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Misreporting is a common source of bias in population surveys involving sensitive topics such as sexual behaviours, abortion or criminal activity. To protect their privacy due to stigmatized or illegal behaviour, respondents tend to avoid fully disclosure of personal information deemed sensitive. This attitude however may compromise the results of survey studies. To circumvent this limitation, this article proposes a novel ego-centric sampling method (ECM) based on the respondent's peer networks to make indirect inferences on sensitive traits anonymously. Other than asking the respondents to report directly on their own behaviour, ECM takes into account the knowledge the respondents have about their social contacts in the target population. By using various scenarios and sensitive analysis on model and real populations, we show the high performance, that is low biases, that can be achieved using our method and the novel estimator. The method is also applied on a real-world survey to study traits of college students. This real-world exercise illustrates that the method is easy-to-implement, requiring few amendments to standard sampling protocols, and provides a high level of confidence on privacy among respondents. The exercise revealed that students tend to under-report their own sensitive and stigmatized traits, such as their sexual orientation. Little or no difference was observed in reporting non-sensitive traits. Altogether, our results indicate that ECM is a promising method able to encourage survey participation and reduce bias due to misreporting of sensitive traits through indirect and anonymous data collection. [ABSTRACT FROM AUTHOR]

Antimicrobial-resistant organisms (AMROs) can colonize people without symptoms for long periods of time, during which these agents can spread unnoticed to other patients in healthcare systems. The accurate identification of asymptomatic spreaders of AMRO in hospital settings is essential for supporting the design of interventions against healthcare-associated infections (HAIs). However, this task remains challenging because of limited observations of colonization and the complicated transmission dynamics occurring within hospitals and the broader community. Here, we study the transmission of methicillin-resistant Staphylococcus aureus (MRSA), a prevalent AMRO, in 66 Swedish hospitals and healthcare facilities with inpatients using a data-driven, agent-based model informed by deidentified real-world hospitalization records. Combining the transmission model, patient-to-patient contact networks, and sparse observations of colonization, we develop and validate an individuallevel inference approach that estimates the colonization probability of individual hospitalized patients. For both model-simulated and historical outbreaks, the proposed method supports the more accurate identification of asymptomatic MRSA carriers than other traditional approaches. In addition, in silica control experiments indicate that interventions targeted to inpatients with a high-colonization probability outperform heuristic strategies informed by hospitalization history and contact tracing. [ABSTRACT FROM AUTHOR]

Abstract Background Much research in epidemiology has been focused on evaluating conventional methods of control strategies in the event of an epidemic or pandemic. Travel restrictions are often suggested as an efficient way to reduce the spread of a contagious disease that threatens public health, but few papers have studied in depth the effects of travel restrictions. In this study, we investigated what effect different levels of travel restrictions might have on the speed and geographical spread of an outbreak of a disease similar to severe acute respiratory syndrome (SARS). Methods We used a stochastic simulation model incorporating survey data of travel patterns between municipalities in Sweden collected over 3 years. We tested scenarios of travel restrictions in which travel over distances >50 km and 20 km would be banned, taking into account different levels of compliance. Results We found that a ban on journeys >50 km would drastically reduce the speed and geographical spread of outbreaks, even when compliance is < 100%. The result was found to be robust for different rates of intermunicipality transmission intensities. Conclusion This study supports travel restrictions as an effective way to mitigate the effect of a future disease outbreak.

In this paper we present a family of models that allows us to estimate egos’ unobserved action dispositions from a joint behavioural outcome of a dyadic social interaction process of both egos’ and alters’ action dispositions. The method is put to test on a data set containing two different types of dyadic activities of high relevance for the spread of sexually transmitted infections (STI), condom use and anal sex. The data consists of individuals older than 15 years old who visited one of the nine youth clinics in the Vastra Gotaland region of Sweden between February 2010 and March 2011 for STI testing. This is hence a group of special interest for STI interventions. We cannot find any difference in condom disposition between women and men. Condoms are initially used more often in less risky types of relationships, especially if the partner ends up as a main partner. When studying the disposition towards anal sex we do however find a difference between men and women. Women are more against practising anal sex than men while the majority of men are neutral towards anal sex. [ABSTRACT FROM AUTHOR]

