analyses from a cross-sectional online survey

Objectives Opportunities for men having sex with men (MSM) to meet each other have very much improved by new communication technologies. Meeting venue-based characteristics can impact how many partners are met and how much sexual risk is taken. We analysed the association between physical and virtual venues and the risk for bacterial sexually transmitted infections (bSTIs) among participants in an MSM online survey. Methods Data were collected during 2013/2014 with a survey targeting MSM living in Germany. The impact of the meeting place with the last non-steady anal sex partner on diagnosis with a bSTI in the previous year was analysed using bivariate and multivariate regression analysis, taking into account self-reported HIV status, serostatus communication, condom use, partner number, age and city size. Results The study sample consisted of 8878 respondents (7799 not diagnosed with HIV; 1079 diagnosed with HIV). Meeting partners online was most common (62% HIV−/51% HIV+), followed by sex venues (11% HIV−/25% HIV+); other venues were each reported by 2–6% of the respondents. Venue-dependent proportions reporting bSTIs in the recent year were 2–4 folds higher among men diagnosed with HIV. In multivariate analysis, HIV status was the strongest predictor for bSTIs (OR=5.0; 95% CI 2.8 to 8.7). Compared with meeting partners online, sex (OR 1.6; 95% CI 1.0 to 2.5) and social venues (OR 1.9; 95% CI 1.4 to 2.6) were associated with increased bSTI risk for men not diagnosed with HIV, but the risk when meeting partners by smartphone apps was only of borderline significance (OR 1.5; 95% CI 0.9 to 2.3). For men diagnosed with HIV, bSTI risk increased for sex venues (OR 1.5; 95% CI 1.1 to 2.1), and was lower for non-gay/other venues (OR 0.2; 95% CI 0.1 to 0.5). Conclusions Venues are connected to social-behavioural facets of corresponding sexual encounters, and may be important arenas for differential HIV and STI education, treatment and prevention

Are men who have sex with men in Europe protected from hepatitis B?

Hepatitis B vaccination is recommended for men who have sex with men (MSM) in many countries, but information on vaccine coverage is scarce. We studied hepatitis B vaccination programmes and coverage among MSM in Europe to guide prevention. From a large (N = 174 209) pan-European MSM survey (EMIS-2010), we used data on self-reported hepatitis B vaccination, age, education, settlement size and disclosure of the same-sex sexual orientation ('outness'). We excluded participants with a history of hepatitis B. In multilevel (participants, countries) logistic regression models, we calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). We analysed data of 163 987 MSM in 38 European countries: 38.3% were 'out' to all or almost all, 56.4% reported vaccination against hepatitis B and 65.5% lived in countries with free recommended hepatitis B vaccination for MSM. In the final model the odds for being vaccinated increased with outness ('out to all or almost all': aOR 1.76, 95% CI 1.70-1.83 vs. 'out to no one') and with living in countries, where hepatitis B vaccination was recommended and free-of-charge for MSM (aOR 2.21, 95% CI 1.47-3.32 vs. 'no or unclear recommendation'). To increase hepatitis B vaccination coverage among MSM, implementation of MSM-specific recommendations and improvement of the societal climate for MSM is needed

Synchronization in a neuronal feedback loop through asymmetric temporal delays

We consider the effect of asymmetric temporal delays in a system of two coupled Hopfield neurons. For couplings of opposite signs, a limit cycle emerges via a supercritical Hopf bifurcation when the sum of the delays reaches a critical value. We show that the angular frequency of the limit cycle is independent of an asymmetry in the delays. However, the delay asymmetry determines the phase difference between the periodic activities of the two components. Specifically, when the connection with negative coupling has a delay much larger than the delay for the positive coupling, the system approaches in-phase synchrony between the two components. Employing variational perturbation theory (VPT), we achieve an approximate analytical evaluation of the phase shift, in good agreement with numerical results.Comment: 5 pages, 4 figure

