Trends in High-Risk Sexual Behaviors among General Population Groups in China: A Systematic Review

Background

The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors.

Methods

We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors.

Results

We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups.

Discussion

Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population.     

Adult Vaccination Strategies for the Control of Pertussis in the United States: An Economic Evaluation Including the Dynamic Population Effects

Background

Prior economic evaluations of adult and adolescent vaccination strategies against pertussis have reached disparate conclusions. Using static approaches only, previous studies failed to analytically include the indirect benefits derived from herd immunity as well as the impact of vaccination on the evolution of disease incidence over time.

Methods

We assessed the impact of different pertussis vaccination strategies using a dynamic compartmental model able to consider pertussis transmission. We then combined the results with economic data to estimate the relative cost-effectiveness of pertussis immunization strategies for adolescents and adults in the US. The analysis compares combinations of programs targeting adolescents, parents of newborns (i.e. cocoon strategy), or adults of various ages.

Results

In the absence of adolescent or adult vaccination, pertussis incidence among adults is predicted to more than double in 20 years. Implementing an adult program in addition to childhood and adolescent vaccination either based on 1) a cocoon strategy and a single booster dose or 2) a decennial routine vaccination would maintain a low level of pertussis incidence in the long run for all age groups (respectively 30 and 20 cases per 100,000 person years). These strategies would also result in significant reductions of pertussis costs (between −77% and −80% including additional vaccination costs). The cocoon strategy complemented by a single booster dose is the most cost-effective one, whereas the decennial adult vaccination is slightly more effective in the long run.

Conclusions

By providing a high level of disease control, the implementation of an adult vaccination program against pertussis appears to be highly cost-effective and often cost-saving.     

Recycling Rates of Aluminum in the United States

Recycling rates of aluminum are defined in different (sometimes inconsistent) ways and poorly quantified. To address this situation, the definitions and calculation methods of four groups of indicators are specified for the United States: (1) indicators used to measure recycling efficiencies of old aluminum scrap at the end‐of‐life (EOL) stage, including EOL collection rate (CR), EOL processing rate, EOL recycling rate, and EOL domestic recycling rate; (2) indicators used to compare generation or use of new with old scrap, including new to old scrap ratio, new scrap ratio (NSR), and old scrap ratio; (3) indicators used to compare production or use of primary aluminum with secondary aluminum, including four recycling input rates (RIRs); and (4) indicators used to track the sinks of aluminum metal in the U.S. anthroposphere. I find that the central estimate of EOL CR varies between 38% and 65% in the United States from 1980 to 2009 and shares a relatively similar historical trend with the primary aluminum price. The RIR is shown to be significantly reduced if excluding secondary aluminum produced from new scrap resulting from the relatively high NSR. In 2003, a time when approximately 73% of all of the aluminum produced globally since 1950 was considered to still be “in service,” approximately 68% to 69% of all metallic aluminum that had entered the U.S. anthroposphere since 1900 was still in use: 67% in domestic in‐use stock and 1% to 2% exported as scrap. Only 6% to 7% was definitely lost to the environment, although the destination of 25% of the aluminum was unknown. It was either exported as EOL products, was currently hibernating, or was lost during collection.     

Overview of Fish Consumption Rates in the United States

Contaminants that accumulate in fish may pose health risks and have raised concerns among consumers. Contaminated finfish and shellfish are possible routes of human exposure to toxic chemicals. Fish advisories are established to protect local populations from the consumption of contaminated commercial and non-commercially caught fish. Children, women of childbearing age, and subsistence fishermen or other highly exposed individuals who for socioeconomic or cultural reasons consume more fish than the general population are among the populations of concern from the ingestion of contaminated fish. Estimating exposure to a toxic chemical among fish-consuming populations requires knowledge about intake rates of fish and shellfish. Data on fish consumption rates come from various sources, including national, state, and local government studies. Although these data have their limitations, they serve as a source for deriving fish consumption rates that may be used by exposure assessors. Data on specific populations of concern are critical. Studies presented here show that ethnicity, age, and geographical region play an important role in fishing behavior and consumption. Results from studies on Native American populations show that this ethnic group eats fish at a higher rate than recreational anglers. This article summarizes data on fish consumption for various populations and provides a framework for evaluating data from these studies for exposure assessment applications.     

