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Insight is a complex and multidimensional phenomenon. Metacognition, awareness of illness or anosognosia are some of the terms used to designate this feature of the mental state exam.
To attempt to explore the evolution of the concept of insight as a psychiatric symptom over the years and to bring up some up-to-date features on this theme.
Literature review, using the most relevant papers, with the keywords “psychiatric insight”, “awareness of illness”, “metacognition” and “phenomenology”.
The term ‘insight’ has been described since 1896 when Kraepelin had noticed that patients with dementia praecox were unaware of their condition. Nowadays, it is recognized in several psychiatric disorders, with different meanings in each one. Overall, insight in psychiatry involves an attempt to see one’s thinking and behaviour ‘objectively’ and comparing it to some representation of mental health. Impaired insight has been linked to poor treatment compliance and outcomes, overall symptom severity, higher relapse, lower self-esteem, and impaired psychosocial functioning. White matter and connectivity problems may be related to poorer insight, as well as impaired frontal lobe functioning. In psychotic disorders, lack of insight is a primary symptom with poorer outcomes. Regarding affective disorders, the lower the mood the better the insight. Neuroimaging has been correlating insight with the inferior frontal gyrus, anterior insula, inferior parietal lobule, and ventromedial prefrontal cortex. In everyday practice, there are scales used to assess insight.
Inferences about patients’ insight are important to evaluate severity of illness, suicidal risk, compliance, and response to treatment.
Since Ancient Times, Man has tried to analyze the passage of time, looking for repetitions, relating them to space to build a notion of a mechanical and chronological time. The idea and problem of time play a central role in both modern philosophy and psychiatry. Many authors contributed to the notion of “lived time” and placed the focus on how time is lived and perceived by the individual. Even though the notion of “time assimilated in space” has an important role in psychiatric nosology, the “lived time” has a psychopathological impact and is a field of study and debate.
This work aims to acknowledge the relevance of the experience of temporal structures (past, present and future) and how they relate to psychopathology.
We did a non-systematic literature revision in the main databases.
Phenomenological psychopathology has been profoundly interested in the philosophical discussions on the nature of time and its relation with the subject’s experience and condition. For instance, the melancholic experience, the maniac experience and the schizophrenic experience constitute changes in how time structures are perceived and lived by the individual.
Temporality has drawn attention to researchers from many different areas of study, having as of this day many approaches possible. It is important to know those contributions and conceptualizations in order to improve as a clinician.
Nowadays, ‘Acute and transient psychotic disorders’ in ICD-10 and ‘Brief psychotic disorders’ in DSM-5 are both classifications of the same clinical entity. Over the years, several concepts have been formulated to define the same syndrome.
To explore the historical evolution of brief psychotic disorders and relate them to current nosologies.
Literature review, using the most relevant papers, with the keywords “brief psychosis”, “bouffée délirante”, “cycloid psychosis”, “psychogenic psychosis”, “atypical psychosis” and “holodysphrenia”.
Initially, in 1896, Kahlbaum coined the term ‘dysphrenia’, a group of severe form of psychosis that remitted without showing the typical sequence of disease states and without leaving a lasting alteration. Later, Kraepelin included this kind of disorder in manic depressive illness, which he first named as ‘periodic delirium’ and then as ‘delirious mania’. Magnan, in the pre-Kraepelinian era, created the term ‘bouffée délirante’, a sudden onset of delusional ideas with rapid evolution and intense symptomatology with complete remission usually followed after a short time. Later on, Henry Ey grabbed this entity and renewed it, contrasting it to the defined concept of schizophrenia. Other psychiatric schools have proposed numerous designations: ‘cycloid psychosis’ by Kleist from the German school, ‘psychogenic psychosis’ by Wimmer of the Scandinavian school and ‘holodysphrenias’ by Barahona-Fernandes from the Portuguese school. Cultural variants are also observed, as ‘amok’ seen in Malaysia or ‘shinbyung’ in Korea.
The intensity and polymorphism of brief psychosis present a clinical challenge. The historical evolution may be helpful on recognizing this entity in current clinical practice.
