American Cancer Society Workshop on the Community and Cancer Prevention and Detection. San Antonio, Texas, December 10-12, 1986. Proceedings.
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Humans↗
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A prospective study of hepatic tuberculosis in 41 black patients.
Forty-one black patients aged 21 to 75 years with hepatic tuberculosis diagnosed at liver biopsy were studied prospectively. The liver varied in size and consistency and was tender in 44 per cent of patients. Abdominal symptoms, weight loss, pyrexia, hepatomegaly, splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and 27 per cent of patients respectively. Twenty-two per cent of chest radiographs were normal. Liver function tests were of little diagnostic value and hepatic imaging techniques often gave normal results. Acid-fast bacilli, caseation and coexistent liver disease were detected in 59, 51 and 37 per cent of patients respectively. Since there was no consistent clinical pattern a high index of suspicion is necessary if this disease is to be detected in communities in which tuberculosis is endemic. In patients with unexplained hepatomegaly or hepatosplenomegaly or pyrexia of unknown origin liver biopsy provides the only means of making this diagnosis.
Adult↗
Detection of diabetes mellitus: a community study.
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Adolescent↗
Effect of health education and primary care on diarrhoeal disease morbidity in children: evaluation of a predictive intervention model.
Two groups of infants (intervention group n = 66, and control group n = 45) at risk of persistent diarrhoea (PD) as identified by a predictive model were followed for 12 months. Families were visited at home weekly; mothers in the intervention group received information about prevention and treatment of diarrhoea and were encouraged to seek help in the field station when their children became ill. These children suffered fewer days with any illness, diarrhoea, or respiratory episodes (p < 0.00001 each). Also, in this group, the incidence of PD decreased to the levels of nonselected population only in children whose mothers consulted for the episode of diarrhoea (2.8%). Results show that the intervention decreased the time children suffered diarrhoea and also respiratory and other illnesses. This suggests that the predictive model identified children with high risk but is not disease-specific. Risk appears to be related to maternal behaviours. The model may be useful in the community for detecting groups vulnerable to common paediatric illnesses, including diarrhoeal disease.
Adolescent↗
[Epidemiology of Microsporum langeronii tinea capitis in the Paris suburban area. Results of 2 school and familial surveys].
INTRODUCTION: One epidemiologic survey was carried out in two children communities, following detection of several cases of Microsporum langeronii tinea capitis. PATIENTS AND METHODS: In one case, 3 year-old children from a day-nursery were contaminated by a child originating from France, who had been previously infected by contact with a friend originating from Ivory Coast. In the second case, lesions were diagnosed in a nursery-school in African children born in France. These were treated before epidemic progression into the school. RESULTS: Our study confirms data from the literature concerning the risk of contamination by Microsporum langeronii, with a familial contamination being more frequent than scholar one. DISCUSSION: The interest of our study was the rapid starting of the epidemiologic survey after first case diagnosis (one to two months) and the treatment of all the patients without scholar eviction. Treatment of all affected patients as well as "asymptomatic carriers" leaded to the arrest to the epidemy. No case of relapse was noted during the following year.
Adolescent↗
Detection of influenza a subtypes in community-based surveillance.
A rapid microtitre cell enzyme immuno assay (cell-EIA) was developed for the detection of influenza A subtypes in nasopharyngeal(NPS) swabs taken for surveillance. During the 1997/1998 influenza season in the United Kingdom, cell-EIA was compared to cell culture for the detection and typing of influenza A viruses in NPS obtained by sentinel general practitioners in community surveillance. The cell EIA can also be used to detect different influenza A subtypes (H3N2, H1N1, H5N3, H5N1, H7N7, and H9N2) and was used as a rapid detection assay for the screening of individuals returning from Hong Kong with influenza-like illness suspected to be due to H5N1 in 1997/98, providing a rapid, efficient, inexpensive method for the screening of influenza A cases during an outbreak or pandemic situation. The cell-EIA results reflected the results obtained by traditional virus culture within the age distribution of samples, clinical symptoms, and time between date of illness onset and sampling of cases, indicating its usefulness in surveillance of human and non-human influenza viruses. During two outbreaks of influenza in schools, Directigen Flu-A, a near patient test, the cell-EIA, and tissue culture were compared. The cell-EIA gave higher sensitivity and specificity (74% and 90%) than Directigen Flu-A (65% and 84.6%) in comparison with cell culture.