Rates of Fetal Polydrug Exposures in Methadone-Maintained Pregnancies from a High-Risk Population

Methadone maintenance treatment (MMT) is the standard of care during pregnancy for opioid-dependency, showing efficacy in improving prenatal care and reducing risk of relapse. By design, however, MMT is only intended to prevent withdrawal thus facilitating cognitive behavioural interventions. In order to maximize the benefits of MMT, it is essential that methadone is both properly prescribed and that additional addiction treatment is concurrently administered. This study aims to determine the effectiveness of MMT engagement in high-risk pregnant women in reducing polydrug use by objective laboratory examination of neonatal meconium.

Patients and Methods

Over a 29-month period, the Motherisk Laboratory at the Hospital for Sick Children in Toronto analyzed meconium samples as per request by social services and hospitals for drugs of abuse.

Results

Of the 904 meconium samples received, 273 were tested for methadone with 164 positive and 109 negative for methadone. Almost half of the methadone positive samples (46.34%) were also positive for at least one other opioid compound, which did not differ statistically from the methadone-negative control samples (46.79%; Chi square test, p=0.94). No differences were found between the methadone positive and negative groups in rates of concurrent amphetamines, cocaine, cannabis, and alcohol use indicating a similar risk of polydrug use between pregnant women taking or not taking methadone in this population.

Discussion

The high rates of additional opioid and other drug use in the MMT group, suggest that MMT is failing this population of patients. It is possible that methadone doses during pregnancy are not appropriately adjusted for changes in pharmacokinetic parameters (e.g. blood volume, renal function) during the second and third trimesters. This may result in sub-therapeutic dosing creating withdrawal symptoms leading to additional substance use. Alternatively, these results may be demonstrating a substantial lack in delivery of addiction support services in this vulnerable population.     

Educational Degrees and Adult Mortality Risk in the United States

We present the first published estimates of U. S. adult mortality risk by detailed educational degree, including advanced postsecondary degrees. We use the 1997–2002 National Health Interview Survey (NHIS) Linked Mortality Files and Cox proportional hazards models to reveal wide graded differences in mortality by educational degree. Compared to adults who have a professional degree, those with an MA are 5 percent, those with a BA are 26 percent, those with an AA are 44 percent, those with some college are 65 percent, high school graduates are 80 percent, and those with a GED or 12 or fewer years of schooling are at least 95 percent more likely to die during the follow-up period, net of sociodemographic controls. These differentials vary by gender and cohort. Advanced educational degrees are associated not only with increased workforce skill level but with a reduced risk of death.     

Weight Cycling and the Risk of Developing Type 2 Diabetes among Adult Women in the United States

Objective: To assess the role of weight cycling independent of BMI and weight change in predicting the risk of developing type 2 diabetes. Research Methods and Procedures: A six‐year follow‐up of 46, 634 young and middle‐aged women in the Nurses’ Health Study II was conducted. Women who had intentionally lost ≥20 lbs at least three times between 1989 and 1993 were classified as severe weight cyclers. Women who had intentionally lost ≥10 lbs at least three times were classified as mild weight cyclers. The outcome was physician‐diagnosed type 2 diabetes. Results: Between 1989 and 1993, ～20% of the women were mild weight cyclers, and 1.6% were severe weight cyclers. BMI in 1993 was positively associated with weight‐cycling status (p < 0.001). During 6 years of follow‐up (1993 to 1999), 418 incident cases of type 2 diabetes were documented. BMI in 1993 had a strong association with the risk of developing diabetes. Compared with women with a BMI between 17 and 22 kg/m², those with a BMI between 25 and 29.9 kg/m² were approximately seven times more likely to develop diabetes, and those with a BMI ≥35 kg/m² were 63 times more likely to be diagnosed with type 2 diabetes. After adjustment for BMI, neither mild (relative risk = 1.11, 95% confidence interval, 0.89 to 1.37) nor severe (relative risk = 1.39, 95% confidence interval, 0.90 to 2.13) weight cycling predicted risk of diabetes. Discussion: Weight cycling was strongly associated with BMI, but it was not independently predictive of developing type 2 diabetes.     

Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States

Background

This study ({"type":"clinical-trial","attrs":{"text":"NCT01682005","term_id":"NCT01682005"}}NCT01682005) aims to assess clinical and cost impacts of complete and incomplete rotavirus (RV) vaccination.

Methods

Beneficiaries who continuously received medical and pharmacy benefits since birth were identified separately in Truven Commercial Claims and Encounters (2000–2011) and Truven Medicaid Claims (2002–2010) and observed until the first of end of insurance eligibility or five years. Infants with ≥1 RV vaccine within the vaccination window (6 weeks-8 months) were divided into completely and incompletely vaccinated cohorts. Historically unvaccinated (before 2007) and contemporarily unvaccinated (2007 and after) cohorts included children without RV vaccine. Claims with International Classification of Disease 9^th edition (ICD-9) codes for diarrhea and RV were identified. First RV episode incidence, RV-related and diarrhea-related healthcare resource utilization after 8 months old were calculated and compared across groups. Poisson regressions were used to generate incidence rates with 95% confidence intervals (CIs). Mean total, inpatient, outpatient and emergency room costs for first RV and diarrhea episodes were calculated; bootstrapping was used to construct 95% CIs to evaluate cost differences.

Results

1,069,485 Commercial and 515,557 Medicaid patients met inclusion criteria. Among commercially insured, RV incidence per 10,000 person-years was 3.3 (95% CI 2.8–3.9) for completely, 4.0 (95% CI 3.3–5.0) for incompletely vaccinated, and 20.9 (95% CI 19.5–22.4) for contemporarily and 40.3 (95% CI 38.6–42.1) for historically unvaccinated. Rates in Medicaid were 7.5 (95% CI 4.8–11.8) for completely, 9.0 (95% CI 6.5–12.3) for incompletely vaccinated, and 14.6 (95% CI 12.8–16.7) for contemporarily and 52.0 (95% CI 50.2–53.8) for historically unvaccinated. Mean cost for first RV episode per cohort member was $15.33 (95% CI $12.99-$18.03) and $4.26 ($95% CI $2.34-$6.35) lower for completely vaccinated versus contemporarily unvaccinated in Commercial and Medicaid, respectively.

Conclusions

RV vaccination results in significant reduction in RV infection. There is evidence of indirect benefit to unvaccinated individuals.     

Cross-Sectional Study on Attitudes among General Practitioners towards Pneumococcal Vaccination for Middle-Aged and Elderly Population in Hong Kong

Objective

To study the attitudes among general practitioners towards pneumococcal vaccination for middle-aged (50–64) and elderly population (over 65) in Hong Kong and the factors affecting their decision to advise pneumococcal vaccination for those age groups.

Design

Cross-sectional study of general practitioners in private practice in Hong Kong.

Participants

Members of Hong Kong Medical Association delivering general practice services in private sector.

Measuring Tool

Self-administered questionnaire.

Main Outcome Measures

Intention to recommend pneumococcal vaccination, barriers against pneumococcal vaccination.

Results

53.4% of the respondents would actively recommend pneumococcal vaccination to elderly patients but only 18.8% would recommend for middle-aged patients. Consultation not related to pneumococcal vaccine was the main reason for not recommending pneumococcal vaccine (43.6%). Rarity of pneumonia in their daily practice was another reason with 68.4% of respondents attending five or less patients with pneumonia each year. In multivariate analysis, factors such as respondents would get vaccination when reaching age 50 (OR_m 10.1), and attending 6 pneumonia cases or more per year (OR_m 2.28) were found to be associated with increasing likelihood for recommending vaccination to the middle-aged. While concerns of marketing a product (OR_m 0.41), consultation not related to vaccination (OR_m 0.45) and limited time (OR_m 0.38) were factors that reduced the likelihood.

Conclusion

Public policy is needed to increase the awareness of impact of pneumococcal pneumonia and the availability of preventive measures.     