Heat in Germany: Health risks and preventive measures

BACKGROUND: Climate change has already led to a significant temperature increase in Germany. The average temperature in the past decade was approximately 2°C above the pre-industrial level and eight of the ten hottest summers since the beginning of systematic weather records in 1881 were recorded in the last 30 years. METHODS: Based on a selective literature search and authors' own results, the article summarises the current state of knowledge on heat and its health impacts for Germany, addresses adaptation measures, and gives an outlook on implementation and research questions. RESULTS: Heat can aggravate pre-existing conditions such as diseases of the cardiovascular system, the respiratory tract, or the kidneys and trigger potentially harmful side effects for numerous medications. A significant increase in mortality is regularly observed during heat events. Previous approaches to mitigate the health impact of high temperatures include, for example, the heat alerts of the German Meteorological Service and recommendations for the preparation of heat-health action plans. CONCLUSIONS: Evidence on health impacts of heat and awareness of the need for heat-related health protection have grown in recent years, but there is still a need for further action and research

COVID-19: cross-border contact tracing in Germany, February to April 2020

Since January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread to become a global pandemic [1]. Active case finding, early detection and isolation of cases and their contacts are essential for breaking transmission chains. A modelling study showed that 70% of contacts should be traced in order to control the outbreak, assuming a baseline reproduction rate of 2.5 [2]. Early warning systems for the serious cross-border spread of infectious pathogens include the International Health Regulations (IHR) 2005 and the Early Warning and Response System (EWRS) for the European Union/European Economic Area (EU/EEA) countries [3,4]. Within Germany, communication channels have been established in accordance with the German Infection Protection Act (Infektionsschutzgesetz; IfSG). Cross-border contact tracing at the national level is operated by the Robert Koch Institute (RKI), the federal public health institute in Germany. The first cases of coronavirus disease 2019 (COVID-19) in Germany occurred in Bavaria at the end of January 2020 [5]. The first SARS-CoV-2 cluster also led to cross-border contacts and exposures on flights since close contacts and suspected cases travelled to Austria and Spain after exposure. This required intensive international communication to identify and share the information on contacts with the responsible health authorities. An international communication and contact tracing team (RKI IC-Team) was rapidly created in the RKI COVID-19 Emergency Operations Centre (EOC) including members of all units of the department for infectious disease epidemiology and other departments at the RKI. The core task of the team was to collect and communicate information on confirmed COVID-19 cases and their contacts to other countries in the event of cross-border relevance. In addition, incoming information on German citizens exposed abroad was communicated through the federal state health authorities to the responsible local health authorities in Germany. The spread of SARS-CoV-2 in Germany triggered the introduction of various measures: (i) mass gatherings with more than 1,000 participants were banned after calendar week 10, (ii) schools and public places were closed in several federal states, (iii) physical distancing measures of at least 1.5 m to another person were recommended, (iv) it was recommended to cancel non-essential travel and (v) quarantine measures for travellers from high risk areas entering Germany were introduced in calendar week 15. Because of the federal structure in Germany, the measures and their implementation varied between the states. This work aimed to describe the extent and course of activities resulting from information on COVID-19 exposure events with a cross-border context. Further, we discuss the challenges experienced and possible workflow improvements.Peer Reviewe

Why are different estimates of the effective reproductive number so different? A case study on COVID-19 in Germany

The effective reproductive number R$_t$ has taken a central role in the scientific, political, and public discussion during the COVID-19 pandemic, with numerous real-time estimates of this quantity routinely published. Disagreement between estimates can be substantial and may lead to confusion among decision-makers and the general public. In this work, we compare different estimates of the national-level effective reproductive number of COVID-19 in Germany in 2020 and 2021. We consider the agreement between estimates from the same method but published at different time points (within-method agreement) as well as retrospective agreement across eight different approaches (between-method agreement). Concerning the former, estimates from some methods are very stable over time and hardly subject to revisions, while others display considerable fluctuations. To evaluate between-method agreement, we reproduce the estimates generated by different groups using a variety of statistical approaches, standardizing analytical choices to assess how they contribute to the observed disagreement. These analytical choices include the data source, data pre-processing, assumed generation time distribution, statistical tuning parameters, and various delay distributions. We find that in practice, these auxiliary choices in the estimation of R$_t$ may affect results at least as strongly as the selection of the statistical approach. They should thus be communicated transparently along with the estimates

Monitoring the HIV continuum of care in key populations across Europe and Central Asia.

