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Habitat barriers limit gene flow and illuminate historical events in a wide-ranging carnivore, the American puma.

We examined the effects of habitat discontinuities on gene flow among puma (Puma concolor) populations across the southwestern USA. Using 16 microsatellite loci, we genotyped 540 pumas sampled throughout the states of Utah, Colorado, Arizona, and New Mexico, where a high degree of habitat heterogeneity provides for a wide range of connective habitat configurations between subpopulations. We investigated genetic structuring using complementary individual- and population-based analyses, the latter employing a novel technique to geographically cluster individuals without introducing investigator bias. The analyses revealed genetic structuring at two distinct scales. First, strikingly strong differentiation between northern and southern regions within the study area suggests little migration between them. Second, within each region, gene flow appears to be strongly limited by distance, particularly in the presence of habitat barriers such as open desert and grasslands. Northern pumas showed both reduced genetic diversity and greater divergence from a hypothetical ancestral population based on Bayesian clustering analyses, possibly reflecting a post-Pleistocene range expansion. Bayesian clustering results were sensitive to sampling density, which may complicate inference of numbers of populations when using this method. The results presented here build on those of previous studies, and begin to complete a picture of how different habitat types facilitate or impede gene flow among puma populations.

Animals↗

Estimating mortality in skeletal populations: influence of the growth rate on the interpretation of levels and trends during the transition to agriculture.

Traditional paleodemographic methods of estimating mortality have been based on unrealistic assumptions about the prevalence of closed and stationary populations. When a living closed population was growing, the mean age at death of its skeletal survivors will be shifted below its true life expectancy. For declining populations, the mean age at death will be higher than true underlying life expectancy at birth. The faster the rate of growth, the larger and more curvilinear is the displacement. Mortality estimates can only be extracted from skeletal populations via an independent estimate of the growth rate. Fertility levels, however, can be estimated directly. The empirical importance of growth rate-dependent mortality estimates is demonstrated by reinterpreting mean-age-at-death data from several populations before and after the agricultural revolution; with detailed consideration given to the Old World populations of Acsadi and Nemeskeri and a New World population from central Illinois.

Agriculture↗

[Family and population in China from the sixteenth to the eighteenth century in the light of a recent work by Liu Ts'ui-Jung].

Taking as its starting point the huge sample of 260,000 people born in China between the 13th and the 19th century used by Liu Ts'ui-Jung in her recent study on Lineage population, our study aims at assessing the premodern demographic evolution of China. Inasmuch the method of family reconstruction actually limited the scope of her book, Liu Ts'ui-Jung was not able to go beyond the description of a specific demographic regime defined by three elements: 1) universal marriage; 2) a moderate level of masculine fertility; and 3) a life expectation at 15 comprised between 30 and 40. These conditions would not allow the constitution of many extended households, whereas the annual rate of growth would be somewhere around 1%, a situation having little in common with the present day "population explosion". Using data included in the book, but not considered for the demonstration, we have been able to establish a dramatic deterioration of the mortality pattern from the middle of the 18th century onwards. Accordingly, the proportion of widows increases whereas population which would be characterized with a long period of growth followed by a crisis generated by a surge of the mortality rate.

China↗

Teens could get new message on waiting for sex. Sex education.

It's best to wait until you are older to have sex. But if you decide to have intercourse, use a condom. We'll show you how. That's the message most New Jersey teens get in their sex education classes. It's the law. But a new source of federal funding could help advocates of "abstinence-only" education find a way around that requirement. The state Department of Health and Senior Services is considering whether to apply for federal money limited to programs teaching teens that abstinence is the only certain way to prevent pregnancy and avoid contracting sexually transmitted diseases, including HIV. The federally funded programs also would have to teach that sex before marriage is morally wrong. About $50 million for these abstinence-only programs was quietly tucked into the welfare bill that President Clinton signed into law in 1996. New Jersey is eligible to receive $843,000. The health department is hearing from people on both sides of the issue, said Celeste Wood, who plans to submit a report to Health Commissioner Len Fishman by the end of the month. Fishman will then decide whether New Jersey should apply for the money, she said. Historically, debate between "comprehensive" and "abstinence-only" sex education has centered around the classroom and education department. Comprehensive programs teach both abstinence and contraception. Abstinence-only programs prohibit discussion of contraception. Comprehensive education advocates have won that battle in New Jersey public schools. The state's core curriculum standards currently call for schools to teach teens about both abstinence and contraception. But the new federal money is being funneled through state health departments. "This skates around the schools by bringing the money in through the public health arena," said Daniel Daley, director of public policy for the Sexuality Information and Education Council of the US. "They are trying to influence community-based programs and make an end-run around the schools." Daley predicts the grants will spur growth of abstinence-until-marriage programs.

