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PubMed2004

Polymerase chain reaction monitoring of transmission of Onchocerca volvulus in two endemic states in Mexico.

To investigate the impact of mass ivermectin treatments in Mexico on Onchocerca volvulus transmission, entomologic surveys were carried out in the two endemic states of Oaxaca and Chiapas. The data suggest that substantial progress towards the goal of elimination has been made. A comparison pre- and post-ivermectin data from a community in Southern Chiapas showed a 97% decrease in seasonal transmission potential, but some level of polymerase chain reaction positivity was still detectable. In other communities from northern Chiapas and Oaxaca where there are no baseline data, there was an absence or near absence of infective flies. Residual transmission was not evenly distributed because differences were seen in the infection and infective rates from different catch points. These findings suggest that while substantial progress towards elimination has been made in Mexico, it may be necessary to modify ivermectin distribution strategies to eliminate transmission in areas where transmission persists.

Animals↗

PubMedDate not supplied

Screening for nutritional risk in community-dwelling old-old.

Screening tools for detecting declining nutrition in community-dwelling old-old are few and problematic. The purpose of this study was to identify the leading risk factors associated with noninvasive measures of poor nutritional status among elders aged 80 or older still living independently in the community. This cross-sectional descriptive study included 68 community-dwelling old-old (average age 85.7). Participants were recruited by parish nurses. In-home interviews were conducted. Relationships between five well-established measures of nutritional risk factors and two measures of nutritional status, body mass index (BMI) categories, and unintentional weight loss were examined. Depression and the food pyramid groups with adequate amounts eaten were predictive of unintentional weight loss in the previous 6 months (p = 0.013) but not of high or low BMI. In this sample, 25% were obese. Screening for depression and food intake may be useful in predicting nutritional decline among community-dwelling old-old and point to targeted interventions in a population who are large users of health care dollars.

Aged↗

PubMedDate not supplied

Pesticide exposure and creatinine variation among young children.

Pesticide exposure may differentially impact young children; they live closer to the ground and take in greater amounts of food relative to body mass than older children or adults. We are using an organophosphate (OP) urinary biomarker screen (gas chromatography with flame photometric detection, GC/FPD) to evaluate pesticide exposure among 154 children < or = 6 years of age living in a heavily farmed border (US-Mexico) community. The screen detects diethylphosphates (DEPs) and dimethylphosphates (DMPs) above a reference range of 1000 non-occupationally exposed individuals (DL=25 microg/g creatinine, Cr). At least one metabolite was detected for 33% of the subjects; many samples contained multiple biomarkers. DEP was detected in 5% of the subjects. DMP and DMTP were frequently measured (25% and 26%, respectively). Biomarker concentrations are adjusted by the body's metabolism of Cr as an indicator of urine dilution. Cr concentrations were examined separately to evaluate their effect on internal dose measures. Cr concentrations were significantly different by season (K-W=0.83, P=0.022). Significant differences exist between the autumn:spring (P=0.038) Cr concentrations and between summer:autumn (P=0.041) Cr concentrations based on Mann-Whitney U=1070.5, z=-2.041, (P=0.041). Our analysis of NHANES III data did not reflect seasonal Cr differences for 6 year olds. No younger children were included. Absorbed daily dose (ADD) estimates were calculated for children with the highest concentrations of metabolite. Calculations are theoretical values assuming that the entirety of a given metabolite was metabolized from a single pesticide. Several class appropriate pesticides were evaluated. For the children with the highest levels, almost all estimated ADDs exceeded the RfD. Although the actual metabolite concentrations dropped appreciably, ADD were still exceeded RfDs at the 95th percentile. The urinary OP screen was effective in identifying subjects with atypical internal doses. Daily Cr yield is a critical component in ADD calculations. Cr variability produces differences in internal dose measurement and estimates of ADD independent of exposure. Cr variability among young children needs to be examined, and caution should be applied when evaluating Cr adjusted internal doses for children.

Agriculture↗

PubMedDate not supplied

Differential characteristics of HIV-infected penitentiary patients and HIV-infected community patients.