Animals↗
Frequency doubling perimetry and the detection of eye disease in the community.
PURPOSE: Frequency Doubling Technology (FDT) perimetry is a novel perimetric test that provides rapid screening (45 to 60 seconds) and full-threshold (4 to 5 minutes) testing for detection of vision loss. The purpose of this study was to determine the specificity and sensitivity of FDT perimetry for the detection of ocular disease. METHODS: A total of 130 participants (257 eyes of 42 men and 88 women) recruited from the community completed FDT perimetry, standard achromatic automated perimetry (SAP), anterior segment biomicroscopy, tonometry, and dilated ophthalmoscopy. FDT results were considered abnormal if 1 point was abnormal (depressed below the 5% level on the screening protocol C-20-5). SAP was considered abnormal if the glaucoma hemifield test or pattern standard deviation was outside normal limits (P < .05) or a hemifield cluster of 3 depressed points on the pattern deviation probability plot (P < .05) was present. An abnormal eye examination was defined as the presence of an abnormality in the anterior segment, lens, or posterior segment that was likely to cause a visual field defect or the presence of glaucomatous or other optic neuropathy. RESULTS: The mean age (+/- SD) of participants was 55.5 years (+/- 10.3). Ethnic groups, as reported by participants, included 77 (59%) African Americans, 40 (31%) Caucasians, and 13 (10%) in other groups. On clinical examination, 116 eyes (45%) were normal, 9 eyes (3.5%) had a cataract with best corrected visual acuity worse than 20/30, 16 eyes (6%) had open-angle glaucoma, and 17 eyes (7%) had retinal findings or lesions that were likely to cause a visual field defect. For FDT perimetry, 22 (8.6%) of 257 tests were unreliable, and for SAP, 65 (25.3%) of 257 tests were unreliable. The sensitivity and specificity of FDT perimetry for detecting an abnormal clinical examination were 55% and 90% and for detecting an abnormal examination that included an abnormal SAP, 64% and 86%. CONCLUSIONS: FDP demonstrated reasonable discriminatory power for detecting eye disease.
Adult↗
Isolation of streptogramin-resistant Enterococcus faecium from human and non-human sources in a rural community.
OBJECTIVES: To detect quinupristin-dalfopristin and virginiamycin M1 resistance in Enterococcus faecium from human, food and environmental sources. MATERIALS AND METHODS: Enterococcal isolates derived from human faeces and urine, meat and seawater were screened for resistance to quinupristin-dalfopristin and virginiamycin M1 by an agar dilution method. Identification of all E. faecium strains and the presence of streptogramin acetyltransferase genes were confirmed using a PCR method. RESULTS: No high-level quinupristin-dalfopristin-resistant strains were isolated. Two isolates from faeces and five from seawater were confirmed to be high-level virginiamycin M1-resistant E. faecium (MIC 32 mg/L); none of these carried the vat(D) or vat(E) acetyltransferase genes that mediate high-level resistance to streptogramin A compounds. CONCLUSION: High-level quinupristin-dalfopristin-resistant strains of E. faecium are uncommon in Cornwall. However streptogramin A-resistant strains were detected from human and animal sources.
Animals↗
Microbial community analyses using a simple, rapid detection method for DNA fingerprints with a fluorescence scanner.
A simple detection procedure was developed for terminal restriction fragment length polymorphism and ribosomal intergenic spacer analysis for microbial community analysis. A fluorescence scanner enables generation of fingerprinting data in these methods within 3 h of obtaining PCR products of microbial communities.
Journal Article↗
Usefulness of a new immuno-radiometric assay to detect hepatitis C core antigen in a community-based population.