Background: There is an increasing trend toward international migration worldwide. With it comes a challenge for public health and public funded health care systems to meet the migrating population's health needs. Men who have sex with men are a key population for HIV, contributing an estimated 42% of new HIV cases in Europe in 2013. HIV monitoring data suggest that foreign-born MSM are not only exposed to a high risk of HIV before migration but also while living in Sweden. The aim of this study is to examine HIV testing prevalence and uptake of HIV prevention interventions among foreign-born MSM living in Sweden.Methods: A web survey available in English and Swedish was conducted from October 1 to October 30, 2013 via a Scandinavian Web community for Lesbian, Gay, Bisexual, Transgender and Intergender people. The web survey included modules on sociodemographics, condom use, sexual risk behaviour and HIV/STI testing experience. 244 eligible MSM participants born abroad and living in Sweden participated in the study. Descriptive and inferential analysis was performed.Results: Half of the foreign-born MSM participants in this study had been tested for HIV during the last 12 months. Participants who had lived in Sweden less than or equal to 5 years were more likely to have been tested for HIV during the last 12 months. Having talked about HIV/STI with a prevention worker during the past year was associated with having been tested for HIV. Requested services among the majority of participants were HIV rapid test, anonymous HIV testing, HIV/STI testing outside of the health care setting and MSM-friendly clinics.Conclusion: Efforts are needed to promote HIV testing among foreign-born MSM. Peer outreach, individual and group counselling may be preferred interventions to do so. In addition, it is critically important to increase HIV testing among foreign-born MSM who have lived in Sweden for more than five years. Further research should explore if scale up of implementation of requested services may increase frequency of HIV testing and detection of new cases linked to treatment among foreign-born MSM living in Sweden. [ABSTRACT FROM AUTHOR]

Author(s): Fredrik Liljeros (corresponding author) [1]; Christofer R. Edling [1]; Luís A. Nunes Amaral [2]; H. Eugene Stanley [2]; Yvonne Ãberg [1] Unlike clearly defined 'real-world' networks [1], social networks [...]

Background: Respondent driven sampling (RDS) was designed to study ‘hidden’ populations, for which there are no available sampling frame. RDS has been shown to recruit far into social networks of the study population and achieve unbiased estimates when certain assumptions are fulfilled. Web-based respondent driven sampling (WebRDS) has been implemented among MSM in Vietnam and produced a sufficient sample of MSM. In order to see if WebRDS could work in a ‘hidden’ population in a high-income setting, we performed a WebRDS among MSM in Sweden to study a sensitive topic, sexual risk behaviour for HIV/STI and Internet use. Methods: A cross-sectional survey was implemented between July 11, 2012 and January 21, 2013 by using a WebRDS software. Men, fifteen years old or above, who reported having ever had sex with another man were included. The web-survey explored sociodemographics, sexual risk behaviour for HIV/STI and Internet use. Results: The WebRDS process created a sample of 123 eligible respondents. The mean age among participants was 32 years old. All respondents reported having had unprotected anal intercourse (UAI) with at least one regular and one casual sex partner during the last 12 months. On average participants reported having had UAI with three casual sexual partners and in total having had seven casual sex partners during the last 12 months. Conclusion: The WebRDS produced a sample of Internet-using MSM in Sweden who all reported sexual risk behaviour for HIV/STI during the last 12 months. It holds promise for future online studies among MSM and a possibility to reach MSM at risk for HIV/STI with interventions or information. Some challenges were found including short recruitment chains, and further research need to address how to optimize WebRDS online recruitment methods in high income settings. [ABSTRACT FROM AUTHOR]

Most centralities proposed for identifying influential spreaders on social networks to either spread a message or to stop an epidemic require the full topological information of the network on which spreading occurs. In practice, however, collecting all connections between agents in social networks can be hardly achieved. As a result, such metrics could be difficult to apply to real social networks. Consequently, a new approach for identifying influential people without the explicit network information is demanded in order to provide an efficient immunization or spreading strategy, in a practical sense. In this study, we seek a possible way for finding influential spreaders by using the social mechanisms of how social connections are formed in real networks. We find that a reliable immunization scheme can be achieved by asking people how they interact with each other. From these surveys we find that the probabilistic tendency to connect to a hub has the strongest predictive power for influential spreaders among tested social mechanisms. Our observation also suggests that people who connect different communities is more likely to be an influential spreader when a network has a strong modular structure. Our finding implies that not only the effect of network location but also the behavior of individuals is important to design optimal immunization or spreading schemes. [ABSTRACT FROM AUTHOR]