Adolescent↗

Still protected against smallpox? Estimation of the duration of vaccine-induced immunity against smallpox.

BACKGROUND: Although the potential for bioterrorism has led to discussions on the durability of vaccine-induced immunity, the actual duration of protection against smallpox is still unknown. It has previously been suggested that at least partial protection against severe and fatal smallpox may persist throughout life. METHODS: In this article, we analyzed 6 major smallpox outbreaks that occurred before and after 1900 in the United Kingdom. These analyses are based on the age-dependent incidence of smallpox and the fraction of severe manifestations among individuals with or without prior vaccination. We used a likelihood-based approach to estimate the duration of immunity from the age-specific frequencies. RESULTS: The expected median duration of protection from disease ranged from 11.7 to 28.4 years after primary vaccination, and the qualitative pattern of duration could be described using Gompertz's Law. Vaccinated individuals appear to have been protected from severe disease with more than 50% probability even 50 years after successful primary vaccination. CONCLUSIONS: These findings suggest that successful primary vaccination offered full protection for a few decades, with partial protection from severe smallpox possibly lasting a lifetime, for a substantial fraction of the population.

Age Factors↗

Temporal trends in demographic profiles and stress levels in medieval (6th-13th century) population samples from continental Croatia.

AIM: To analyze and compare the demographic profiles and disease frequencies of early (6th-9th century) and late (10th-13th century) medieval skeletal series from continental Croatia. METHODS: Age and sex distributions in three early (n=277) and six late (n=175) medieval skeletal series were compared. All skeletons were analyzed for the presence of dental enamel hypoplasia, periostitis, trauma, and presence of Schmorl s depressions in vertebral bodies. RESULTS: Data collected from the skeletal series suggested significantly higher stress in the late medieval period. This stress may have affected mortality, as evidenced by significantly higher subadult mortality and shorter adult average life span. Men in the late medieval series, in particular, seem to have been under greater stress. They exhibited significantly higher mortality in the 21-25 years age category, and significantly higher frequencies of periosteal lesions, cranial and postcranial trauma, and Schmorl s depressions. CONCLUSION: The frequencies of all skeletal indicators of stress increased significantly during the late medieval period. This was accompanied by a significant increase in subadult mortality and shortening of the average life span of adult men and women.

Age Distribution↗

Human adaptability research into the beginning of the third millennium.

Human adaptability, as a field of inquiry within human biology, became defined during the research activities of the International Biological Program (IBP) (1964-1974). During this period, research was focused on ecological, physiological, and genetic studies of human populations within the theoretical frameworks of adaptation and evolution. Other defining characteristics of the IBP human adaptability research were standardization of methods, multidisciplinary projects, international cooperation, and a concern with human health issues. Some observers suggest that this research contributed to the ongoing transformation of physical anthropology and related fields from a largely descriptive to an analytical science. During the 25 years between the end of the IBP and the present, a number of research trends have continued: Several new multidisciplinary projects were initiated and completed; a subfield of demography within human biology has matured; nutrition, infant and child growth, and health studies have proliferated; and molecular genetics and DNA analysis have superseded the earlier population genetics. International programs today are geared toward more practical and applied studies with less emphasis on basic science. Continuation of human adaptability research into the 21st century is likely to make contributions in 3 broad areas: population, environment, and health. Productive research is likely to contribute to these 3 areas in the following categories: reproduction, psychosocial stress, life span approaches to health, effects of losses in biodiversity on health, a human biology of poverty, emerging infectious diseases, epidemiology of modernization, evolutionary medicine, and aging. The success of much of this research in its contribution to knowledge will come from the integrated perspectives of a biobehavioral framework of inquiry.

