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The influence of growth rate and nutrient limitation on the microbial composition and biochemical properties of a mixed culture of oral bacteria grown in a chemostat.

A sample of human dental plaque was homogenized in transport fluid and inoculated simultaneously into a glucose-limited and a glucose-excess chemostat maintained at pH 7.0 and a dilution rate (D) of 0.05 h-1. In an attempt to ensure the establishment of slow-growing bacterial populations, two further inoculations of each chemostat with fresh samples of dental plaque took place before a steady-state was attained at this dilution rate. The dilution rate was increased step-wise to D = 0.6 h-1, and then returned directly to D = 0.05 h-1. Contrary to chemostat theory, microbial communities with a high species diversity were maintained under all of the experimental conditions employed, although not all of the bacterial populations present in the inocula established successfully in the chemostat. At each steady-state the bacteriological composition and biochemical properties (fermentation products, enzyme assays and acid production) of the communities of each chemostat was determined. Higher cell yields and a slightly more diverse community were obtained from the glucose-limited chemostat at all dilution rates. A complex mixture of end products of metabolism was obtained from the glucose-limited chemostat, suggesting amino acid catabolism, while lactate was the predominant acid of the glucose-excess culture. In washed-cell experiments, communities from the glucose-excess chemostat produced the lower terminal pH values following a pulse of glucose, with the lowest pH values occurring at the higher dilution rates. A film of micro-organisms, which accumulated around the neck of the chemostat, was sampled at the end of the experiment. The microbial composition of the films from each chemostat differed markedly, and both were different to the community of the bulk fluid of the respective chemostat. Spirochaetes and a population of yeasts were detected in the films from the glucose-limited and glucose-excess chemostats, respectively. No invertase or glucosyltransferase activity, and little glucoamylase-specific glycogen was detected in the communities from either chemostat, although significant endogenous activity, particularly at high dilution rates, was obtained with washed-cells from the glucose-excess chemostat. The results suggest that the chemostat could make a valuable contribution to the study of the ecology of dental plaque.

Bacteria↗

Gender disparities in tuberculosis: report from a rural DOTS programme in south India.

SETTING: Tiruvallur District, south India. OBJECTIVES: To examine gender differences in tuberculosis among adults aged >14 years with respect to infection and disease prevalence, health care service access, care seeking behaviour, diagnostic delay, convenience of directly observed treatment (DOT), stigma and treatment adherence. METHODS: Data were collected from 1) community survey, 2) self-referred out-patients seeking care at governmental primary health institutions (PHIs), 3) tuberculosis suspects referred for sputum microscopy at PHIs, and 4) tuberculosis patients notified under DOTS. Community survey results were compared with those for patients notified at PHIs. RESULTS: In the community, 66% of males and 57% of females had tuberculosis infection. The prevalence of smear-positive tuberculosis was 568 and 87/100,000, respectively, among males and females. Fewer males than females attended PHIs (68 men for every 100 women). Females constituted 13% of all smear-positive patients detected in the community survey, and 20% of those detected at PHIs (P < 0.05). The probability of notification decreased significantly with age among both males and females. Significantly more females than males felt inhibited discussing their illness with family (21% vs. 14%) and needed to be accompanied for DOT (11% vs. 6%). Males had twice the risk of treatment default than females (19% vs. 8%; P < 0.01). CONCLUSIONS: Despite facing greater stigma and inconvenience, women were more likely than men to access health services, be notified under DOTS and adhere to treatment. Men and elderly patients need additional support to access diagnostic and DOT services.

Adolescent↗

[Feasibility of drug use detection among individuals 15-25 years of age in community medicine].

The objective of this work is to study the feasibility of the detection of drug use or misused substances during a visit with a municipal doctor, and to describe the interrogatory strategies used spontaneously by doctors. One tenth of the clients aged 15-25 of the 26 participating doctors, (the majority of them men visiting the doctor for a psychological problem), showed a "warning" signal and were detected. The doctors often chose to approach the problem of drugs directly and detected usage in two-thirds of the cases. Cannabis was most often concerned, but the use of psychotropic drugs with alcohol was the case in one-third of the subjects interrogated. On the other hand, a certain frustration was felt by the doctors because of the difficulty of approaching the root problems and of acquiring psychotherapeutic monitoring.

