Cluster-Randomized Controlled Trial of an HIV/Sexually Transmitted Infection Risk-Reduction Intervention for South African Men

Objectives. We tested the efficacy of a sexual risk-reduction intervention for men in South Africa, where heterosexual exposure is the main mode of HIV transmission.Methods. Matched-pairs of neighborhoods in Eastern Cape Province, South Africa, were randomly selected and within pairs randomized to 1 of 2 interventions based on social cognitive theory and qualitative research: HIV/sexually transmitted infection (STI) risk-reduction, targeting condom use, or attention-matched control, targeting health issues unrelated to sexual risks. Sexually active men aged 18 to 45 years were eligible. The primary outcome was consistent condom use in the past 3 months.Results. Of 1181 participants, 1106 (93.6%) completed the 12-month follow-up. HIV and STI risk-reduction participants had higher odds of reporting consistent condom use (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.03, 1.71) and condom use at last vaginal intercourse (OR = 1.40; 95% CI = 1.08, 1.82) than did attention-control participants, adjusting for baseline prevalence. No differences were observed on unprotected intercourse or multiple partnerships. Findings did not differ for sex with steady as opposed to casual partners.Conclusions. Behavioral interventions specifically targeting men can contribute to efforts to reduce sexual risk behaviors in South Africa.South Africa has more HIV cases than any other country, and like other sub-Saharan countries, has a predominantly heterosexual epidemic.1 In such an epidemic, men have an especially critical role to play: they are the ones who don male condoms, a particularly effective and available means of prevention, and thus control their use. They have, it has been argued, more power than women in relationships2–4 and are responsible for infecting women in many contexts, including forced intercourse and violence.3 Although calls for male responsibility in sexual behavior related to HIV and other sexually transmitted infections (STIs) have been made repeatedly,5–7 to our knowledge, only 1 study has evaluated an intervention created specifically for heterosexual men in South Africa.8 Men who received the gender-based-violence-and-HIV-risk-reduction intervention were more likely to report talking with a partner about condoms and using condoms consistently 1-month postintervention compared with men in an alcohol-and-HIV-risk-reduction control intervention.The present study evaluated an HIV/sexually transmitted infection (STI) risk-reduction intervention for South African men who have intercourse with women. We used a cluster-randomized design to reduce the potential for contamination between treatment arms that would be present if we were to randomize individuals. We randomized randomly selected neighborhoods (i.e., clusters) to a 3-session intervention based on social cognitive theory9 and extensive formative research10 and designed to reduce HIV/STI risk behavior or to a 3-session attention-control intervention designed to promote health by improving diet and physical activity. We hypothesized that the HIV/STI risk-reduction intervention would increase self-reported consistent condom use during vaginal intercourse in the postintervention period, the primary outcome, compared with the attention-control intervention, controlling for baseline condom use.     

Anodal motor cortex stimulation paired with movement repetition increases anterograde interference but not savings

Retention of motor adaptation is evident in savings, where initial learning improves subsequent learning, and anterograde interference, where initial learning impairs subsequent learning. Previously, we proposed that use‐dependent movement biases induced by movement repetition contribute to anterograde interference, but not to savings. Here, we evaluate this proposal by limiting or extending movement repetition while stimulating the motor cortex (M1) with anodal transcranial direct current stimulation (tDCS), a brain stimulation technique known to increase use‐dependent plasticity when applied during movement repetition. Participants first adapted to a counterclockwise rotation of visual feedback imposed either abruptly (extended repetition) or gradually (limited repetition) in a first block (A1), during which either sham or anodal tDCS (2 mA) was applied over M1. Anterograde interference was then assessed in a second block (B) with a clockwise rotation, and savings in a third block (A2) with a counterclockwise rotation. Anodal M1 tDCS elicited more anterograde interference than sham stimulation with extended but not with limited movement repetition. Conversely, anodal M1 tDCS did not affect savings with either limited or extended repetition of the adapted movement. Crucially, the effect of anodal M1 tDCS on anterograde interference did not require large errors evoked by an abrupt perturbation schedule, as anodal M1 tDCS combined with extended movement repetition within a gradual perturbation schedule similarly increased anterograde interference but not savings. These findings demonstrate that use‐dependent plasticity contributes to anterograde interference but not to savings.     

Hippocampal brain‐derived neurotrophic factor mediates recovery from chronic stress‐induced spatial reference memory deficits