PURPOSE: To identify particular characteristics of HIV+ patients from correctional facilities (CF) compared with an HIV+ population from the community to better detect variables for intervention. METHOD: In our hospital, HIV+ patients are admitted to an infectious diseases ward (IDW) when they come from the community or to a penitentiary unit (PU) when they are transferred from CF. We retrospectively reviewed admissions of those patients in both areas during 1999. RESULTS: Admissions of HIV+ patients to IDW and PU generate 2.3% and 53.4% of hospital and PU stays, respectively. Both populations were equivalent in terms of mean age, CD4 count, viral load, prophylaxis for opportunistic infections, average stay, and death during stay. Male sex (91% vs. 74%), previous or current intravenous drug use (88% vs. 77%), and hepatitis C virus (HCV) seropositivity (97% vs. 82.6%) were more frequent in the PU than in the IDW. Multivariate analysis identified three factors as being independently related to admission from prison: longer time of known HIV infection (average 3.3 years; 95% CI 1.9-4.6), no previous antiretroviral treatment (odds ratio [OR] 2.95; 95% CI 1.46-6.0), and admission due to tuberculosis (OR 2.5; 95% CI 1.03-6.0). CONCLUSION: HIV infection is still a serious medical problem in CF. Although imprisonment can provide access to health programs, HIV-infected prison patients suffer more frequently from tuberculosis and take less antiretroviral treatment.

Adult↗

PubMed2004

Soil-transmitted helminthiases and health behaviors among schoolchildren and community members in a west-central border area of Thailand.

The prevalence of soil-transmitted helminthic infections and health behaviors related to infections in schoolchildren and villagers of a community (4 hamlets) was studied in Hauy Kayeng subdistrict, Thong Pha Phum district, in the north of Kanchanaburi Province. The intestinal helminth infection rate of the schoolchildren was 15.6%. Hookworm infection was the most prominent (9.8%), followed by Trichuris trichiura (6.2%), and Ascaris lumbricoides (2.2%). The community showed higher prevalence rates and was infected with more types of intestinal helminths than the schoolchildren. Thirty-five point two percent (35.2%) of the residents were infected with soil-transmitted helminths, 30.5% with hookworm, 3.4% with A. lumbricoides and 2.2% with T. trichiura. Almost all hookworm cases (94.3%) were light intensity infections, while only 1.3% were heavy infections. Moreover, the hookworm infection rate in the community was found to be much higher when a stool culture method was used (39.1%). With this technique, 2.3% Strongyloides stercoralis infections were detected in the community population. Examination of the health behavior of the study samples showed that approximately 75% always defecated in a toilet. Schoolchildren who always wore shoes comprised 67%, which was lower than the community, at 85%.

Adolescent↗

PubMed2005

Healthcare-associated outbreaks and community-acquired infections due to MRSA carrying the Panton-Valentine leucocidin gene in southeastern Germany.

In response to several isolations of methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leucocidin gene (PVL-MRSA), the present study was conducted to document the spread of infection in a small region of southeastern Germany. During a 9-month period, two healthcare-associated outbreaks with PVL-MRSA occurred, affecting 83 patients, personnel and contacts of personnel, and 34 additional cases were detected in the community. The clinical spectrum ranged from colonization to skin infection and necrotizing pneumonia. The findings represent the largest number of PVL-MRSA cases detected in Germany so far, and demonstrate the potential of this emerging pathogen to spread within the community and in healthcare institutions.

Adolescent↗

PubMed2006

Field and microcosm experiments to evaluate the effects of agricultural Cu treatment on the density and genetic structure of microbial communities in two different soils.

The effects of Cu amendment on indigenous soil microorganisms were investigated in two soils, a calcareous silty clay (Ep) and a sandy soil (Au), by means of a 1-year field experiment and a two-month microcosm incubation. Cu was added as 'Bordeaux mixture' [CuSO(4), Ca(OH)(2)] at the standard rate used in viticulture (B1=16 kg Cu kg(-1) soil) and at a higher level of contamination (B3=48 kg Cu ha(-1) soil). More extractable Cu was observed in sandy soil (Au) than in silty soil (Ep). Furthermore, total Cu and Cu-EDTA declined with time in Au soil, whereas they remained stable in Ep soil. Quantitative modifications of the microflora were assessed by C-biomass measurements and qualitative modifications were assessed by the characterization of the genetic structure of bacterial and fungal communities from DNA directly extracted from the soil, using B- and F-ARISA (bacterial and fungal automated ribosomal intergenic spacer analysis). In the field study, no significant modifications were observed in C-biomass whereas microcosm incubation showed a decrease in B3 contamination only. ARISA fingerprinting showed slight but significant modifications of bacterial and fungal communities in field and microcosm incubation. These modifications were transient in all cases, suggesting a short-term effect of Cu stress. Microcosm experiments detected the microbial community modifications with greater precision in the short-term, while field experiments showed that the biological effects of Cu contamination may be overcome or hidden by pedo-climatic variations.