Adolescent↗

Comparison of three methods for detection of pneumococcal antigen in sputum of patients with community-acquired pneumonia.

In a prospective study of 249 patients with community-acquired pneumonia, three tests for the detection of pneumococcal antigen in sputum were compared: a coagglutination test for detecting capsular antigens (Cap-CoA), a sandwich enzyme immunoassay (PnC-EIA) and a coagglutination test (PnC-CoA), both the latter detecting the pneumococcal C-polysaccharide common to all pneumococcal types. Sixty-three patients had culture-positive pneumococcal pneumonia, 45 pneumonia caused by other bacteria and 141 pneumonia of viral or unknown etiology. The sensitivity of Cap-CoA (63%) and PnC-CoA (65%) was somewhat higher than that of PnC-EIA (49%), but not significantly so. The specificity was 96-98% for all three methods. Using PnC-CoA 66 patients with possible pneumococcal infection were detected, the diagnosis being verified by culture in 41. Using Cap-CoA 59 such patients were detected, the diagnosis being verified in 40, and using the PnC-EIA 47 such patients were detected, the diagnosis being verified in 31. Antigen was found almost as often in non-purulent as in purulent samples, and as often in washed as in non-washed purulent samples. However, antibiotic treatment before the sputum sample was obtained resulted in significantly lower sensitivity of both PnC-CoA and Cap-CoA. This study confirms the high sensitivity and specificity of methods for pneumococcal antigen detection in sputum. Since CoA is easier and quicker to perform, and cheaper than the EIA, either PnC-CoA or Cap-CoA would seem to be the technique of choice for detection of pneumococcal antigen, whereby all sputum samples, including non-purulent samples, can be used.

Adolescent↗

Early detection of cervical cancer among Native American women: a qualitative supplement to a quantitative study.

The North Carolina Native American Cervical Cancer Prevention Project was a 5-year (1989-1995) National Cancer Institute-funded, community-based, early detection of cervical cancer intervention implemented among two Native American tribes in North Carolina: the eastern band of the Cherokee Indians and the Lumbee. The initial quantitative analysis of the intervention showed modest effects and found that the intervention had different effects in the two communities. Due to the equivocal findings, a retrospective qualitative study was conducted. The qualitative study found that two types of factors influenced the intervention's results. The first were project and intervention characteristics, and the second were community and cultural factors over which the project had no control. The community and cultural factors took two forms: enhancers, which contributed to greater intervention effect, and attenuators, which created barriers to success. Examples of each factor are presented, and implications for cervical cancer detection among Native American women are discussed.

Community-Institutional Relations↗

[Detecting sleeping sickness: comparative efficacy of mobile teams and community health workers].

The solution to the problem of human African trypanosomiasis (HAT) first of all requires improved case detection. Effective tests have been available for a number of years but the results of medical surveys are still mediocre, mainly because the populations are poorly mobilized. Those few mobile teams still visiting villages obtain very low presentation rates. In spite of major information campaigns among villagers, in Côte d'Ivoire the Institut Pierre Richet (IPR) and Trypanosomiasis Clinical Research Project (PRCT) teams examined only 42% (9311) of the 22,300 inhabitants of a disease focus during a conventional ten-day survey. In the same focus, community health workers specially trained in sleeping sickness and in the collection of blood samples on filter-paper examined 73% of the population (15,000 individuals) in less than two months. Implementation of a sleeping sickness control strategy is restricted to two types of intervention: either conventional mobile teams which are on hand, competent and rapidly operational but which fail to carry out exhaustive case detection, or integration of case detection into primary health care by entrusting surveillance to the community health workers. This approach requires a minimum of training but ensures that sentinels are permanently present in the village communities. By using the community health workers rather than mobile teams it should be possible to achieve comprehensive monitoring. In operational terms, the cost of surveillance per person is US$ 0.55 for the mobile teams as against US$ 0.10 for the community health workers. Integration of HAT case detection into primary health care is therefore an effective and economical solution, provided the community health workers are properly supervised and above all motivated.

Community Health Workers↗

Polymerase chain reaction for detection of Legionellae DNA in urine samples from patients with community-acquired pneumonia.