Chronic restraint stress impairs hippocampal‐mediated spatial learning and memory, which improves following a post‐stress recovery period. Here, we investigated whether brain‐derived neurotrophic factor (BDNF), a protein important for hippocampal function, would alter the recovery from chronic stress‐induced spatial memory deficits. Adult male Sprague‐Dawley rats were infused into the dorsal hippocampal cornu ammonis (CA)3 region with an adeno‐associated viral vector containing the sequence for a short hairpin RNA (shRNA) directed against BDNF or a scrambled sequence (Scr). Rats were then chronically restrained (wire mesh, 6 h/day for 21 days) and assessed for spatial learning and memory using a radial arm water maze (RAWM) either immediately after stressor cessation (Str‐Imm) or following a 21‐day post‐stress recovery period (Str‐Rec). All groups learned the RAWM task similarly, but differed on the memory retention trials. Rats in the Str‐Imm group, regardless of adeno‐associated viral contents, committed more errors in the spatial reference memory domain on the single retention trial during day 3 than did the non‐stressed controls. Importantly, the typical improvement in spatial memory following the recovery from chronic stress was blocked with the shRNA against BDNF, as Str‐Rec‐shRNA performed worse on the RAWM compared with the non‐stressed controls or Str‐Rec‐Scr. The stress effects were specific for the reference memory domain, but knockdown of hippocampal BDNF in unstressed controls briefly disrupted spatial working memory as measured by repeated entry errors on day 2 of training. These results demonstrated that hippocampal BDNF was necessary for the recovery from stress‐induced hippocampal‐dependent spatial memory deficits in the reference memory domain.     

Eating disorders and associated mental health comorbidities in female veterans

Eating disorders (EDs) remain understudied among veterans, possibly due to the perception that primarily male population does not suffer from EDs. However, previous research suggests that male and female veterans do experience EDs. The high rates of posttraumatic stress disorder (PTSD), depression, and obesity observed among veterans may make this group vulnerable to disordered eating. Retrospective chart review was used to obtain data from 492 female veterans who were presented to a women?s primary care center at a large, urban VA medical center between 2007 and 2009. A total of 2.8% of this sample had been diagnosed with an ED. In bivariate analyses, presence of PTSD and depression were significantly associated with having an ED diagnosis. However, when these two disorders were included in a multivariate model controlling for age, only depression diagnosis and lower age were significantly related to ED status. In sum, the rate of EDs in this sample is comparable to prevalence estimates of EDs in the general population. Current findings underscore the importance of assessing for EDs among VA patients and the need for further research among veterans.     

Paternal age of schizophrenia probands and endophenotypic differences from unaffected siblings

We evaluated the discrepancy of endophenotypic performance between probands with schizophrenia and unaffected siblings by paternal age at proband birth, a possible marker for de novo mutations. Pairs of schizophrenia probands and unaffected siblings (N=220 pairs) were evaluated on 11 neuropsychological or neurophysiological endophenotypes previously identified as heritable. For each endophenotype, the sibling-minus-proband differences were transformed to standardized scores. Then for each pair, the average discrepancy was calculated from its standardized scores. We tested the hypothesis that the discrepancy is associated with paternal age, controlling for the number of endophenotypes shared between proband and his or her sibling, and proband age, which were both associated with paternal age. The non-significant association between the discrepancy and paternal age was in the opposite direction from the hypothesis. Of the 11 endophenotypes only sensori-motor dexterity was significant, but in the opposite direction. Eight other endophenotypes were also in the opposite direction, but not significant. The results did not support the hypothesized association of increased differences between sibling/proband pairs with greater paternal age. A possible explanation is that the identification of heritable endophenotypes was based on samples for which schizophrenia was attributable to inherited rather than de novo/non-inherited causes.     

Making sense of the spectrum of glomerular disease associated with complement dysregulation

Over recent years, complement has emerged as a major player in the development of a number of glomerular diseases, including atypical haemolytic uraemic syndrome, membranoproliferative glomerulonephritis and the recently described C3 glomerulonephritis. Some patients and pedigrees show overlapping features of these conditions. Intriguingly, a few complement gene mutations are common to different disease phenotypes. In this review, we explore the evidence for complement dysregulation in these diseases and the clinical interface between them, and present a hypothesis to explain the variable phenotype associated with dysregulation of the alternative complement pathway.     

A Comparative Study of Three-Year Weight Loss and Outcomes After Laparoscopic Gastric Bypass in Patients with “Yellow Light” Psychological Clearance

The relationship between psychological factors and bariatric surgical outcomes is unclear. While some psychological contraindications to bariatric surgery are described, there is no consensus on preoperative psychological evaluation or on factors that can predict bariatric outcomes. Our aim was to determine whether full or reserved psychological clearance predicts early weight loss or compliance with follow-up. We found no clinically significant differences in short-term weight loss outcomes or in attendance at scheduled follow-up visits between patients receiving full or “green light” clearance versus “yellow light” clearance, meaning clearance with recommendations for ongoing therapy. Further research may identify psychological predictors of success following bariatric surgery and help optimize preoperative evaluation practices.     

The in vivo expressed Mycobacterium tuberculosis (IVE-TB) antigen Rv2034 induces CD4 T-cells that protect against pulmonary infection in HLA-DR transgenic mice and guinea pigs

Tuberculosis (TB) remains a life-threatening infectious disease of global proportions with serious negative health and economic consequences. The lack of sufficient protection induced by Mycobacterium bovis BCG, the current vaccine for TB, as well as the impact of HIV co-infection and the emergence of drug resistant Mycobacterium tuberculosis (Mtb) strains all urge for improved vaccines against TB.