Epidemiology of Reported HIV and Other Sexually Transmitted Infections During the COVID-19 Pandemic, New York City.

Early in the coronavirus disease 2019 (COVID-19) crisis, a statewide executive order (PAUSE) severely restricted the movement of New Yorkers from 23 March to 7 June 2020. We used New York City surveillance data for human immunodeficiency virus (HIV), chlamydia, gonorrhea, and syphilis to describe trends in diagnosis and reporting surrounding PAUSE. During PAUSE, the volume of positive HIV/sexually transmitted infection tests, and diagnoses of HIV, chlamydia, gonorrhea, and syphilis declined substantially, reaching a nadir in April before rebounding. Some shifts in characteristics of reported cases were identified.

Environmental factors associated with blood lead among newcomer women from South and East Asia in the Greater Toronto Area.

BACKGROUND: Newcomers bring with them histories of environmental exposure in their home countries and may have different sources of lead (Pb) exposure compared to other residents of their adopted country. AIMS: To describe past and current factors associated with Pb exposure and blood Pb among South and East Asian newcomer women of reproductive age in the Greater Toronto Area (GTA), Ontario, Canada. METHODS: In collaboration with public health units and community organizations a community-based research model was utilized by recruiting peer researchers to assist in all aspects of the study. Blood samples were taken and phone interviews were conducted. Canadian Health Measures Survey (CHMS) cycles 1, 2, and 3 data was used to contextualize the distribution blood Pb levels. Multiple regression was applied to log-transformed blood lead measurements, using a hierarchical model building process. RESULTS: In total, 211 participants were recruited from Bangladesh, China, India, Pakistan and Sri Lanka. The distribution of the blood Pb varied by country of origin, and higher blood Pb values were found above 75th percentile compared to the CHMS. Distal factors significantly influencing blood Pb concentrations related to life history, such as duration of stay in Canada (RR=0.91; 95% CI 0.86-0.97), living near agricultural fields (RR=0.78; 95% CI 0.62-0.93), and country of origin. Proximal factors with significant contribution were use of cosmetics, traditional remedies, and smoking cigarettes. RECOMMENDATIONS: Different past and current exposures may be important in various newcomer populations, informing international stakeholders, public health agencies, and primary care practitioners to adapt health education and exposure reduction programs to consider pre- and post-migration factors.

Metal Concentrations in Newcomer Women and Environmental Exposures: A Scoping Review.

Newcomer women from developing countries are recognized to be at risk for elevated exposures to environmental contaminants and associated negative health effects. As such, data on exposure sources and contaminant body burden concentrations is critical in the development of effective public health policies and interventions in support of newcomer health. We conducted a scoping review to gather evidence on important toxic metals of health concern, lead (Pb), mercury (Hg) and cadmium (Cd), and their concentrations and potential exposure sources among newcomer women. An initial 420 articles were identified through the databases MEDLINE, EMBASE and Scopus, many reporting by ethnicity rather than newcomer/immigrant status. Several articles reported metal concentrations for other biomarkers but did not include blood, nor stratify results. From the remainder, we selected a total of 10 articles for full textual review, which reported blood Pb, Hg or Cd levels for newcomer women and/or stratified blood metal results according to foreign birth or country of origin. Three of the articles reported higher Pb, Hg and Cd concentrations in newcomer women compared to their native-borne counterparts. Exposures identified as contributing to elevated Pb, Hg and Cd blood concentrations included: pica behaviour, the use of lead-glazed cookware or eye cosmetics, and fish/shellfish consumption. The review revealed a limited availability of data on metal body burden concentrations, exposure sources and routes among newcomer women specifically. More research is needed to better understand the extent to which newcomer women are disproportionately at risk of elevated metal exposures due to either country of origin or current exposures and to inform relevant, multi-national risk management strategies.

Competition between an avoidance response and a safety signal: evidence for a single learning system.

Two experiments examined competition between an instrumental avoidance response and a Pavlovian safety signal for association with omission of electric shock in a human fear conditioning paradigm. Self-reported shock expectancies and skin conductance responses were consistent with blocking of learning of the instrumental contingency by prior training of the Pavlovian contingency, and vice versa. The results support the idea that a common learning mechanism underlies both Pavlovian and instrumental conditioning. The expectancy data suggest that this learning mechanism is cognitive in nature, and that Pavlovian and instrumental learning involve external and internal attributions, respectively. The procedure may thus serve as a laboratory model for attributional processes involved in the acquisition of threat expectancies in anxiety and anxiety disorders.

Mathematical learning disorder in school-age children with attention-deficit hyperactivity disorder.