A new immuno-radiometric assay (IRMA) to detect hepatitis C virus (HCV) core antigen (HCVcAg) has been developed. The aim of the present study was to investigate the sensitivity and specificity of this IRMA to measure HCV antigenemia, based on the detection of HCV RNA as the gold standard, and to assess the utility of the IRMA in a community-based population. Anti-HCV positive residents in a hyperendemic area of HCV infection in Japan were studied. Serum levels of HCVcAg were measured using IRMA, and the presence of HCV RNA was determined by a qualitative reverse transcription-polymerase chain reaction (RT-PCR) assay. The sensitivity and the specificity of the IRMA were 96.4 and 100%, respectively. The sensitivity of the IRMA was similar between serological HCV group I (HCV genotypes 1a and 1b) (97.6%) and group II (HCV genotypes 2a and 2b) (94.0%). There was a strong correlation between serum HCVcAg level and HCV-RNA measured by a quantitative RT-PCR (r = 0.832, P < 0.0001). There also was a very strong correlation of HCVcAg level between IRMA measurements performed on serum and those performed on plasma (r = 0.984, P < 0.0001). In conclusion, this new IRMA is useful for the detection of HCV core antigen in a community-based population.
Female↗
Episodic memory and visuospatial ability in detecting and staging dementia in a community-based sample of very old adults.
BACKGROUND: This study examined the efficacy of a cognitive test battery in detecting and staging dementia in a community-based sample of very old adults. METHOD: The sample consisted of 398 nondemented and 108 demented adults taken from all the inhabitants in the Kungsholmen parish of Stockholm, Sweden (2,368 individuals), aged 75 years and older, who were part of a large-scale epidemiological study on aging and dementia. Participants received a cognitive test battery that consisted of specialized episodic memory tasks, as well as standardized psychometric measures of visuospatial ability and primary memory. RESULTS: A discriminant analysis revealed that highly supported episodic memory tasks (recognition, cued recall) were primarily responsible for correctly classifying normal old adults (94.5%) from those with the diagnosis of dementia (66.7%). Using the Mini-Mental State Exam (MMSE) as the criterion of dementia severity, a correct classification of 88.9% was achieved for mildly demented subjects and 77.8% for moderately demented subjects. Visuospatial tasks made the greatest contribution in distinguishing those at different levels of dementia severity. CONCLUSION: The results of this investigation indicate that cognitively supported measures assessing episodic memory may be particularly useful in the detection of dementia, whereas visuospatial measures are more effective in staging the disease. Consistent with biological models of the progression of dementia, this suggests that visuospatial abilities may deteriorate later and/or at a slower rate than episodic memory skills in the early stages of dementia. It is noteworthy that these conclusions are based on samples of very old adults taken from the general population.
Aged↗
Comparison of FEV6 and FVC for detection of airway obstruction in a community hospital pulmonary function laboratory.
The National Lung Health Education Program recommends that primary care providers perform spirometry tests on cigarette smoking patients 45 years or older in order to detect airways obstruction and aid smoking cessation efforts [Ferguson GT, Enright Pl, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus statement from the national lung education program. Chest 2000; 117: 1146-61]. An abbreviated forced expiratory maneuver that requires exhalation for 6s (FEV6) has recently been proposed as a substitute for forced vital capacity (FVC) to facilitate performance of such spirometry. We set out to assess the accuracy of diagnosis of obstruction and abnormal pulmonary function using FEV6 in comparison to FVC in a community hospital population. One hundred pulmonary function tests performed at a community hospital were randomly selected and retrospectively analyzed. Sixty-three of the 100 tests had satisfactory 6-s expiration and were subject to further analysis. We compared the spirometric interpretation using Morris predictive equations for FEV1/FVC and Hankison predictive equations for FEV1/FVC and FEV1/FEV6. The Hankison set of equations is the only published reference formulas for prediction of FEV6. We found that versus our Morris gold standard, Hankison based FEV1/FVC interpretation was 100% sensitive and 67% specific for the diagnosis of obstruction and 100% sensitive and 65% specific for the diagnosis of any abnormality. The Hankison based FEV1/FEV6 interpretation was 97% sensitive and 47% specific for diagnosing obstruction and 100% sensitive and 50% specific for identifying any abnormality versus the Morris FVC based gold standard. In conclusion, in our hospital based pulmonary function laboratory, FEV6 based interpretation has excellent sensitivity for detection of spirometric abnormalities. However, its moderate specificity may hinder its utility as a screening test. Further testing is necessary to determine its reliability in different patient populations with less highly trained operators.