Plants not only respond to herbivorous damage but adjust their defense system after egg deposition by pest insects. Thereby, parasitoids use oviposition-induced plant volatiles to locate their hosts. We investigated the olfactory behavioral responses of Trichogramma pretiosum Riley, 1879 (Hymenoptera: Trichogrammatidae) to volatile blends emitted by maize (Zea mays L.) with singular and stacked events after oviposition by Spodoptera frugiperda Smith, 1797 (Hymenoptera: Trichogrammatidae) moths. Additionally, we examined possible variations in gene expression and on oviposition-induced volatiles. We used a Y-tube olfactometer to test for the wasp responses to volatiles released by maize plants oviposited by S. frugiperda and not-oviposited plants. Using the real-time PCR technique (qRT-PCR), we analyzed the expression of lipoxygenase and three terpene synthases genes, which are enzymes involved in the synthesis of volatile compounds that attract parasitoids of S. frugiperda. Olfactometer tests showed that T. pretiosum is strongly attracted by volatiles from transgenic maize emitted by S. frugiperda oviposition (VTPRO 3, more than 75% individuals were attracted). The relative expression of genes TPS10, LOX e STC was higher in transgenic hybrids than in the conventional (isogenic line) hybrids. The GC-MS analysis revealed that some volatile compounds are released exclusively by transgenic maize. This study provides evidence that transgenic hybrids enhanced chemical cues under oviposition-induction and helped to increase T. pretiosum efficiency in S. frugiperda control. This finding shows that among the evaluated hybrids, genetically modified hybrids can improve the biological control programs, since they potentialize the egg parasitoid foraging, integrating pest management.
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04–2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04–3.80; immunosuppression: HR = 5.06, 95% CI 2.26–11.41; hypertension: HR = 2.30, 95% CI 1.77–3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
Critical cascades are found in many self-organizing systems. Here, we examine critical cascades as a design paradigm for logic and learning under the linear threshold model (LTM), and simple biologically inspired variants of it as sources of computational power, learning efficiency, and robustness. First, we show that the LTM can compute logic, and with a small modification, universal Boolean logic, examining its stability and cascade frequency. We then frame it formally as a binary classifier and remark on implications for accuracy. Second, we examine the LTM as a statistical learning model, studying benefits of spatial constraints and criticality to efficiency. We also discuss implications for robustness in information encoding. Our experiments show that spatial constraints can greatly increase efficiency. Theoretical investigation and initial experimental results also indicate that criticality can result in a sudden increase in accuracy.
Harvest weed seed control (HWSC) is a weed management technique that intercepts and destroys weed seeds before they replenish the soil weed seedbank and can be used to control herbicide-resistant weeds in global cropping systems. Wild radish (Raphanus raphanistrum L.) is a problematic, globally distributed weed species that is considered highly susceptible to HWSC, as it retains much of its seed on the plant during grain harvest. However, previous studies have demonstrated that R. raphanistrum is capable of adapting its life cycle, in particular its flowering time, to allow individuals more time to mature and potentially shed seeds before harvest, thereby evading HWSC interception. This study compared the vegetative growth plus physiological and ecological fitness of an early-flowering R. raphanistrum biotype with an unselected genetically related biotype to determine whether physiological costs of early flowering exist when in competition with wheat (Triticum aestivum L.). Early flowering time adaptation in R. raphanistrum did not change the relative growth rate or competitive ability of R. raphanistrum. However, the height of first flower was reduced in the early flowering time–selected population, indicating that this population would retain more pods below the typical harvest cutting height (15 cm) used in HWSC. The presence of wheat competition (160 to 200 plants m−2) increased flowering height in the early flowering time–selected population, which would likely increase the susceptibility of early-flowering R. raphanistrum plants to HWSC. Overall, early-flowering adaption in R. raphanistrum is a possible strategy to escape being captured by the HWSC; however, increasing crop competition is likely to be an effective strategy to maintain the effectiveness of HWSC.