Adaptation, Physiological↗

Births: final data for 2001.

OBJECTIVES: This report presents 2001 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco, and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.026 million births that occurred in 2001 are presented. Denominators for population-based rates are derived from the 1990 U.S. census. As a result, rates are generally larger than would be the case if 2000-based estimates were used. The magnitude of the overestimate will vary by population subgroup; overestimates are likely greatest for those of Hispanic origin. RESULTS: The number of births, the birth rate, fertility rate, and total fertility rates all declined 1 percent in 2001. The teenage birth rate reached another historic low. Birth rates for women in their twenties declined slightly, whereas rates for women aged 30 to 44 years continued to rise. Births to unmarried women changed very little. Smoking by pregnant women was down again. Women were more likely to begin care in the first trimester of pregnancy (83.4 percent). The cesarean delivery rate rose for the fifth consecutive year to 24.4 percent; the primary cesarean rate was up 5 percent and the rate of vaginal births after a previous cesarean fell 20 percent. Preterm and low birthweight levels both rose for 2001. The twin birth rate continued to climb, and following 2 years of decline, the rate of triplet/+ births also increased.

Adolescent↗

Genetic variation in Echinacea angustifolia along a climatic gradient.

BACKGROUNDS AND AIMS: Echinacea angustifolia is a widespread species distributed throughout the Great Plains region of North America. Genetic differentiation among populations was investigated along a 1500 km north-south climatic gradient in North America, a region with no major geographical barriers. The objective of the study was to determine if genetic differentiation of populations could be explained by an isolation-by-distance model or by associations with climatic parameters known to affect plant growth and survival. METHODS: Historical climatic data were used to define the nature of the climatic gradient and AFLP markers were used to establish patterns of population genetic differentiation among ten Echinacea populations collected from North Dakota to Oklahoma. A total of 1290 fragments were scored using six EcoRI/MseI and three PstI/MseI primer combinations. Assessment of the correlation between climatic, genetic and geographic distances was assessed by Mantel and partial Mantel tests. KEY RESULTS: PstI/MseI combinations produced significantly fewer fragments, but a larger percentage was unique compared with EcoRI/MseI markers. Using estimates of F(ST), populations in Oklahoma and southern Kansas were identified as the most divergent from the other populations. Both the neighbour-joining tree and principal co-ordinate analysis clustered the populations in a north-south spatial orientation. About 60% of the genetic variation was found within populations, 20% among populations and the remaining 20% was partitioned among groups that were defined by the topology of the neighbour-joining tree. Significant support was found for the isolation-by-distance model independent of the effects of annual mean precipitation, but not from annual mean temperature and freeze-free days. CONCLUSIONS: Echinacea angustifolia populations exhibit genetic divergence along a north-south climatic gradient. The data support an isolation-by-distance restriction in gene flow that is independent of annual mean precipitation.

Adaptation, Physiological↗

Ross River virus disease clusters and spatial relationship with mosquito biting exposure in Redland Shire, southern Queensland, Australia.

The spatial heterogeneity in the risk of Ross River virus (family Togaviridae, genus Alphavirus, RRV) disease, the most common mosquito-borne disease in Australia, was examined in Redland Shire in southern Queensland, Australia. Disease cases, complaints from residents of intense mosquito biting exposure, and human population data were mapped using a geographic information system. Surface maps of RRV disease age-sex standardized morbidity ratios and mosquito biting complaint morbidity ratios were created. To determine whether there was significant spatial variation in disease and complaint patterns, a spatial scan analysis method was used to test whether the number of cases and complaints was distributed according to underlying population at risk. Several noncontiguous areas in proximity to productive saline water habitats of Aedes vigilax (Skuse), a recognized vector of RRV, had higher than expected numbers of RRV disease cases and complaints. Disease rates in human populations in areas which had high numbers of adult Ae. vigilax in carbon dioxide- and octenol-baited light traps were up to 2.9 times those in areas that rarely had high numbers of mosquitoes. It was estimated that targeted control of adult Ae. vigilax in these high-risk areas could potentially reduce the RRV disease incidence by an average of 13.6%. Spatial correlation was found between RRV disease risk and complaints from residents of mosquito biting. Based on historical patterns of RRV transmission throughout Redland Shire and estimated future human population growth in areas with higher than average RRV disease incidence, it was estimated that RRV incidence rates will increase by 8% between 2001 and 2021. The use of arbitrary administrative areas that ranged in size from 4.6 to 318.3 km2 has the potential to mask any small scale heterogeneity in disease patterns. With the availability of georeferenced data sets and high-resolution imagery, it is becoming more feasible to undertake spatial analyses at relatively small scales.