Adult↗
Association of hemostatic variables with MRI-detected cerebral abnormalities: the atherosclerosis risk in communities study.
OBJECTIVES: Population-based and clinical prospective studies have shown independent associations of several hemostatic factors with ischemic heart disease and stroke. MRI-detected cerebral infarcts and white matter lesions are often detected in elderly individuals without clinical disease. It has been hypothesized that these types of lesions are often the consequence of cerebral ischemic damage and may be the precursors of clinical stroke. METHODS: This study examined the relation between a range of hemostatic factors measured at baseline in middle-aged participants who were free of diagnosed cardiovascular disease in the Atherosclerosis Risk in Communities Study and MRI-detected cerebral abnormalities at a 6-year follow-up examination. RESULTS: Plasma fibrinogen and perhaps von Willebrand factor were associated positively, and protein C was associated negatively, with cerebral infarctions. Adjusted for other risk factors, the odds ratio for cerebral infarction was 1.21 (95% confidence interval, CI = 1.02-1.44) per standard deviation increment for fibrinogen, 1.15 (95% CI = 0.97-1.37) per standard deviation increment for von Willebrand factor, and 0.77 (95% CI = 0.62-0.95) per standard deviation increment for protein C. No hemostatic factor, however, was associated with white matter disease. CONCLUSIONS: This study has only a follow-up MRI, and it is likely that some MRI lesions were present at baseline. Nevertheless, increased levels of fibrinogen and von Willebrand factor and reduced levels of protein C appear to be associated with cerebral infarction identified by MRI.
Aged↗
Detecting structural and functional differences in activated sludge bacterial communities originating from laboratory treatment of elementally and totally chlorine-free bleaching effluents.
The ability to differentiate functional and structural diversity of bacterial communities present in activated sludges adapted to elementally (ECF) and totally (TCF) chlorine-free bleaching effluents was evaluated. Community function was evaluated through substrate utilization patterns in BiologGN microplates, and taxonomic structure was evaluated by fluorescent in situ hybridization using probes targeting the Eubacteria; the alpha, beta, and gamma subclasses of the Proteobacteria; and gram-positive bacteria with high GC content. Over 6-week sampling periods, ECF-and TCF-adapted sludge bacterial communities presented reproducible substrate utilization patterns that through principal components (PCs) analysis, separated the ECF samples from the TCF samples. Application of the fluorescent in situ hybridization technique was complicated by the intense autofluorescence of the bleaching effluent sludge samples that interfered with detection of specific hybridization signals. The most notable difference in community structure detected using the chosen set of probes was the relatively greater proportion of cells of the alpha subclass in TCF sludge (27%) than in ECF sludge (6%). Nonspecific hybridization with beta and gamma probes was relatively high, but both sludges appeared to have similar proportions of cells of the beta (20-22%) and gamma (11-12%) subclasses. The two sludges presented relatively few gram-positive cells with high GC content (<0.2% of eubacterial counts). Differences in both metabolic potential and taxonomic structure of the microbial communities in the ECF- and TCF-activated sludges were detected. The kinetics of the development of these differences in treatment plants and their relationships with treatment efficiency and production process conditions should now be evaluated.
Chlorine↗
Large-scale entomologic assessment of Onchocerca volvulus transmission by poolscreen PCR in Mexico.
To study the impact of mass Mectizan treatment on Onchocerca volvulus transmission in Mexico, entomological surveys were carried out in the endemic foci of Oaxaca, Southern Chiapas, and Northern Chiapas. Collected flies were screened by polymerase chain reaction (PCR) for O. volvulus parasites. The prevalence of infected and infective flies was estimated using the PoolScreen algorithm and with a novel probability-based method. O. volvulus infective larvae were not detected in flies from 6/13 communities. In 7/13 communities, infective flies were detected, with prevalences ranging from 1.6/10,000 to 29.0/10,000 and seasonal transmission potentials ranging from 0.4 to 3.3. Infected and infective flies were found in a community in Northern Chiapas, suggesting that, according to World Health Organization criteria, autochthonous transmission exists in this focus. These data suggest that O. volvulus transmission in Mexico has been suppressed or brought to a level that may be insufficient to sustain the parasite population.