The preservation of Military Macaw Ara militaris in Mexico required the implementation of a nationwide assessment evaluating its vulnerability using IUCN criteria. With the combined effort of several institutions, the abundance, location, dispersion, habitat availability, and climatic conditions of areas occupied by the species were determined. Although the species’ extent of occurrence is extensive (263,919 km2) only 29% of this constitutes area of occupancy. Published estimates indicate a series of isolated populations containing from four macaws to 215. Macaws occurred in 35 populations in four regions of 16 states containing an estimated 1,563–3,263 macaws; lower than required for long-term viability. Within regions, neighbouring populations were separated by an average of 68 km. The extent of occurrence is heterogeneous, and macaws inhabit areas that differ in elevation, precipitation, temperature, and forest cover. Higher local abundances occur in landscapes where annual precipitation is ≥1,100 mm, and primary forest availability ≥1,800 km2. Although the existence of undetected macaw groups in Mexico is possible, these are likely to contain only small numbers of individuals, as most detected areas with macaws contain less than 40 individuals, and larger concentrations are more likely to be noticed due to their conspicuous behaviour. The species is threatened primarily by its low overall abundance, fragmented distribution, and forest loss around populations with the highest abundance. With the information generated, it is possible to design and implement specific management and conservation strategies at different geographic scales for the recovery and maintenance of the species in Mexico. It is necessary to strengthen collaborative programmes among conservation organizations, government agencies, and local communities in each region of the country to organize and finance community-based actions such as monitoring, habitat restoration, protection from poaching and the creation of a network of conservation corridors and macaw reserves focused on conservation.
During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.
We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.
Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.
Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.
Four new actinospore types belonging to the sphaeractinomyxon collective group (Cnidaria, Myxosporea) are described from the coelomic cavity of a marine Baltidrilus sp. (Oligochaeta, Naididae) inhabiting a northern Portuguese estuary. Host identification supports the usage of marine oligochaetes, namely of the family Naididae Ehrenberg, 1828, as definitive hosts for myxosporeans inhabiting estuarine/marine environments. The absence of mixed infections in the host specimens analysed is suggested to reflect the influence of host-, parasite- and environmental-related factors regulating myxosporean–annelid interactions. Molecular analyses matched the SSU rDNA sequences of three of the four new types with those of mugiliform-infecting Myxobolus spp., namely Myxobolus mugiliensis and a Myxobolus sp. from flathead grey mullet Mugil cephalus, and Myxobolus labrosus from thicklip grey mullet Chelon labrosus. These results directly link, for the first time, the sphaeractinomyxon collective group to a myxospore counterpart, further confirming their previously hypothesized specific involvement in the life cycle of myxobolids that infect mullets. Acknowledging this life cycle relationship, the functionality of the sphaeractinomyxon morphotype is suggested to have been decisive for the evolutionary hyperdiversification of the genus Myxobolus in mullets. Unlike other actinospore morphotypes, sphaeractinomyxon lack valvular processes, which implies a limited capability for buoyancy. Considering the benthic-feeding nature of mullets, this feature is most likely crucial in promoting successful transmission to the vertebrate host.
Bipartite networks represent pairwise relationships between nodes belonging to two distinct classes. While established methods exist for analyzing unipartite networks, those for bipartite network analysis are somewhat obscure and relatively less developed. Community detection in such instances is frequently approached by first projecting the network onto a unipartite network, a method where edges between node classes are encoded as edges within one class. Here we test seven different projection schemes by assessing the performance of community detection on both: (i) a real-world dataset from social media and (ii) an ensemble of artificial networks with prescribed community structure. A number of performance and accuracy issues become apparent from the experimental findings, especially in the case of long-tailed degree distributions. Of the methods tested, the “hyperbolic” projection scheme alleviates most of these difficulties and is thus the most robust scheme of those tested. We conclude that any interpretation of community detection algorithm performance on projected networks must be done with care as certain network configurations require strong community preference for the bipartite structure to be reflected in the unipartite communities. Our results have implications for the analysis of detected community structure in projected unipartite networks.
This study was designed to verify whether fluoxetine (FL), a serotonin (5-HT) re-uptake inhibitor, would interfere with nortriptyline (NT), a biphasic U-shaped curvilinear dose-response relationship recently described in our laboratory. We associated 10 mg/kg NT or vehicle to 0, 5, 10, 20 and 40 mg/kg FL, in one group, and 10 mg FL or vehicle to 0, 5, 10, 20 and 40 mg/kg NT, in another group, 30 min before the tail suspension test (TST) in mice. Although we were not able to confirm a synergistic effect between FL and NT, FL-NT association seems to require higher doses of NT to block its own anti-immobility effect at high doses, thus widening NT effective antidepressant-like dose range in mice submitted to TST.
Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.
We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.
We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).
Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.
The co-occurence of depression and congestive heart failure (CHF) represents a great challenge and opportunity for those interested in exploring the complex interactions between the brain and the heart. The cumulative effect of these medical conditions has an evident effect on quality of life.
The objective of this study was to evaluate the quality of life and symptoms of depression among a group of 103 adult patients with CHF recruited from an outpatient cardiology practice and determine the factors related to a poor outcome. The challenge was to identify the group of patients who are at risk of suffering from depression and poor quality of life as early as possible and try to provide them appropriate psychiatric treatment.
The results of this study lead us to suggest that an older female patient with a more severe illness (NYHA ≥ II) and renal impairment is at great risk of presenting simultaneously depressive sintomatology and poorer perception of quality of life, thus beeing a strong candidate to a very negative evolution of her cardiac condition.
These findings allow us to define a group of patients that would surely benefit from a closer psychiatric and cardiac management.
The high prevalence of depression, the complexity of managing it and the recent evidence demonstrating that depression is associated with increased morbidity and mortality suggests that is important the development of collaborative and integrative approaches combining the medical expertise and interest of psychiatrists, cardiologists and internists and the involvement of psychologists and social workers.
More than one in five women die from ischemic heart disease (IHD) and given their longer life expectancy, these numbers are expected to rise and so is the concomitant disability burden. Women are still under-represented in cardiovascular research with much of the knowledge from clinical trials conducted largely with men being applied to women, disregarding potential gender differences in both biomedical and psychosocial domains. Gender differences in both pathophysiology and biological risk factors may underlie distinct prevalence rates, symptom profiles and even medical outcomes. Not only do women have more persistent and atypical symptoms, but have more frequent hospitalizations, lower rates of general well-being and increased functional limitations in daily life activities. Gender related specificities regarding psychosocial risk factors might further explain this. The authors review the key issues on this topic and outline suggestions for future research. Ultimately, a better understanding of this matter will translate not only into improved clinical management of female patients but also genderspecific strategies in the prevention of CVD.
Women remain under-represented in cardiovascular clinical trials even though, in Europe, 55% of female deaths are caused by cardiovascular disease. Women have less extensive and less severe disease but poorer outcome compared to men. Gender related specificities in risk factors and adaptation to illness, or both, might further explain this.
As part of a larger study examining the impact of depression and type D personality in cardiac patients, a sample of 243 (148 females) highly educated controls (mean age = 41 ± 10 years) were evaluated on demographic, behavioral, psychosocial [BDI-II (Beck Depression Inventory, 2nd edition); HADS (Hamilton Anxiety and Depression Scale); DS-14 (Type D personality)] and clinical risk factors known to be implicated in cardiovascular disease.
Women had significantly less alcohol consumption (p< .001) and exercise (p< .05), but had higher cholesterol and triglycerides (p < .05) than men. Past psychiatric complaints (p< .05), current depression (p< .05), moderate levels of anxiety (p< .05), and negative affectivity (p< .05) were all significantly more common among women. Age-adjusted multivariate analyses confirmed that lack of exercise together with dietary concerns and increased levels of mental distress (depression, anxiety and negative affectivity) tend to cluster in women. Importantly, no gender differences were detected in traditional cardiovascular risk factors such as hypertension and diabetes, or Type D personality prevalence.
In a highly educated sample, women presented with increased behavioral and psychosocial difficulties than men. These vulnerabilities may augment the impact of putative pathophysiological risk factors for cardiac disease.
Most reactions to grief are adaptive. However, there is the possibility that some individuals present a complicated grief disorder, where there is a pathological intensification of symptoms lasting more than 6 months, deserving special treatment.
Evaluate the effectiveness of two types of intervention in complicated grief: group intervention (GI) and cognitive-narrative (CN) therapy.
Patients in a complicated grief process were selected (n = 70), and distributed in three groups: cognitive–narrative therapy group (CNTG), group intervention group (GIG) and a control group (CG). Inclusion criteria: adults, with a reference to mourning situation, with personal meaning, for over six months and results in ICG ≥30points (cutoff). The Inventory of Complicated Grief (ICG), the Center for epidemiologic studies depression scale (CES-D) and the trauma questionnaire (ICD-11) were used. Follow-up was performed 3 months after the end of each intervention. Data analysis was performed using the statistical package from social sciences (SPSS 20).