Aedes↗

Profiles of child sexual abuse cases in Ireland: an archival study.

OBJECTIVE: This study aimed to profile subgroups of CSA cases referred for assessment at two national CSA assessment centers in Ireland. METHOD: Historical and clinical data for 150 CSA cases were drawn from records of two Dublin-based national specialist sexual abuse assessment and therapeutic centers. Three main comparisons were made involving: (1) 113 confirmed CSA cases and 37 unconfirmed CSA cases, (2) 55 confirmed CSA cases that displayed clinically significant behavior problems, and the 56 confirmed CSA cases without significant adjustment difficulties, and (3) 19 confirmed CSA cases in which violence was a central feature, and 79 confirmed cases in which violence was not a central feature. RESULTS: There were three main findings. (1) More unconfirmed cases were male; had single or separated parents; and a father with a criminal history. As a group, the confirmed cases were largely youngsters who had been abused by male adults or adolescents outside their nuclear family and who subsequently were well supported by one or two parents. (2) Poorly adjusted CSA victims had a history of coercive violent abuse while better adjusted children were victims of nonviolent abuse. (3) Victims of violent CSA were more likely to have experienced penetrative abuse and to display more externalizing behavior problems. CONCLUSIONS: Confirmed and unconfirmed CSA cases, well and poorly adjusted CSA cases, and victims of violent and nonviolent CSA referred for assessment at two national CSA assessment centers in Ireland had distinctive clinical profiles.

Adolescent↗

Familial aggregation of Parkinson's disease: The Mayo Clinic family study.

Data on the familial aggregation of Parkinson's disease (PD) remain conflicting. We conducted a historical cohort study of 1,001 first-degree relatives of 162 probands with PD and of 851 relatives of 147 control probands representative of the population of Olmsted County, Minnesota (from 1976 through 1995). In addition, we studied 2,713 first-degree relatives of 411 probands with PD referred to the Mayo Clinic from 1996 through 2000 and 625 spouses of PD or control probands. Whenever possible, relatives were interviewed and screened for parkinsonism either directly or through a proxy, and those who screened positive were examined or a copy of their medical record was obtained to confirm the diagnosis (family study method). Thirty relatives of population-based PD probands, 18 relatives of population-based control probands, 65 relatives of referral PD probands, and 8 spouses had developed PD. Combining population-based with referral PD probands and population-based control probands with spouses, the relative risk was modestly increased (relative risk, 1.71; 95% confidence interval, 1.11-2.64). Relatives of probands with younger onset (</=66 years; first tertile) had a more significantly increased risk (relative risk, 2.62; 95% confidence interval, 1.66-4.15), whereas relatives of probands with later onset had no increased risk. The relative risk decreased when the incidence of all types of parkinsonism was considered.

Adult↗

Extrapolaholics anonymous: why demographers' rejections of a huge rise in cohort life expectancy in this century are overconfident.

Criticisms of demographers by other demographers have become frequent in scientific literature, generally consisting of accusations that trends observed in the recent past have been extrapolated unjustifiably into the future. Demographers, along with their colleagues in the actuarial profession, are in an invidious position in this regard, knowing full well that extrapolation is almost always only minimally justifiable, but knowing also that their readers, colleagues, and sources of funding tend to be much more interested in the future than in the past. It is unfortunate that, while actuaries typically resolve this dilemma by emphasizing the limitations of their methods and thereby lowering expectations that their predictions will be accurately fulfilled, demographers are more prone to respond combatively, attempting to reinforce the credibility of their extrapolations by recourse to data from areas in which their expertise is less tested, such as biology. This is valuable in that it raises the profile of the debate on the likely rate of scientific progress relevant to mortality rates, but it also runs the risk of lowering the technical quality of that debate, by telling policy makers and the public what they want to hear and thereby entrenching their expectations without recourse to the relevant biological facts. Extrapolations based on plausible sequences of scientific advances and the sociopolitical responses to them, summarized in this article, have led to the prediction of four-digit life expectancies of cohorts born in the 21st century and possibly even in the 20th. This prediction has attracted inevitable ridicule from prominent demographers, but being founded on science and sociology rather than on history it may be much more reliable than the extrapolations that those demographers presently prefer.