Polymerase chain reaction (PCR) was used for detecting Legionella DNA in water, sputum, tracheal aspirate and bronchoalveolar lavage fluid. There is paucity of data on the use of PCR for detection of Legionella in serum and urine samples. In 82 patients admitted with community-acquired pneumonia, urinary PCR was used in addition to urinary antigen assay for Legionella pneumophila serogroup 1 and serological tests (indirect immunofluorescence and ELISA) in paired sera. PCR was positive in urine samples from 21 patients (26%): in six of seven patients with acute legionellosis by CDC criteria, and 15 patients with negative urine antigen showing no fourfold rise in antibody titers in immunofluorescence test.

Adolescent↗

A latent trait analysis of an inventory designed to detect symptoms of anxiety and depression using an elderly community sample.

An 18-item inventory designed by Goldberg et al. (1987) to detect symptoms of anxiety and depression was administered to an elderly general population sample. Latent trait analysis was used to assess the dimensionality of the inventory and the location and discriminatory ability of the symptoms. The items showed different patterns of discrimination in this group compared to the sample of general practice attenders on which the inventory was developed. Overall, the items did define two correlated dimensions of anxiety and depression. In addition, a third dimension of sleep disturbance was detected. Both individual scales and the total symptom scores were sensitive and relatively specific detectors of depressive disorders assessed according to ICD-10 and DSM-III-R criteria. The retention of sleep items on their original scales did not affect the sensitivity of the scales to detect depressive disorders. A two-step administration procedure suggested for use in the administration of the scales was investigated but found to be sensitive to differences between the current sample and the sample on which the inventory was developed. This symptom inventory can be recommended for use in epidemiological investigations as a brief, valid and acceptable method of detecting elevated levels of anxiety and depression in elderly persons.

Aged↗

Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial.

OBJECTIVE: To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). METHODS: We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. FINDINGS: In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10(5) and 98.1/10(5) person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10(5) and 158/10(5) person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). CONCLUSION: The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes.

Adolescent↗

Role of target groups in integrated leprosy programmes.

The introduction of integrated leprosy services into the primary health care set-up has taken away active case-detection in the community and is replaced by passive reporting by the suspected, afflicted individuals. This can only be made operative effectively with intensive IEC activities in the community. A research study involving school-children (219,000) in leprosy work achieved spectacular success in new case-detection, effective monitoring, completion of MDT and coverage of a large number of individuals (750,000). The results evaluated on a representative sample of 20,000 school students (pre- and post-test), showed over 90% success in creating awareness about the cause of the disease, its symptoms, curability by fixed duration MDT and better attitudes and perceptions of the community towards leprosy-affected individuals. It is emphasised that, in view of the experience gained from the study, other more cohesive and disciplined target groups, such as scouts and guides, NCC cadets, NSS volunteers, should be identified for leprosy work throughout the country in a planned and coordinated manner in order to implement and sustain leprosy eradication activities in the near-elimination and post-elimination phases.

Adolescent↗

Parasite communities in Boops boops (L.) (Sparidae) after the Prestige oil-spill: detectable alterations.

Environmental pollution affects parasite populations and communities, both directly and through effects on intermediate and final hosts. In this work, we present a comparative study on the structure and composition of metazoan parasite communities in the bogue, Boops boops, from two localities (Galician coast, Spain) affected by the Prestige oil-spill (POS). We focus on the distribution of both individual parasite species and larger functional groupings by using both univariate and multivariate analyses. Our results indicate directional trends in community composition that might be related to the Prestige oil-spill disturbance of the natural coastal communities off Galicia. Endoparasite communities in B. boops reflected a notable change in the composition and abundance of the benthic fauna in the localities studied post-spill probably due to organic enrichment after the POS.

Animals↗

Detection of aneuploidy-inducing carcinogens in the Syrian hamster embryo (SHE) cell transformation assay.

As evidenced by the recent report of the Commission of the European Communities (CEEC) project (Detection of Aneugenic Chemicals-CEEC project, 1993), there currently is a great deal of effort towards developing and validating assays to detect aneuploidy-inducing chemicals. In this report, we describe the utility of the Syrian hamster embryo (SHE) cell transformation assay for detecting carcinogens with known or suspected aneuploidy-inducing activity. The following carcinogens were tested: asbestos, benomyl, cadmium chloride, chloral hydrate, diethylstilbestrol dipropionate, and griseofulvin. Thiabendazole, a noncarcinogen, was also tested. Chemicals of unknown or inconclusive carcinogenicity data, colcemid, diazepam, econazole nitrate, and pyrimethamine were also evaluated. All of the above chemicals except thiabendazole induced a significant increase in morphological transformation (MT) in SHE cells. Based on these results as well as those published in the literature previously, the SHE cell transformation assay appears to have utility for detecting carcinogens with known or suspected aneuploidy-inducing ability.