Population Structure of Peronospora effusa in the Southwestern United States

Peronospora effusa is an obligate pathogen that causes downy mildew on spinach and is considered the most economically important disease of spinach. The objective of the current research was to assess genetic diversity of known historical races and isolates collected in 2014 from production fields in Yuma, Arizona and Salinas Valley, California. Candidate neutral single nucleotide polymorphisms (SNPs) were identified by comparing sequence data from reference isolates of known races of the pathogen collected in 2009 and 2010. Genotypes were assessed using targeted sequencing on genomic DNA extracted directly from infected plant tissue. Genotyping 26 historical and 167 contemporary samples at 46 SNP loci revealed 82 unique multi-locus genotypes. The unique genotypes clustered into five groups and the majority of isolates collected in 2014 were genetically closely related, regardless of source location. The historical samples, representing several races, showed greater genetic differentiation. Overall, the SNP data indicate much of the genotypic variation found within fields was produced during asexual development, whereas overall genetic diversity may be influenced by sexual recombination on broader geographical and temporal scales.     

BMI and Rates of Suicide in the United States: An Ecological Analysis

BMI has been inversely associated with risk of completed suicide in several cohort studies, but putative mechanisms for this association and its generalizability throughout the United States are uncertain. We ascertained recent population‐based, state‐level data on rates of obesity, completed suicide (by method), firearm ownership, smoking, major depression, income, education, white race, and nonmetropolitan residence, compiled from federal agencies and surveys, and determined the adjusted population‐weighted correlations of statewide obesity rates with measures of completed and attempted suicide. Statewide prevalence of obesity was strongly inversely correlated with age adjusted suicide rate (multivariable‐adjusted r = ?0.66; P < 0.001). The correlation was somewhat stronger for rates of nonfirearm‐related (r = ?0.75; P < 0.001) than firearm‐related suicides (r = ?0.53; P < 0.001), and was of similar magnitude as the positive correlations of firearm prevalence with suicide rate (r = 0.75; P < 0.001) or of obesity with prevalence of diabetes (r = 0.41; P = 0.006). In analyses of fatal and nonfatal suicidal acts, obesity rates were inversely correlated with rates of suicidal acts using firearms (r = ?0.53; P = 0.02) and suffocation (r = ?0.76; P < 0.001) but not other methods. Obesity rates were also inversely correlated with the case–fatality ratios of acts using poisoning (r = ?0.51; P = 0.01). Thus, statewide rates of obesity are strongly inversely correlated with rates of completed suicide in multivariable analyses, a finding that appears to relate to fewer attempts by suffocation and a lower case–fatality ratio for poisonings, although the mechanism for the inverse correlation with firearm‐related suicides requires further elucidation.     

Raptor Electrocution Rates for a Utility in the Intermountain Western United States

ABSTRACT We estimated electrocution rates for raptors and common ravens (Corvus corax) for the Moon Lake Electrical Association in northeastern Utah and northwestern Colorado, USA. From July 2001 to May 2003, we conducted mortality searches at randomly selected distribution line segments and poles within 3 regions, but rate estimates (0.0036–0.0112 deaths/pole/yr) may have been biased by the effects of scavengers and by long sampling intervals (≥ 3 months), which prevented us from determining the cause of death for most birds because of advanced decay. In 2002–2003, we conducted carcass removal experiments in the Rangely Oil Field (ROF) in northwestern Colorado to estimate scavenging effects, and in 2003–2004, we reduced sampling intervals to 1 month and searched for dead birds at all distribution poles in the ROF. The shorter sampling interval nearly tripled the number of birds suitable for necropsy, but we were still unable to establish cause of death for >40% of our sample. Instead of eliminating the unknowns from rate estimates, we estimated minimum annual electrocution rates using only confirmed electrocutions and maximum annual electrocution rates based on all available mortalities, including mortalities without known causes. Golden eagles (Aquila chrysaetos) accounted for 63% of dead birds found in 2003–2004, but they were removed by scavengers at rates well below hawks and owls (6.8% vs. 55.6%). We compared maximum rates for the ROF in 2003–2004 with the rates estimated from a survey conducted at the same poles in 1999 to assess the effects of retrofitting conducted by Moon Lake from 1999 to 2003. Electrocution rates in 2003–2004 were 47% lower than those in 1999. Raptor densities in the ROF did not change during our study, suggesting the reduction was not the result of changes in raptor populations. However, estimates of raptor densities in 1999 were not available, and we cannot be sure that numbers of birds using the oil field in 1999 were similar to those in 2003–2004. Our research emphasizes the difficulties of estimating electrocution rates precisely but suggests that utilities will have the greatest effect on mortality by monitoring power lines at large scales and focusing subsequent mitigation efforts in areas that pose the greatest risk to the greatest number of birds.     