Cohort Studies↗

Demography of pediatric primary care in Europe: delivery of care and training.

OBJECTIVE: The Union of National European Pediatric Societies and Associations recognized the lack of information regarding demography of delivery of care and training for the doctors who care for children in Europe. Therefore, the Union of National European Pediatric Societies and Associations studied factors and explanations for the variation between countries regarding pediatric primary care (PPC) and community pediatrics (CP) as well as the extent of formal training provided for those who take care of children at the community level. METHODS: An explanatory letter and a questionnaire with 12 questions regarding delivery of PPC and CP and training was mailed to the president of each of 41 national pediatric societies in Europe. Statistical data about population, country's income, and infant mortality rate (IMR) were also obtained from World Health Organization data. Statistical analysis using multivariate and linear regression was conducted to ascertain which variables were associated with IMR. Descriptive statistics regarding demography and training are also reported. RESULTS: In 1999, a total of 167 444 pediatricians served a population of 158 million children who were younger than 15 years and living in the 34 reporting European countries. The median number of children per pediatrician was 2094; this varied from 401 to 15 150. A pediatric system for PPC existed in 12 countries; 6 countries had a general practitioner system, and a combined system was reported from 16 countries. Pediatricians did not work at the primary care level at all in 3 countries. In 14 of 34 countries, pediatricians worked in various aspects of community medicine, such as developmental pediatrics, well-infant care, school physicians, and so forth. IMR was lower in countries with a higher income per capita. In addition, a pediatric system of primary care had a protective effect when looking at IMR as the outcome. In 75% of the countries, some form of training in pediatric care for pediatricians was reported; the corresponding data for general practitioners was 60%. Community-based teaching programs were offered to pediatricians and general practitioners in a minority of countries only. CONCLUSIONS: At the end of the century, Europe showed a considerable variation in both delivery of PPC and training for doctors who care for children. This study identified 3 different health care delivery systems for PPC, as well as 2 types of pediatricians who work in community-based settings. Formal training in PPC or CP for both pediatricians and general practitioners varied from established curricula to no teaching at all. Economic and sociopolitical issues, professional power, and geographical and historical factors may explain the differences in pediatric care among European countries.

Adolescent↗

Diagnosing psychotic disorders in the emergency department in the context of substance use.

OBJECTIVE: For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode. METHODS: Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months). RESULTS: Of the 223 patients whose symptoms were diagnosed in the emergency department as a primary psychotic disorder, one-quarter were determined by the BELD to have substance-induced psychosis or no psychosis. Overall, the diagnostic agreement was only fair (kappa=.32). Patients with an emergency department diagnosis of primary psychosis were significantly more likely than those with an emergency department diagnosis of substance-induced psychosis to be hospitalized, started on antipsychotic medication, and referred to mental health services instead of treatment for substance use (p<.001). Patients given an emergency department diagnosis of primary psychosis who were found by the BELD to have substance-induced psychosis or no psychosis were significantly more likely to be treated for a psychotic disorder rather than for substance-induced psychosis (p<.001) CONCLUSIONS: Clinicians in psychiatric emergency departments appear to have a tendency to attribute psychotic symptoms to a primary psychotic disorder rather than to concurrent substance use. Given that the diagnosis has significant implications for future management, it is important to improve diagnostic approaches in the emergency department.

Adolescent↗

Genealogy construction in a historically isolated population: application to genetic studies of rheumatoid arthritis in the Pima Indian.