Anti-Infective Agents↗

PubMed1976

Hypertension detection and control in a rural white Kentucky community.

This report presents data on the prevalence of elevated blood pressure and the status of hypertension control in a rural Kentucky community. Medical care is provided to the population under study by a long established organization of nurse practitioners. With the exception of young males, detection of hypertension has been relatively successful. However, fewer than 50 per cent of persons with blood pressure greater than 160/100 mmHg are receiving antihypertensive therapy, and greater than 60 per cent of individuals on therapy have blood pressure greater than 160/100 mmHg. Despite detection of hypertension control has not been achieved in this rural white community.

Adolescent↗

PubMed1991

Six years of occult blood screening in an urban public hospital: concepts, methods, and reflections on approaches to reducing avoidable mortality among black Americans.

While early cancer detection is frequently overused in high socioeconomic status communities, opportunities for early detection often are overlooked by practitioners serving lower income and minority populations. Review of our patient records in 1980 revealed that only 13% of patients had a record of a rectal examination, and less than 1% had either proctoscopy or fecal occult blood testing. Our program has made a dramatic impact on colorectal cancer detection, performing 8192 fecal occult blood tests in the first 5 1/2 years of our program. As with other programs, stage of cancer is greatly influenced by fecal occult blood testing, with 0 modified Dukes' stage D compared to 33% for the hospital registry, and 35% stage A compared to 0 for the registry. Compliance with diagnostic evaluation has been excellent (89.6%). The program has allowed for increased communication between patients and staff. Education about diet and other prevention has been institutionalized. Patients see our nurses as their advocates and openly express their fears and concerns about their health and health care. We began our fecal occult blood testing program at a time when it was considered the "standard of care" although randomized clinical trial proof was, and is, incomplete. This program provides evidence that "standard of care" is feasible in the public sector.

Black or African American↗

PubMed1981

Effectiveness of a community program to promote early breast cancer detection.

There are no known means of preventing breast cancer, and efforts to control the disease must be directed toward early detection and improved treatment. To assist in achieving this, we developed a two-tier educational program aimed at educating women regarding breast cancer facts and the proper performance of breast self-examination (BSE). Educational efforts are first directed at nurses who are then encouraged to transmit this information to women and their partners in the community. The program combines a lecture and demonstration with more informal small group discussions that allow for individual demonstrations of the technique of BSE. Follow-up of both nurse and lay participants by means of telephone interviews has shown that women can be motivated to practice BSE, and be made aware of proper techniques.

Breast↗

PubMed1990

Use of illiterate volunteer workers for malaria case detection and treatment.

We evaluated the use of illiterate community volunteers for malaria case detection and treatment in Guatemala. Volunteer workers, known as Volunteer Medicators, were selected by members of their communities and were trained and supervised by National Malaria Service (NMS) staff. Their responsibilities included recording basic demographic data and administering a three-day course of chloroquine (25 mg kg-1) to all febrile patients who visited their homes. Patient information was recorded on a special form which consisted of stick-figure drawings. During a one-year evaluation period, no differences were noted between literate and illiterate Volunteer Medicators with respect to the length of time required for their training or supervision, the average number of patients they treated per month, the frequency of errors in recording data or administering medication, or their acceptance by the community residents.

Community Health Workers↗

PubMed2004

Aquatic mesocosm assessments of a neem (azadirachtin) insecticide at environmentally realistic concentrations--2: zooplankton community responses and recovery.