Author(s): Fredrik Liljeros (corresponding author) [1, 2]; Christofer R. Edling [2]; H. Eugene Stanley [3]; Y. Ãberg [2]; Luis A. N. Amaral [4] Liljeros et al . reply Jones and [...]

The modern medical treatment of HIV with antiretroviral therapy (ART) has drastically reduced the morbidity and mortality in patients infected with this virus. ART has also been shown to reduce the transmission risk from individual patients as well as the spread of the infection at the population level. This position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy is based on a workshop organized in the fall of 2012. It summarizes the latest research and knowledge on the risk of HIV transmission from patients on ART, with a focus on the risk of sexual transmission. The risk of transmission via shared injection equipment among intravenous drug users is also examined, as is the risk of mother-to-child transmission. Based on current knowledge, the risk of transmission through vaginal or anal intercourse involving the use of a condom has been judged to be minimal, provided that the person infected with HIV fulfils the criteria for effective ART. This probably also applies to unprotected intercourse, provided that no other sexually transmitted infections are present, although it is not currently possible to fully support this conclusion with direct scientific evidence. ART is judged to markedly reduce the risk of blood-borne transmission between people who share injection equipment. Finally, the risk of transmission from mother to child is very low, provided that ART is started well in advance of delivery. [ABSTRACT FROM AUTHOR]

Organizational growth processes have consistently been shown to exhibit a fatter-than-Gaussian growth-rate distribution in a variety of settings. Long periods of relatively small changes are interrupted by sudden changes in all size scales. This kind of extreme events can have important consequences for the development of biological and socio-economic systems. Existing models do not derive this aggregated pattern from agent actions at the micro level. We develop an agent-based simulation model on a social network. We take our departure in a model by a Schwarzkopf et al. on a scale-free network. We reproduce the fat-tailed pattern out of internal dynamics alone, and also find that it is robust with respect to network topology. Thus, the social network and the local interactions are a prerequisite for generating the pattern, but not the network topology itself. We further extend the model with a parameter that weights the relative fraction of an individual's neighbours belonging to a given organization, representing a contextual aspect of social influence. In the lower limit of this parameter, the fraction is irrelevant and choice of organization is random. In the upper limit of the parameter, the largest fraction quickly dominates, leading to a winner-takes-all situation. We recover the real pattern as an intermediate case between these two extremes. [ABSTRACT FROM AUTHOR]

We investigate what structural aspects of a collection of twelve empirical temporal networks of human contacts are important to disease spreading. We scan the entire parameter spaces of the two canonical models of infectious disease epidemiology—the Susceptible-Infectious-Susceptible (SIS) and Susceptible-Infectious-Removed (SIR) models. The results from these simulations are compared to reference data where we eliminate structures in the interevent intervals, the time to the first contact in the data, or the time from the last contact to the end of the sampling. The picture we find is that the birth and death of links, and the total number of contacts over a link, are essential to predict outbreaks. On the other hand, the exact times of contacts between the beginning and end, or the interevent interval distribution, do not matter much. In other words, a simplified picture of these empirical data sets that suffices for epidemiological purposes is that links are born, is active with some intensity, and die. [ABSTRACT FROM AUTHOR]