PURPOSE: Due to the characteristics of complex traits, many traits may not be amenable to traditional epidemiologic methods. We illustrate an approach that defines an isolated population as the "unit" for carrying out studies of complex disease. We provide an example using the Pima Indians, a relatively isolated population, in which the incidence and prevalence of Type 2 diabetes, gallbladder disease, and rheumatoid arthritis (RA) are significantly increased compared with the general U.S. population. A previous study of RA in the Pima utilizing traditional methods failed to detect a genetic effect on the occurrence of the disease. METHODS: Our approach involved constructing a genealogy for this population and using a genealogic index to investigate familial aggregation. We developed an algorithm to identify biological relationships among 88 RA cases versus 4,000 subsamples of age-matched individuals from the same population. Kinship coefficients were calculated for all possible pairs of RA cases, and similarly for the subsamples. RESULTS: The sum of the kinship coefficient among all combination of RA pairs, 5.92, was significantly higher than the average of the 4,000 subsamples, 1.99 (p < 0.001), and was elevated over that of the subsamples to the level of second cousin, supporting a genetic effect in the familial aggregation. The mean inbreeding coefficient for the Pima was 0.00009, similar to that reported for other populations; none of the RA cases were inbred. CONCLUSIONS: The Pima genealogy can be anticipated to provide valuable information for the genetic study of diseases other than RA. Defining an isolated population as the "unit" in which to assess familial aggregation may be advantageous, especially if there are a limited number of cases in the study population.

Arizona↗

Host specificity of insect herbivores in tropical forests.

Studies of host specificity in tropical insect herbivores are evolving from a focus on insect distribution data obtained by canopy fogging and other mass collecting methods, to a focus on obtaining data on insect rearing and experimentally verified feeding patterns. We review this transition and identify persisting methodological problems. Replicated quantitative surveys of plant-herbivore food webs, based on sampling efforts of an order of magnitude greater than is customary at present, may be cost-effectively achieved by small research teams supported by local assistants. Survey designs that separate historical and ecological determinants of host specificity by studying herbivores feeding on the same plant species exposed to different environmental or experimental conditions are rare. Further, we advocate the use of host-specificity measures based on plant phylogeny. Existing data suggest that a minority of species in herbivore communities feed on a single plant species when alternative congeneric hosts are available. Thus, host plant range limits tend to coincide with those of plant genera, rather than species or suprageneric taxa. Host specificity among tropical herbivore guilds decreases in the sequence: granivores > leaf-miners > fructivore > leaf-chewers = sap-suckers > xylophages > root-feeders, thus paralleling patterns observed in temperate forests. Differences in host specificity between temperate and tropical forests are difficult to assess since data on tropical herbivores originate from recent field studies, whereas their temperate counterparts derive from regional host species lists, assembled over many years. No major increase in host specificity from temperate to tropical communities is evident. This conclusion, together with the recent downward revisions of extremely high estimates of tropical species richness, suggest that tropical ecosystems may not be as biodiverse as previously thought.

Animals↗

[Study on the identification of HIV/AIDS and its surveillance system in rural areas of central China].

OBJECTIVE: To explore the effective strategies for human immunodeficiency virus (HIV) surveillance and identification in rural areas of central China. METHODS: In a selected rural prefecture area of central China, an epidemiological investigation was conducted for all reported HIV/AIDS cases. A historical and analytic review was performed, with particular interests in examining the HIV epidemic reporting and identification system. RESULTS: Among all 626 reported HIV-infected individuals in the selected prefecture, 86.1% (539/626) of them were infected through commercial plasma donation or clinically operated blood transfusion. With respect to disease surveillance and identification in the area, 52.2% (327/626) of all the cases were reported by hospitals or clinics. The number and proportion of HIV/AIDS cases identified or reported at county, prefecture, and provincial levels were 207 (33.1%), 303 (48.4%) and 116 (18.5%), respectively. The number and proportion of HIV/AIDS identified through specific epidemiological investigations and/or voluntary testing had been increased in recent years. In addition, among HIV/AIDS cases that were clinically identified, the proportion of those who were identified as outpatients had steadily increased,with the highest proportion (59.3%) observed in 2004. CONCLUSIONS: In rural areas of central China where the major mode of HIV transmission was through commercial plasma donation or clinically operated blood transfusion, hospitals and clinics seemed to have played and would continue to play important roles regarding HIV identification and surveillance. The role of institutions or settings at the prefecture level regarding HIV identification and surveillance should not be ignored.

Acquired Immunodeficiency Syndrome↗