With respect to complicated grief symptoms (CGx) and depression symptoms (Dx) there were statistically significant differences between the CNTG and the CG, but not with the GIG. There was no statistically significant effect in post-traumatic symptoms (PTx), even though both interventions had a slight decrease. When the CNTG and the GIG were directly compared, there was only a statistically significant difference between PTx.
In our single center cohort, CNTG was a more effective intervention in complicated grief patients for CGx and Dx reduction. For PTx, no intervention was superior. Larger multi-center studies are needed to validate these results.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Disgust propensity (DP) and disgust sensitivity (DS) contribute to individual differences in the experience of disgust. Studies have shown that DP and DS are predictive of some anxiety (e.g., spider phobia and blood-injection-injury phobia) and obsessive-compulsive and related disorders.
The aim of this study was to develop and validate a Portuguese version of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R; van Overveld= et al., 2006) for use in Portuguese-speaking populations.
Two hundred and six participants (162 females), with ages between 18 and 47 (M = 25.92; SD = 8.75), filled in the DPSS-R, which was first translated and adapted into Portuguese language by individuals highly proficient in English and then back-translated by a bilingual with no prior knowledge of the scale. Finally, the DPSS-R was subjected to a think-aloud procedure.
The results showed good internal consistency (Cronbach's alfa = .833) for a DPSS-R. The two subscales displayed an adequate internal consistency (DPCronbach'salfa = .776; DSCronbach'salfa = .790). Test-retest analysis documented good intraclass correlation coefficient for the two subscales (ICCPropensity = .889; ICC Sensitivity = .900). We also confirmed the bifactorial structure using a confirmatory factor analysis, since we obtained appropriate values in all goodness of fit indices (χ2df = 1,906; CFI = .94; PCFI = .736; GFI = .93; PGFI = .607; RMSEA = .067).
DPSS-R obtained good psychometric properties and may therefore be proposed as a valid instrument to assess DS and DP in the Portuguese population. This instrument may provide an important contribute to study the development and maintenance of psychopathology associated with disgust.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Traumatising experiences have been shown to be important in suicide ideation and attempt. A prolonged and continuous exposure to stressing interpersonal events can have more complex consequences. Therefore, the concept of Complex Post-Traumatic Stress Disorder (C-PTSD) has been emerging.
Our goal is to relate the symptoms of C-PTSD with suicide attempt and to evaluate the differences between C-PTSD and PTSD on those patients. Moreover, we compared our findings with a control population without prior suicide attempts.
Fifty patients that had been hospitalised in the Psychiatry ward following a suicide attempt were evaluated one week after the event with the ICD-11 Trauma Questionnaire (PTSD and C-PTSD). The same evaluation was performed on a control population without known suicide attempts.
There is a statistically significant relationship (P < 0.001) between the symptoms of C-PTSD and PTSD and suicide attempt, which effect is higher for C-PTSD. These symptoms are almost absent in the control group.
C-PTSD seams to be a more relevant risk factor for suicidal attempts. This aspect is important to define preventive and treatment programs and for suicidal attempts follow-up. The importance of traumatic events and of traumatic stress symptoms as moderator factors should be considered in future research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Dirofilariosis caused by Dirofilaria immitis (heartworm) is a zoonosis, considered an endemic disease of dogs and cats in several countries of Western Europe, including Portugal. This study assesses the levels of D. immitis exposure in humans from Northern Portugal, to which end, 668 inhabitants of several districts belonging to two different climate areas (Csa: Bragança, Vila Real and Csb: Aveiro, Braga, Porto, Viseu) were tested for anti-D. immitis and anti-Wolbachia surface proteins (WSP) antibodies. The overall prevalence of seropositivity to both anti-D. immitis and WSP antibodies was 6.1%, which demonstrated the risk of infection with D. immitis in humans living in Northern Portugal. This study, carried out in a Western European country, contributes to the characterisation of the risk of infection with D. immitis among human population in this region of the continent. From a One Health point of view, the results of the current work also support the close relationship between dogs and people as a risk factor for human infection