Algorithms↗
Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults.
Streptococcus pneumoniae is suspected to cause an important proportion of community-acquired pneumonia (CAP) whose aetiology cannot be detected with conventional tests. In this study, the authors evaluated the diagnostic yield of a new immunochromatographic membrane test (ICT) for the detection of the S. pneumoniae antigen in the urine of patients admitted with diagnosed CAP. ICT was performed in unconcentrated and concentrated urine from all the patients. ICT was repeated 1 month after discharge in a group initially testing positive. The authors also studied the ICT in clinically stable human immunodeficiency virus type 1 (HIV1)-infected patients. S. pneumoniae antigen was detected in all of the 68 (100%) patients tested with definitive pneumococcal pneumonia. In five of these cases ICT was only positive when it had been performed on the patients. The S. pneumoniae antigen was also detected in 36 (69.2%) of 52 patients with probable pneumococcal pneumonia and in 50 of 277 (18%) patients without pneumococcal pneumonia. ICT remained positive in 16 (69.5%) of 23 patients, 1 month after hospital discharge. Nasopharyngeal colonisation with S. pneumoniae was detected in 8 (12%) of 68 clinically stable HIV1 infected patients, but none tested ICT positive. The Binax NOW it immunochromatographic membrane test is a rapid, sensitive and specific test for detecting pneumococcal community-acquired pneumonia in adults. The test may remain positive for several weeks after pneumococcal pneumonia.
Acquired Immunodeficiency Syndrome↗
Presence of human papillomavirus infection of the uterine cervix as determined by different detection methods in a low-risk community-based population.
OBJECTIVE: To evaluate the effectiveness of various screening tests for detecting genital human papillomavirus (HPV) in a community-based population and to determine the prevalence of cervical lesions on colposcopically directed biopsies in patients found to have HPV by any screening test. DESIGN: Cross-sectional analysis of 208 female patients screened for HPV by clinical examination, Papanicolaou test, dot blot hybridization test (ViraPap, Digene Inc, Silver Spring, Md), and polymerase chain reaction (PCR) analysis. All persons with abnormal or positive results by any method were offered colposcopic evaluation. SETTING: Two community-based family practice offices in southeastern Michigan. MAIN OUTCOME MEASURES: The presence of HPV as determined by each test and results of colposcopic biopsies (gold standard) in patients who had HPV identified by any test. RESULTS: The prevalence of HPV infection was 20.3% by PCR analysis, 3.1% by ViraPap, 3.0% by the Papanicolaou test, and 0% by clinical examination. Symptomatic patients (those with complaints of vaginal odor, swelling, or itching) were more likely to harbor HPV as determined by PCR analysis than were asymptomatic women (P = .03, odds ratio = 2.65). Human papillomavirus type 16 or 18 was found in 41% of patients with positive PCR analyses and in all patients with positive ViraPap tests that were typed. Colposcopy with biopsy (gold standard for the presence of HPV disease) was performed on 34 of the 41 patients who tested positive for HPV by PCR analysis. Histologic results revealed that 79.4% of these patients had cervical disease: 14.6% had cervical intraepithelial neoplasia, 38.3% had condyloma, and 26.5% had cervicitis. CONCLUSIONS: Human papillomavirus as detected by PCR analysis was present in 20.3% of women in our population and was often one of the higher-risk types (16 or 18). A positive PCR analysis was predictive of cervical disease on colposcopic biopsy. The ViraPap test, Papanicolaou test, and clinical examination were insensitive measures for detecting HPV-related lesions in this population.
Adolescent↗
Mammographic detection of early breast cancer. Ten years' experience in a community hospital.
Mammography is currently the most effective method for detecting early breast cancer. In one community hospital during the decade 1974 through 1983, 35% of 415 cases of breast cancer were discovered by xeromammography alone, with a false-positive interpretation rate of 65% and a false-negative rate of 11.1%. Mammography was responsible for detecting an increasing number of smaller cancers with fewer axillary metastases. Such lesions have the most favourable five- and ten-year survival rates. Much lower detection rates of preclinical breast cancer have been reported from other community hospitals.
Breast Neoplasms↗