OBJECTIVES: The aim of the study was to measure and compare national continuum of HIV care estimates in Europe and Central Asia in three key subpopulations: men who have sex with men (MSM), people who inject drugs (PWID) and migrants. METHODS: Responses to a 2016 European Centre for Disease Prevention and Control (ECDC) survey of 55 European and Central Asian countries were used to describe continuums of HIV care for the subpopulations. Data were analysed using three frameworks: Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; breakpoint analysis identifying reductions between adjacent continuum stages; quadrant analysis categorizing countries using 90% cut-offs for continuum stages. RESULTS: Overall, 29 of 48 countries reported national data for all HIV continuum stages (numbers living with HIV, diagnosed, receiving treatment and virally suppressed). Six countries reported all stages for MSM, seven for PWID and two for migrants. Thirty-one countries did not report data for MSM (34 for PWID and 41 for migrants). In countries that provided key-population data, overall, 63%, 40% and 41% of MSM, PWID and migrants living with HIV were virally suppressed, respectively (compared with 68%, 65% and 68% nationally, for countries reporting key-population data). Variation was observed between countries, with higher outcomes in subpopulations in Western Europe compared with Eastern Europe and Central Asia. CONCLUSIONS: Few reporting countries can produce the continuum of HIV care for the three key populations. Where data are available, differences exist in outcomes between the general and key populations. While MSM broadly mirror national outcomes (in the West), PWID and migrants experience poorer treatment and viral suppression. Countries must develop continuum measures for key populations to identify and address inequalities

Winner-take-all selection in a neural system with delayed feedback

We consider the effects of temporal delay in a neural feedback system with excitation and inhibition. The topology of our model system reflects the anatomy of the avian isthmic circuitry, a feedback structure found in all classes of vertebrates. We show that the system is capable of performing a `winner-take-all' selection rule for certain combinations of excitatory and inhibitory feedback. In particular, we show that when the time delays are sufficiently large a system with local inhibition and global excitation can function as a `winner-take-all' network and exhibit oscillatory dynamics. We demonstrate how the origin of the oscillations can be attributed to the finite delays through a linear stability analysis.Comment: 8 pages, 6 figure

Descriptive epidemiology of stigma against depression in a general population sample in Alberta

<p>Abstract</p> <p>Background</p> <p>Mental health illnesses, such as depression, are responsible for a growing disease burden worldwide. Unfortunately, effective treatment is often impeded by stigmatizing attitudes of other individuals, which have been found to lead to a number of negative consequences including reduced help-seeking behavior and increased social distance. Despite the high prevalence of depression in Canada, little research has been conducted to examine stigma against depression in the Canadian general population. Such information is crucial to understanding the current state of stigmatizing attitudes in the Canadian communities, and framing future stigma reduction initiatives. The objectives of this study were to estimate the percentages of various stigmatizing attitudes toward depression in a general population sample and to compare the percentages by demographics and socioeconomic characteristics.</p> <p>Methods</p> <p>We conducted a cross-sectional telephone survey in Alberta, Canada, between February and June 2006. Random digit dialing was used to recruit participants who were aged 18-74 years old (n = 3047). Participants were presented a case vignette describing a depressed individual, and responded to a 9-item Personal Stigma questionnaire. The percentages of stigmatizing attitudes were estimated and compared by demographic and socioeconomic variables.</p> <p>Results</p> <p>Among the participants, 45.9% endorsed that depressed individuals were unpredictable and 21.9% held the view that people with depression were dangerous. Significant differences in stigmatizing attitudes were found by gender, age, education, and immigration status. A greater proportion of men than women held stigmatizing views on each stigma item. No consistent trend emerged by age in stigma against depression. Participants with higher levels of education reported less stigmatizing attitudes than those with less education. Participants who were not born in Canada were more likely to hold stigmatizing attitudes than those who were born in Canada.</p> <p>Conclusion</p> <p>In the general population, stigmatizing attitudes towards depression differ by demographic characteristics. Men, those with less education and immigrants should be the targets of stigma reduction campaigns.</p