Objectives: Survey data from men who have sex with men (MSM) in Asian cities indicate ongoing and drastic increases in HIV prevalence. It is unknown which behavioural factors are most important in driving these epidemics. We aimed to analyse detailed sexual behaviour data among MSM in Vietnam and to model HIV transmission using improved assumptions on sexual network structure. Setting: Vietnam. Participants: Internet-using men who had ever had sex (any type) with a man, aged >18 years and living in Vietnam. The study was cross-sectional, population-based and performed in 2012, using online respondent-driven sampling. The Internet-based survey instrument was completed by 982 participants, of which 857 were eligible. Questions included sociodemographyand retrospective sexual behaviour, including number of unprotected anal sex (UAS) acts per partner. Primary and secondary outcome measures: Estimated basic reproductive number over 3 months as a function of transmission risk per UAS act; frequency distributions of number of UAS partners and UAS acts during last 3 months. Results: 36% (CI 32% to 42%) reported UAS at least once during the last 3 months. 36% (CI 32% to 41%) had ever taken an HIV test and received the result. UAS partner numbers and number of UAS acts were both highly skewed and positively correlated. Using a weighted configuration model, taking into account partner numbers, frequency of UAS and their correlations, we estimated the basic reproductive number (R0) over 3 months. The results indicated rapid transmission overa wide range of values of per-act transmissibility. Conclusions: Men with multiple partners had unexpectedly high UAS frequency per partner, paired with low HIV testing rates. The study highlights the importance of collecting data on frequency of UAS acts and indicates the need to rapidly scale-up HIV prevention services and testing opportunities for MSM in Vietnam. [ABSTRACT FROM AUTHOR]

A criminal career can be either general, with the criminal committing different types of crimes, or specialized, with the criminal committing a specific type of crime. A central problem in the study of crime specialization is to determine, from the perspective of the criminal, which crimes should be considered similar and which crimes should be considered distinct. We study a large set of Swedish suspects to empirically investigate generalist and specialist behavior in crime. We show that there is a large group of suspects who can be described as generalists. At the same time, we observe a non-trivial pattern of specialization across age and gender of suspects. Women are less prone to commit crimes of certain types, and, for instance, are more prone to specialize in crimes related to fraud. We also find evidence of temporal specialization of suspects. Older persons are more specialized than younger ones, and some crime types are preferentially committed by suspects of different ages. [ABSTRACT FROM AUTHOR]

Objective: Lack of representative data about hidden groups, like men who have sex with men (MSM), hinders an evidence-based response to the HIV epidemics. Respondent-driven sampling (RDS) was developed to overcome sampling challenges in studies of populations like MSM for which sampling frames are absent. Internet-based RDS (webRDS) can potentially circumvent limitations of the original RDS method. We aimed to implement and evaluate webRDS among a hidden population. Methods and Design:This cross-sectional study took place 18 February to 12 April, 2011 among MSM in Vietnam. Inclusion criteria were men, aged 18 and above, who had ever had sex with another man and were living in Vietnam. Participants were invited by an MSM friend, logged in, and answered a survey. Participants could recruit up to four MSM friends. We evaluated the system by its success in generating sustained recruitment and the degree to which the sample compositions stabilized with increasing sample size. Results: Twenty starting participants generated 676 participants over 24 recruitment waves. Analyses did not show evidence of bias due to ineligible participation. Estimated mean age was 22 years and 82% came from the two large metropolitan areas. 32 out of 63 provinces were represented. The median number of sexual partners during the last six months was two. The sample composition stabilized well for 16 out of 17 variables. Conclusion: Results indicate that webRDS could be implemented at a low cost among Internet-using MSM in Vietnam. WebRDS may be a promising method for sampling of Internet-using MSM and other hidden groups. [ABSTRACT FROM AUTHOR]

Background: The Internet has become an important venue for seeking sexual partners and may facilitate transmission of sexually transmitted infections. Methods: We examined a 64-day data log of flirt messages expressing sexual interest among MSM within the Qruiser.com community. We used logistic regression to analyze characteristics of MSM sending and receiving flirt messages and negative binomial regression to examine individual activity and popularity. The structural properties, including the core structure of the flirt network, were analyzed. Results: The MSM population consisted of approximately 40% homosexuals and 37% bisexuals, while the remaining 23% included men who identified as heterosexual but searched for sex with men and "experimental". MSM were more likely to send flirt messages if they were homosexual and aged 40+ years; young people aged <30 years were more likely to receive a flirt. Possession of a webcam was strongly associated with both sending flirt messages and being a flirt target. The distributions of flirts sent (max kout = 2162) and received (max kin = 84) were highly heterogeneous. Members in central cores were more likely homosexuals, singles, and aged 31-40 years. The probability of a matched flirt (flirt returned from target) increased from 1% in the outer core to 18% in the central core (core size = 4). Discussion: The flirt network showed high degree heterogeneity similar to the structural properties of real sexual contact networks with a single central core. Further studies are needed to explore use of webcam for Internet dating [ABSTRACT FROM AUTHOR]