A neem-based insecticide, Neemix 4.5, was applied to forest pond enclosures at environmentally realistic concentrations (i.e., below the worst-case expected environmental concentration of 35 microg L(-1)). Crustacean zooplankton communities were examined by multivariate ordination (nonmetric multidimensional scaling) and time-course analyses of population trends among indicator taxa over two field seasons to determine application effects on community structure and recovery patterns. Significant effects on zooplankton community structure were detected at all main test concentrations (n = 5) of 28, 17, and 10 microg L(-1) azadirachtin. There was also evidence of adverse effects on zooplankton communities at an auxiliary test concentration (n = 2) of 5 microg L(-1) azadirachtin. Community-level effects resulted primarily from reductions in adult copepods with short-term, reciprocal increases in cladocerans. Copepod nauplii were not significantly affected. Response patterns suggested that the reductions in adult copepods resulted from growth-regulating effects of the active ingredient azadirachtin, or other neem compounds, and not from formulation ingredients. There was no evidence of recovery among adult copepods within the season of application. At the beginning of the second sampling season, there were apparent carryover effects similar to the community responses in the previous year. By the end of the second season, there was evidence indicating recovery of community structure at the two lower test concentrations of 10 and 17 microg L(-1), but not at 28 microg L(-1). The selective toxicity to adult copepods is problematic in that this group has a relatively long life cycle (1 year), contributes a major component of zooplankton biomass and respiration, and occupies critical functional guilds within zooplankton food web structures. Mitigation measures such as reductions in application rates and efforts to avoid deposition of sprayed materials on water bodies will be required to reduce the risk of harmful effects on zooplankton communities of forest ponds and other shallow, standing-water bodies.

Animals↗

PubMed1996

Cancer detection activities coordinated by nursing students in community health.

This article describes ongoing cancer screening in a low-income and ethnically diverse community (primarily Southeast Asian and Hispanic). These services are part of the comprehensive care provided in a district nursing community health clinical. Screening services occur within the refugee community and include mammograms, individualized breast self-exam (BSE) teaching, home follow-up on the BSE teaching, and assistance obtaining any additional screening or treatment, if necessary. Except for technician activities, students plan, implement, and evaluate all services. The first event was in spring 1995, the second in summer 1995, and the third in fall 1995. Thus far, 85 women have received services. Cambodian and Laotian women show the lowest level of knowledge and experience related to breast cancer detection. This article provides some of the first data on cancer screening for low-income Cambodian and Laotian women in the United States. The article also shows how ongoing cancer screening and prevention services can be provided to populations that have not been successfully reached through usual means, e.g., referral by nurse practitioner, physician, and electronic or print media. Specific means of overcoming barriers to screening, prevention, and learning are described in detail.

Breast Neoplasms↗

PubMed1994

A retrospective study of the diagnostic accuracy of a community hospital-based PET center for the detection of coronary artery disease using rubidium-82.

UNLABELLED: A retrospective analysis has been carried out to determine the diagnostic accuracy of PET of the heart with 82Rb at a community hospital based center. METHODS: Utilization statistics were derived from a total of 1460 patients scanned for the first 36 mo of the center's operation. Diagnostic accuracy for detection of coronary artery disease (CAD) was assessed using three readers blinded to the clinical information. A total of 287 rest and dipyridamole-stress scans of patients who had coronary angiograms within 6 mo of the PET scan were selected by the computer for this study. Each rest/stress scan was read by at least two of the three readers. RESULTS: The average sensitivity for all three readers was 87% for greater than 67% diameter stenosis and the average specificity was 88% for myocardial regions perfused by normal coronary arteries. The average accuracy was 88% for patients with greater than 67% diameter stenosis. Sensitivity and accuracy improved to 92% and 91% respectively for stenosis greater than 90% in diameter. CONCLUSION: These results compare well with published results from major hospital-based centers and the recently published results from a private PET center in Georgia.

Coronary Angiography↗

PubMed2006

Community-based surveillance of malaria vector larval habitats: a baseline study in urban Dar es Salaam, Tanzania.

BACKGROUND: As the population of Africa rapidly urbanizes it may be possible to protect large populations from malaria by controlling aquatic stages of mosquitoes. Here we present a baseline evaluation of the ability of community members to detect mosquito larval habitats with minimal training and supervision in the first weeks of an operational urban malaria control program. METHODS: The Urban Malaria Control Programme of Dar es Salaam recruited and provided preliminary training to teams of Community-Owned Resource Persons (CORPs) who performed weekly surveys of mosquito breeding sites. Two trained mosquito biologists accompanied each of these teams for one week and evaluated the sensitivity of this system for detecting potential Anopheles habitats. RESULTS: Overall, 42.4% of 986 habitats surveyed by an inspection team had previously been identified by CORPs. Agricultural habitats were detected less often than other habitats (30.8% detected, Odds Ratio [95%CI] = 0.46 [0.29-0.73], P = 0.001). Non-agricultural artificial habitats were less suitable than other habitats (29.3% occupancy, OR = 0.69 [0.46-1.03], P = 0.066) but still constituted 45% (169/289) of occupied habitats because of their abundance (51 % of all habitats). CONCLUSION: The levels of coverage achieved by modestly trained and supported CORPs at the start of the Dar es Salaam UMCP were insufficient to enable effective suppression of malaria transmission through larval control. Further operational research is required to develop surveillance systems that are practical, affordable, effective and acceptable so that community-based integrated vector management can be implemented in cities across Africa.