Aneuploidy↗

Blinded application of microscopy, bacteriological culture, immunoassays and PCR to detect gastrointestinal pathogens from faecal samples of patients with community-acquired diarrhoea.

A blinded trial in two different laboratories was performed to compare the detection of selected enteric pathogens in 92 unselected faecal samples collected from patients with community-acquired diarrhoea by conventional and PCR-based techniques. Conventional techniques detected a single potential etiological agent in 15% of the samples, whereas results of PCR detected evidence of at least one agent in 41% of the samples. Overall, the detection rates for the different pathogens were as follows: adenovirus serogroup F, 1%; Campylobacter spp., 7.6%; Salmonella spp., 4%; enteroaggregative Escherichia coli, 9.8%; enteropathogenic E. coli, 6.5%; enterotoxigenic Clostridium perfringens, 3%; Cryptosporidium spp., 13%; and Giardia spp., 11%. Results for the detection of Salmonella spp., Campylobacter spp. and C. perfringens were similar by both techniques, whereas Cryptosporidium and Giardia spp. were detected 22 times more often by PCR than by conventional microscopy. It was not possible to compare the results for detection of enteroaggregative E. coli and enteropathogenic E. coli since these were only investigated by PCR. The results of this small study clearly demonstrate the advantages of PCR-based methods compared to conventional techniques for the detection of gastrointestinal pathogens.

Clinical Laboratory Techniques↗

Richness and diversity of bacterioplankton species along an estuarine gradient in Moreton Bay, Australia.

Bacterioplankton community diversity was investigated in the subtropical Brisbane River-Moreton Bay estuary, Australia (27 degrees 25 minutes S, 153 degrees 5 minutes E). Bacterial communities were studied using automated rRNA intergenic spacer analysis (ARISA), which amplifies 16S-23S ribosomal DNA internally transcribed spacer regions from mixed-community DNA and detects the separated products on a fragment analyzer. Samples were collected from eight sites throughout the estuary and east to the East Australian Current (Coral Sea). Bacterioplankton communities had the highest operational taxonomic unit (OTU) richness, as measured by ARISA at eastern bay stations (S [total richness] = 84 to 85 OTU) and the lowest richness in the Coral Sea (S = 39 to 59 OTU). Richness correlated positively with bacterial abundance; however, there were no strong correlations between diversity and salinity, NO(3)(-) and PO(4)(3-) concentrations, or chlorophyll a concentration. Bacterioplankton communities at the riverine stations were different from communities in the bay or Coral Sea. The main differences in OTU richness between stations were in taxa that each represented 0.1% (the detection limit) to 0.5% of the total amplified DNA, i.e., the "tail" of the distribution. We found that some bacterioplankton taxa are specific to distinct environments while others have a ubiquitous distribution from river to sea. Bacterioplankton richness and diversity patterns in the estuary are potentially a consequence of greater niche availability, mixing of local and adjacent environment communities, or intermediate disturbance. Furthermore, these results contrast with previous reports of spatially homogeneous bacterioplankton communities in other coastal waters.

Animals↗

[Bacteremia in patients discharged from the emergency unit].

BACKGROUND: To know the clinical and epidemiologic characteristics, the evolution and the rate of adequate empiric antibiotic treatment in adult patients with a bacteremia discovered after discharge from an emergency unit. PATIENTS AND METHOD: During 10 years (1989-1998), we registered the clinical and epidemiological data from patients with a bacteremia detected after discharge from emergency. The results were compared with those of patients admitted to hospital who had a community-acquired bacteremia. RESULTS: 85 patients were analysed (52 males), 45% aged over 70 years. Overall, they represented 13.9% of community-acquired bacteremias detected during the same period. Most frequent source was the urinary tract (69%) followed by an unknown source (12%). E. coli was isolated in 62% of cases. In 16 cases, treatment was considered incorrect. Three patients died. CONCLUSIONS: A non-worthless number of patients with bacteremia are discharged from the emergency unit, and 21% of them receive inadequate treatment. Fatal outcome is rare but avoidable in some cases.