Decreasing the number of people who must be vaccinated to immunize a community against an infectious disease could both save resources and decrease outbreak sizes. A key to reaching such a lower threshold of immunization is to find and vaccinate people who, through their behavior, are more likely than average to become infected and to spread the disease further. Fortunately, the very behavior that makes these people important to vaccinate can help us to localize them. Earlier studies have shown that one can use previous contacts to find people that are central in static contact networks. However, real contact patterns are not static. In this paper, we investigate if there is additional information in the temporal contact structure for vaccination protocols to exploit. We answer this affirmative by proposing two immunization methods that exploit temporal correlations and showing that these methods outperform a benchmark static-network protocol in four empirical contact datasets under various epidemic scenarios. Both methods rely only on obtainable, local information, and can be implemented in practice. For the datasets directly related to contact patterns of potential disease spreading (of sexually-transmitted and nosocomial infections respectively), the most efficient protocol is to sample people at random and vaccinate their latest contacts. The network datasets are temporal, which enables us to make more realistic evaluations than earlier studies-we use only information about the past for the purpose of vaccination, and about the future to simulate disease outbreaks. Using analytically tractable models, we identify two temporal structures that explain how the protocols earn their efficiency in the empirical data. This paper is a first step towards real vaccination protocols that exploit temporalnetwork structure-future work is needed both to characterize the structure of real contact sequences and to devise immunization methods that exploit these. [ABSTRACT FROM AUTHOR]

Sexual contact patterns, both in their temporal and network structure, can influence the spread of sexually transmitted infections (STI). Most previous literature has focused on effects of network topology; few studies have addressed the role of temporal structure. We simulate disease spread using SI and SIR models on an empirical temporal network of sexual contacts in high-end prostitution. We compare these results with several other approaches, including randomization of the data, classic mean-field approaches, and static network simulations. We observe that epidemic dynamics in this contact structure have well-defined, rather high epidemic thresholds. Temporal effects create a broad distribution of outbreak sizes, even if the per-contact transmission probability is taken to its hypothetical maximum of 100%. In general, we conclude that the temporal correlations of our network accelerate outbreaks, especially in the early phase of the epidemics, while the network topology (apart from the contact-rate distribution) slows them down. We find that the temporal correlations of sexual contacts can significantly change simulated outbreaks in a large empirical sexual network. Thus, temporal structures are needed alongside network topology to fully understand the spread of STIs. On a side note, our simulations further suggest that the specific type of commercial sex we investigate is not a reservoir of major importance for HIV. [ABSTRACT FROM AUTHOR]

Networks portray a multitude of interactions through which people meet, ideas are spread and infectious diseases propagate within a society. Identifying the most efficient 'spreaders' in a network is an important step towards optimizing the use of available resources and ensuring the more efficient spread of information. Here we show that, in contrast to common belief, there are plausible circumstances where the best spreaders do not correspond to the most highly connected or the most central people. Instead, we find that the most efficient spreaders are those located within the core of the network as identified by the k-shell decomposition analysis, and that when multiple spreaders are considered simultaneously the distance between them becomes the crucial parameter that determines the extent of the spreading. Furthermore, we show that infections persist in the high-k shells of the network in the case where recovered individuals do not develop immunity. Our analysis should provide a route for an optimal design of efficient dissemination strategies. [ABSTRACT FROM AUTHOR]

Contact networks are extracted for 295,108 inpatients over a two-year period from a database used for administering a local public healthcare system that serves 1.8 million individuals in Stockholm county. Structural and dynamic properties of the network that are important for the transmission of contagious diseases are analyzed by methods derived from network epidemiology. The contact networks are found to be very much determined by an extreme (age-independent) variation in the duration of hospital stays and the hospital structure. The structure of contacts between inpatients are found to exhibit structural properties such as a high level of transitivity, assortativity, and variation by number of contacts, which are likely to be of importance for the transmission of less contagious diseases. If these properties are considered when designing prevention programs, the risk and effect of epidemic outbreaks may be decreased. [ABSTRACT FROM AUTHOR]