Estimating the Breeding Population of Long-Billed Curlew in the United States

ABSTRACT Determining population size and long-term trends in population size for species of high concern is a priority of international, national, and regional conservation plans. Long-billed curlews (Numenius americanus) are a species of special concern in North America due to apparent declines in their population. Because long-billed curlews are not adequately monitored by existing programs, we undertook a 2-year study with the goals of 1) determining present long-billed curlew distribution and breeding population size in the United States and 2) providing recommendations for a long-term long-billed curlew monitoring protocol. We selected a stratified random sample of survey routes in 16 western states for sampling in 2004 and 2005, and we analyzed count data from these routes to estimate detection probabilities and abundance. In addition, we evaluated habitat along roadsides to determine how well roadsides represented habitat throughout the sampling units. We estimated there were 164,515 (SE=42,047) breeding long-billed curlews in 2004, and 109,533 (SE=31,060) breeding individuals in 2005. These estimates far exceed currently accepted estimates based on expert opinion. We found that habitat along roadsides was representative of long-billed curlew habitat in general. We make recommendations for improving sampling methodology, and we present power curves to provide guidance on minimum sample sizes required to detect trends in abundance.     

Rates and Characteristics of Sleep Paralysis in the General Population of Denmark and Egypt

In the current research we report data from two studies that examined rates and characteristics of sleep paralysis (SP) in the general population of Denmark and Egypt. In Study I, individuals from Denmark and Egypt did not differ in age whereas there were more males in the Egyptian sample (47 vs. 64 %); in Study II, individuals from Denmark and Egypt were comparable in terms of age and gender distribution. In Study I we found that significantly fewer individuals had experienced SP in Denmark [25 % (56/223)] than in Egypt [44 % (207/470)] p < .001. In Study II we found that individuals who had experienced at least one lifetime episode of SP from Denmark (n = 58) as compared to those from Egypt (n = 143) reported significantly fewer SP episodes in a lifetime relative to SP experiencers from Egypt (M = 6.0 vs. M = 19.4, p < .001). SP in the Egyptian sample was characterized by high rates of SP (as compared to in Denmark), frequent occurrences (three times that in the Denmark sample), prolonged immobility during SP, and great fear of dying from the experience. In addition, in Egypt, believing SP to be precipitated by the supernatural was associated with fear of the experience and longer SP immobility. Findings are discussed in the context of cultural elaboration and salience theories of SP.     

Population Growth and Demography of Common Loons in the Northern United States

ABSTRACT We used recent developments in theoretical population ecology to construct basic models of common loon (Gavia immer) demography and population dynamics. We parameterized these models using existing survival estimates and data from long-term monitoring of loon productivity and abundance. Our models include deterministic, 2-stage, density-independent matrix models, yielding population growth-rate estimates (λ) of 0.99 and 1.01 for intensively studied populations in our Wisconsin, USA, and New Hampshire, USA, study areas, respectively. Perturbation analysis of these models indicated that estimated growth rate is extremely sensitive to adult survival, as expected for this long-lived species. Also, we examined 20 years of count data for the 2 areas and evaluated support for a set of count-based models of population growth. We detected no temporal trend in Wisconsin, which would be consistent with fluctuation around an average equilibrium state but could also result from data limitations. For New Hampshire, the model set included varying formulations of density dependence and partitioning of stochasticity that were enabled by the annual sampling resolution. The best model for New Hampshire included density regulation of population growth and, along with the demographic analyses for both areas, provided insight into the possible importance of breeding habitat availability and the abundance of nonbreeding adults. Based on these results, we recommend that conservation organizations include nonbreeder abundance in common loon monitoring efforts and that additional emphasis be placed on identifying and managing human influences on adult loon survival.