poses major technical challenges because it requires selective manipulation of dendritic structure without disturbing other properties of the affected neuron, followed by quantitative analysis of neuronal function and the resulting behavioral consequences.This study uses the Drosophila genetic model system to selectively abolish dendrites from a subset of identified wing muscle motoneurons that have well-described and stereotyped dendritic morphologies (13) and firing patterns during flight (14) and courtship song (15, 16). Surprisingly, we find that motoneurons that lack 90% of their dendrites are still contacted by appropriate synaptic partners and produce qualitatively normal firing patterns and wing movements during flight and courtship song. However, normal dendritic architecture is essential for particularly challenging tasks, such as the integration of optomotor input for adequate control of flight power output, or the temporal accuracy of switching between different song elements during courtship to ensure mating success. Our data demonstrate that the vast majority of basic motor functions can be satisfactorily accomplished with motoneurons that have significant dendritic defects but normal axonal structure and membrane currents. However, a complex 3D dendritic architecture is mandatory for intricate regulation of behavioral output, which in turn imposes a positive selection pressure on the maintenance of such complex dendritic trees through evolution.     

Consistency of Recall of Sexual and Drug-Using Behaviors for Homeless Persons with Dual Diagnosis

In this paper we present data from a study of the consistency of recall of several sexual and drug-using behaviors gathered from face-to-face interviews with homeless persons who have dual diagnosis (severe mental illness plus a substance use disorder). Factors associated with inconsistent reporting are also examined. One hundred and thirty-three individuals participating in a longitudinal study of HIV risk behaviors were recruited for a retrospective recall study. Participants were completing monthly interviews that included assessments of sexual behaviors and drug use. Participants completed an additional interview using the same instruments and were randomly assigned to a 3- or 6-month recall condition; the data from the additional interview were correlated with the regular, monthly interviews. Results indicated that reports of sexual and substance-using behaviors were generally reported consistently for both 3- and 6-month recall periods; however, coefficients for the 3-month interval were generally better than those for the 6-month interval. One exception was that protected intercourse was generally not reported consistently. Inconsistent reporting of sexual and drug-using behaviors was associated with the severity of substance abuse; inconsistent reporting of sexual behaviors was also associated with African-American race. Our data suggest that a 3-month recall interval is generally superior to a 6-month interval for persons with severe mental illness.     

Modular patterning of structure and function of the striatum by retinoid receptor signaling

Retinoid signaling plays a crucial role in patterning rhombomeres in the hindbrain and motor neurons in the spinal cord during development. A fundamentally interesting question is whether retinoids can pattern functional organization in the forebrain that generates a high order of cognitive behavior. The striatum contains a compartmental structure of striosome (or "patch") and intervening matrix. How this highly complex mosaic design is patterned by the genetic programs during development remains elusive. We report a developmental mechanism by which retinoid receptor signaling controls compartmental formation in the striatum. We analyzed RARbeta(-/-) mutant mice and found a selective loss of striosomal compartmentalization in the rostral mutant striatum. The loss of RARbeta signaling in the mutant mice resulted in reduction of cyclin E2, a cell cycle protein regulating transition from G(1) to S phase, and also reduction of the proneural gene Mash1, which led to defective neurogenesis of late-born striosomal cells. Importantly, during striatal neurogenesis, endogenous levels of retinoic acid were spatiotemporally regulated such that transduction of high levels of retinoic acid through RARbeta selectively expanded the population of late-born striosomal progenitors, which evolved into a highly elaborate compartment in the rostral striatum. RARbeta(-/-) mutant mice, which lacked such enlarged compartment, displayed complex alternations of dopamine agonist-induced stereotypic motor behavior, including exaggeration of head bobbing movement and reduction of rearing activity. RARbeta signaling thus plays a crucial role in setting up striatal compartments that may engage in neural circuits of psychomotor control.