Aged↗

Relationship between the method of detection and prognostic factors for breast cancer in a community with a screening programme.

OBJECTIVES: To analyse and compare the prognostic factors of breast cancer in the target population of our community-screening programme as a function of the method of detection and to analyse the differences in the prognostic factors as a function of the patient's age and the screening episode. SETTING: A Breast Cancer-Screening Programme (BCSP) in Northeast Spain. METHODS: Observational study of all primary malignant breast lesions diagnosed in a woman between 50 and 69 years of age between 18 October 1995 and 31 December 2002. The 16 centres that women from the target population might have attended were contacted. RESULTS: A total of 225 (37.2%) of the lesions included were diagnosed through the BCSP, 59 (9.7%) interval cancers were detected, and 321 (53.1%) were detected through other circuits. Node involvement was significantly lower in the lesions detected at screening (32%) in comparison to the interval cancers (41.8%) and those detected through other circuits (47.5%). A significantly larger percentage of the interval tumours (28.6%) and the lesions diagnosed outside the BCSP (22.1%) scored >5.4 on the Nottingham Prognostic Index (NPI) than those diagnosed within the programme (10.9%). The relation between the NPI and the detection method was only statistically significant in the 65-69-year-old age group. The NPI score of the tumours detected by the BCSP showed a statistically significant association with age. CONCLUSION: This analysis has shown notable differences in some prognostic factors for breast cancer according to the method of detection. Association between age and the a priori prognosis of the malignant lesions arises.

Aged↗

[Importance of the results of a virological examination of sewage. A quantitative evaluation of the finding of enteroviruses in sewage].

In order to evaluate quantitatively the effectiveness of virological examinations of sewage, a labeled virus in a dose of 7.5X10(9) PFU was introduced into the canalization system of a community. Such an amount of virus could be found in the canalization system if 5--10% of the residents would excrete it simultaneously. The labeled virus was selectively detected in the community sewage. This procedure has demonstrated that the routine methods for sewage collection, specimen treatment, and virus isolation permit virus detection when 5--10% of this virus excretors are available. The labeled virus entered the canalization system most actively within the first 2 hours after administration, then its amount declined, and within 24 hours ceased. The labeled virus was found on all swabs which were in the sewage flow since the time of administration to the 7th day. The maximum amount of virus was found on the swab which was in the sewage flow for the first 2 hours after virus administration. By 7 days the amount of labeled virus on swabs decreased 10-fold. Under experimental conditions, in sewage kept at 25 degrees C enteroviruses of the group of poliomyelitis, ECHO, and Coxsackie had approximately similar inactivation rate (0.16--0.22 Ig TCD50 per day) and the half-life period (1.3 days), that is, in 7 days the virus titer on a swab should decline by 1.0--1.5 Ig TCD50.

Enterovirus↗

[Antibiotic resistance transformation in community-acquired urinary infections].

OBJECTIVE: To detect the prevalence of uropathogens in community-acquired urinary tract infection in our environment, and the degree of sensitivity to antibiotics used as empirical treatment. PATIENTS AND METHOD: Retrospective longitudinal study on 16,392 consecutive urine cultures collected in the emergency department of Hospital del Mar, between January 1997 and December 2001. Resistance rates were compared through variance analysis. RESULTS: 8,743 urine cultures with significant count were obtained. 6,062 Escherichia coli (69.3%), 517 Proteus mirabilis (5.9%) and 390 Klebsiella pneumoniae (4.5%) were identified. Escherichia coli showed progressive growth rate and significant resistances to most of antibiotics evaluated, especially to quinolones which came close to 30%. Fosfomycin showed the least resistance rate (0.9%) and remained stable along the years studied. CONCLUSIONS: These results suggest that higher rate of resistance to quinolones does not advise its use as empirical in community-acquired urinary tract infection treatment in our environment. According to our experience, fosfomycin can be an excellent option for cystitis treatment in patients without risk factors, while for the treatment of parenchymatous urinary tract infection, complicated urinary tract infections, and urinary tract infections associated to risk factors, preference could be second or third generation oral cephalosporins, or amoxicillin-clavulanic acid.

Adolescent↗