OBJECTIVES: To explore the prevalence of mathematics disorder (MD) relative to reading disorders (RD) in school-age children with attention-deficit hyperactivity disorder (ADHD) and examine the effects of age, sex, cooccurring conduct disorder (CD), and ADHD subtype on this comorbidity. METHODS: Participants were school-age children (n = 476) with confirmed DSM-IV diagnosis of ADHD. The assessment included semistructured parent and teacher interviews and standardized measures of intelligence, academic attainment, and language abilities. Based on the presence or absence of concurrent learning disorders, we compared the emerging 4 groups: ADHD-only, ADHD + MD, ADHD + RD, and ADHD + MD + RD. RESULTS: Overall prevalence of comorbid ADHD + MD was 18.1%. Age, sex, ADHD subtypes, or comorbid CD did not affect the frequency of MD. Children with concurrent ADHD and either MD or RD attained lower IQ, language, and academic scores than those with ADHD alone. Children with ADHD + MD + RD were more seriously impaired and demonstrated distinct deficits in receptive and expressive language. CONCLUSION: MDs are relatively common in school-age children with ADHD and are frequently associated with RDs. Children with ADHD + MD + RD are more severely impaired. These deficits simply cannot be explained as consequences of ADHD and might have unique biological underpinnings, with implications for diagnostic classification and therapeutic interventions.

Predictive validity of DSM-IV and ICD-10 criteria for ADHD and hyperkinetic disorder.

BACKGROUND: The goal of this study was to compare the predictive validity of the two main diagnostic schemata for childhood hyperactivity - attention-deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual- IV) and hyperkinetic disorder (HKD; International Classification of Diseases- 10th Edition). METHODS: Diagnostic criteria for ADHD and HKD were used to classify 419 children ages 6 to 16 years referred to a clinic for behavioral problems into one of four groups: HKD, ADHD combined subtype (ADHD-C), ADHD hyperactive-impulsive subtype (ADHD-HI), ADHD inattentive subtype (ADHD-IA). These groups were compared on clinical characteristics including total symptom severity, overall impairment, exposure to psychosocial and neuro-developmental risks, family history of ADHD in first-degree family members, rate and type of comorbidity, intelligence, academic achievement, and on laboratory tests of motor response inhibition and working memory with each other and with normal controls (47). RESULTS: Of the 419 cases, there were 46 HKD (11.0%), 200 ADHD-C (47.7%), 60 ADHD-HI (14.3%) and 113 ADHD-IA (27.0%) cases. The HKD group had more symptoms and was more impaired on teachers' ratings than were the other groups. The ADHD-C and HKD groups had poorer inhibitory control than the ADHD-IA, ADHD-HI and control groups, and all four clinic groups showed inhibition deficit compared to controls. Groups did not differ in working memory. Compared to controls, the HKD, ADHD-C, ADHD-HI and ADHD-IA groups had higher familial risk of ADHD, greater psychosocial risk exposure, lower intellectual level and poorer academic attainment. However, we observed no differences among the clinic groups in these characteristics. CONCLUSIONS: Like earlier versions, ICD-10 and DSM-IV continue to delineate diagnostic entities with substantially different prevalence in clinic samples. However, HKD, ADHD-C, ADHD-IA and ADHD-HI groups overlap substantially in terms of important clinical characteristics, although HKD and ADHD-C may be somewhat more severe variants of the condition than ADHD-IA and ADHD-HI.

Performance monitoring and response inhibition in anxiety disorders with and without comorbid ADHD.

Anxiety disorder (ANX) is characterized by heightened arousal, psychosocial and academic difficulties, and comorbidity with other disorders, in particular, attention-deficit/hyperactivity disorder (ADHD). The heightened arousal contributes to cognitive impairment by adversely affecting executive control of cognition. The nature of the effect on executive control is poorly understood. Research in this area could inform intervention, diagnostic, and etiological research. Our objective was to characterize children with ANX on measures of executive functioning, while controlling for comorbid ADHD. We compared children ages 6-14 with ANX (N=21), ADHD (N=78), ANX+ADHD (N=38), and normal controls (NC; N=40) on the stop task, a measure of performance monitoring and response inhibition. No difference was observed between NC and ANX groups in performance monitoring. Compared to the NC group, the three clinical groups showed inhibition deficits, and both ADHD and ANX+ADHD groups monitored less after responses. ANX was not associated with performance monitoring or inhibition deficits once comorbid ADHD was considered. This emphasizes the importance of controlling for comorbid ADHD in studies of cognition and anxiety.

The parent interview for child symptoms: a situation-specific clinical research interview for attention-deficit hyperactivity and related disorders.

OBJECTIVE: To describe the properties of a semistructured research interview of parents designed to evaluate attention-deficit hyperactivity disorder (ADHD) and related psychopathology. METHOD: We examined interrater reliability in 48 videotaped interviews randomly selected from a large clinic sample. We examined convergence of the Parent Interview for Child Symptoms (PICS) and Conners' Parent Rating Scale (CPRS) scores in 594 clinic-referred cases and 26 control subjects, comparing the groups generated by cross-tabulation on measures of intelligence, academic achievement, and inhibitory control. RESULTS: Intraclass correlation coefficients for symptom scores of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) were excellent. We found good reliability for diagnoses of ADHD (e = 0.73) and CD (kappa = 0.73) and excellent reliability for the diagnosis of ODD (kappa = 0.80). Two-thirds of cases were classified similarly on the PICS and the CPRS. Greater impairment in inhibitory control was observed in cases identified as ADHD by the PICS, compared with those identified by the CPRS-ADHD index. CONCLUSIONS: The PICS displays good reliability and validity, indicating that a balance between clinical applicability and reliability can be achieved in the development of clinical research instruments.