The article reports a study which analyzed the sociodemographic characteristics of the spatial bridgers and the spread of chlamydia in Sweden. Statistical analysis was used to characterize the individuals engaged in spatial bridging behavior. The results showed that number of sociodemographic information could not be used to characterize the spatial bridgers. It was pointed out that intervention against chlamydia, spatial bridgers shall be considered as important for sustaining the disease.

The structures of sexual networks are essential for understanding the dynamics of sexually transmitted infections. Standard epidemiological models largely disregard the complex patterns of intimate contacts. Social network analysis offers important insight into how to conceptualize and model social interaction and has the potential to greatly enhance the understanding of disease epidemics. [Copyright &y& Elsevier]

Abstract: We model a sexually transmitted infection in a network population where individuals have different numbers of partners, separated into steady and casual partnerships, where the risk of transmission is higher in steady partnerships. An individual''s number of partners of the two types defines its degree, and the degrees in the community specify the degree distribution. For this structured network population a simple model for disease transmission is defined and the basic reproduction number is derived, being a size-biased (i.e. biasing individuals with many partners) average number of new infections caused by individuals during the early stages of the epidemic. First a homosexual population is considered and then a heterosexual population. The heterosexual model is fitted to data from a census survey on sexual activity from the Swedish island of Gotland. The main empirical finding is that, for relevant transmission rates, the effect that so-called superspreaders have on is over-estimated when not admitting for different types of partnerships. [Copyright &y& Elsevier]

During epidemic control, containment of the disease is usually achieved through increasing a devoted resource to reduce the infectiousness. However, the impact of this resource expenditure has not been studied quantitatively. For disease spread, the recovery rate can be positively correlated with the average amount of resource devoted to infected individuals. By incorporating this relation we build a novel model and find that insufficient resource leads to an abrupt increase in the infected population size, which is in marked contrast with the continuous phase transitions believed previously. Counterintuitively, this abrupt phase transition is more pronounced in less contagious diseases. Furthermore, we find that even for a single infection source, the public resource needs to be available in a significant amount, which is proportional to the total population size, to ensure epidemic containment. Our findings provide a theoretical foundation for efficient epidemic containment strategies in the early stage. [ABSTRACT FROM AUTHOR]

During epidemic control, containment of the disease is usually achieved through increasing a devoted resource to reduce the infectiousness. However, the impact of this resource expenditure has not been studied quantitatively. For disease spread, the recovery rate can be positively correlated with the average amount of resource devoted to infected individuals. By incorporating this relation we build a novel model and find that insufficient resource leads to an abrupt increase in the infected population size, which is in marked contrast with the continuous phase transitions believed previously. Counterintuitively, this abrupt phase transition is more pronounced in less contagious diseases. Furthermore, we find that even for a single infection source, the public resource needs to be available in a significant amount, which is proportional to the total population size, to ensure epidemic containment. Our findings provide a theoretical foundation for efficient epidemic containment strategies in the early stage.

Methicillin-resistant Staphylococcus aureus (MRSA) is a continued threat to human health in both community and healthcare settings. In hospitals, control efforts would benefit from accurate estimation of asymptomatic colonization and infection importation rates from the community. However, developing such estimates remains challenging due to limited observation of colonization and complicated transmission dynamics within hospitals and the community. Here, we develop an inference framework that can estimate these key quantities by combining statistical filtering techniques, an agent-based model, and real-world patient-to-patient contact networks, and use this framework to infer nosocomial transmission and infection importation over an outbreak spanning 6 years in 66 Swedish hospitals. In particular, we identify a small number of patients with disproportionately high risk of colonization. In retrospective control experiments, interventions targeted to these individuals yield a substantial improvement over heuristic strategies informed by number of contacts, length of stay and contact tracing., Competing Interests: SP, FM, FL, HM No competing interests declared, JS Discloses partial ownership of SK Analytics., (© 2018, Pei et al.)