Animals↗

PubMed2006

The effect of varying levels of sodium bicarbonate on polychlorinated biphenyl dechlorination in Hudson River sediment cultures.

The addition of different concentrations of sodium bicarbonate had a profound effect on 2,3,4,5-chlorobiphenyl (2,3,4,5-CB) dechlorination in Hudson River sediment cultures. The most extensive dechlorination was observed in cultures to which 100 mg l(-1) bicarbonate was added. Cultures amended with 1000 mg l(-1) bicarbonate had the least extensive dechlorination, with 2,4-CB and 2,5-CB as predominant end-products. A significant loss of total chlorinated biphenyl mass was observed in cultures to which < or = 500 mg l(-1) bicarbonate was added, suggesting that degradation beyond chlorinated biphenyls occurred. The dynamics of acetate formation were different among the treatments, with high acetate concentrations detected throughout the 303-day experiment in cultures to which 1000 mg l(-1) bicarbonate had been added. Sodium bicarbonate addition also had a significant impact on bacterial community structure as detected by polymerase chain reaction-denaturant gradient gel electrophoresis (PCR-DGGE) of 16S rRNA gene fragments. Three putative polychlorinated biphenyl (PCB) dechlorinators were identified; one Dehalococcoides-like population was detected in all enrichment cultures, whereas two Dehalobacter-like populations were only detected in the enrichment cultures with the most extensive dechlorination. These results suggest that the availability of bicarbonate, and potentially sodium, may affect PCB dechlorination in Hudson River sediment and thus need to be taken into consideration when assessing the fate of PCBs or implementing bioremediation.

Acetates↗

PubMed2006

Molecular detection of epiphytic Acaryochloris spp. on marine macroalgae.

A molecular method for detecting the epiphyte community on marine macroalgae was developed by using PCR-denaturing gradient gel electrophoresis. Selective amplification of 16S rRNA gene fragments from either cyanobacteria or algal plastids improved the detection of minor epiphytes. Two phylotypes of Acaryochloris, a chlorophyll d-containing cyanobacterium, were found not only on red macroalgae but also on green and brown macroalgae.

Chlorophyll↗

PubMed2004

Screening mammography performance and cancer detection among black women and white women in community practice.

BACKGROUND: Despite improvement in mammography screening attendance, black women continue to have poorer prognosis at diagnosis than white woman. Data from the Carolina Mammography Registry were used to evaluate whether there may be differences in mammography performance or detected cancers when comparing black women with white women who are screened by mammography. METHODS: Prospectively collected data from community-based mammography facilities on 468,484 screening mammograms (79,397 in black women and 389,087 in white women) were included for study. Mammograms were linked to a pathology data base for identification of cancers. Sensitivity, specificity, positive predictive value, and cancer detection rates were compared between black women and white women. Logistic regression methods were used to control for covariates associated with performance characteristics. Differences in cancer characteristics were compared between black women and white women using chi-square statistics. RESULTS: Screening mammography performance results for black women compared with white women were as follows: sensitivity, odds ratio (OR) = 1.07 (95% confidence interval [95% CI], 0.83-1.39); specificity, OR = 1.02 (95% CI, 0.98-1.06); and positive predictive value, OR = 1.07 (95% CI, 0.94-1.23). Among women with no previous screening, black women had a larger proportion of invasive tumors that measured > or = 2 cm (38% vs. 26%; P = 0.04). The cancer detection rate was highest among black women who reported symptoms at screening (13.9 per 1000 black women vs. 7.9 per 1000 white women). Invasive cancers in black women were poorer grade (P = 0.001), and more often had negative estrogen receptor status and progesterone receptor status (P < 0.001). CONCLUSIONS: Overall, screening mammography performed equally well in black women and white women controlling for age, breast density, and time since previous mammogram. Black women who reported symptoms had larger and higher grade tumors compared with white women. Educational efforts need to be strengthened to encourage black women to react sooner to symptoms, so that the tumors detected will be smaller and black women will have a better prognosis when they appear for mammography.

Adult↗