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PubMed1991

[Hospitalization survey of rural family practice].

Data on hospital admissions were recorded in 3 village clinics in central Israel during the period 1977-1986. This period coincided with the introduction of regionalization of hospitals, as well as with the growth of board-certified family practice in Israel. The age-adjusted rate of admission from these 3 villages was 74/1000/year, considerably lower than the national rate of 124/1000/year. There was an abrupt decrease in admission rate in 1983, the year of the doctors' strike, followed by a compensatory rise the following year, mainly for surgical procedures. During the years of the survey hospital stay decreased progressively, but the average of the survey population for the whole period (8.3 days) was greater than that of the national population (5.8 days). Hospital stay was longer in the tertiary hospital center than in regional hospitals. Relatively low admission rates but with relatively long hospitalization may be characteristic of higher quality community care. There were marked demographic differences between the 3 villages. The different age structures and ethnic origins of the populations affected hospitalization trends. However, differences in economic status had no detectable effect. Community-based hospitalization surveys over long periods may be useful in demonstrating changes in morbidity patterns over the years, as well as the effects of changes in the health care system.

Data Collection↗
PubMed2005

Contribution of respiratory syncytial virus, influenza and parainfluenza viruses to acute respiratory infections in San Luis Potosí, Mexico.

BACKGROUND: Respiratory viruses are the main pathogens associated with acute respiratory illness (ARI) in children. OBJECTIVE: To establish the relationship between the presence of respiratory syncytial virus (RSV), influenza and parainfluenza viruses in the community and the number of ARI and pneumonia cases reported to the State Health Services Epidemiology Department (SHSED) in San Luis Potosí, México. METHODS: We compared the weekly number of ARI and pneumonia episodes in children younger than 5 years of age reported to the SHSED for weeks in which the different respiratory viruses were detected in the community. Excess respiratory infection episodes compared with nonepidemic periods were calculated for each of the viruses. RESULTS: From July 2003 through June 2004, there were 236,597 ARI episodes and 2350 pneumonia cases reported to the SHSED. Distinct epidemic periods for parainfluenza type 1 and influenza were observed, whereas RSV and parainfluenza type 3 epidemic periods showed some overlap. The weekly number of excess ARI was greatest when influenza circulated in the community, whereas excess pneumonia cases were greatest when RSV was prevalent. Overall RSV was associated to the largest number of excess ARI and pneumonia cases reported to the SHSED. CONCLUSIONS: RSV detection is associated to the greatest number of ARI and pneumonia episodes in the state of San Luis Potosí. Influenza epidemics are associated to a significant number of ARI visits. Appropriate surveillance systems will be required to assess the impact of influenza immunization and other preventive measures on the number of ARI and pneumonia cases in our community.

Acute Disease↗
PubMed2006

Cat allergen level: its determinants and relationship to specific IgE to cat across European centers.

BACKGROUND: Cat allergen level in settled house dust and its determinants in Europe are unknown. OBJECTIVE: The aim of this study is to quantify the level of cat allergens in mattress dust, to study its determinants, and to analyze the relationship with cat specific IgE on community level across European centers. METHODS: Trained field workers collected dust from approximately 3000 mattresses during home visits in 22 European Community Respiratory Health Survey II centers. Sieved dust extracts were assayed for cat allergen using a mAb ELISA assay. RESULTS: The overall geometric mean cat allergen was 0.94 microg/g, ranging from 0.12 microg/g in Huelva, Spain, to 3.76 microg/g in Antwerp, Belgium. Current cat owners' homes showed substantially higher levels than past cat owners' and never cat owners' homes (geometric mean and 95% CI, 61.4 microg/g [48.4-77.9] vs 1.37 microg/g [0.97-1.9] vs 0.29 microg/g [0.27-0.31]). Community prevalence of cat ownership was moderately correlated with cat allergen levels in noncat owners (r(s) = 0.50), but not for past or current cat owners. The multilevel model identified community prevalence of cat keeping as the only statistically significant determinant of mattress cat allergen levels for noncat owners. However, averaged cat allergen levels per center were not related to community prevalence of detectable specific IgE to cat. CONCLUSION: Not having a cat in the home is associated with substantially lower Fel d 1 concentration, but does not protect against high Fel d 1 exposure in communities where cat ownership is common. CLINICAL IMPLICATIONS: People (including patients with cat allergy) who do not own cats may be exposed to high levels of cat allergen in their home, particularly if they live in communities with high levels of cat ownership.

Allergens↗
PubMedDate not supplied

Cost-effective strategies to screen for left ventricular systolic dysfunction in the community--a concept.

Early detection of heart failure caused by left ventricular systolic dysfunction (LVSD) is important, since early treatment has been shown to retard the progression of heart failure. While traditional echocardiography remains the standard for the detection of LVSD, electrocardiography and serum brain natriuretic peptide have also been shown to predict LVSD. Recently, hand-held echocardiography systems have been shown to have high predictive accuracy for assessment of LVSD. With the availability of the above bedside and relatively less-costly techniques, compared with traditional echocardiography, the major question now is what is the most cost-effective strategy for screening subjects for LVSD. To date, no studies have systematically addressed this issue, but preliminary data are becoming available. This review article discusses the pros and cons of various investigative strategies and likely cost-effectiveness of each strategy to screen for LVSD.

Community Health Services↗
PubMed2002

Prostate-specific antigen testing accuracy in community practice.

BACKGROUND: Most data on prostate-specific antigen (PSA) testing come from urologic cohorts comprised of volunteers for screening programs. We evaluated the diagnostic accuracy of PSA testing for detecting prostate cancer in community practice. METHODS: PSA testing results were compared with a reference standard of prostate biopsy. Subjects were 2,620 men 40 years and older undergoing (PSA) testing and biopsy from 1/1/95 through 12/31/98 in the Albuquerque, New Mexico metropolitan area. Diagnostic measures included the area under the receiver-operating characteristic curve, sensitivity, specificity, and likelihood ratios. RESULTS: Cancer was detected in 930 subjects (35%). The area under the ROC curve was 0.67 and the PSA cutpoint of 4 ng/ml had a sensitivity of 86% and a specificity of 33%. The likelihood ratio for a positive test (LR+) was 1.28 and 0.42 for a negative test (LR-). PSA testing was most sensitive (90%) but least specific (27%) in older men. Age-specific reference ranges improved specificity in older men (49%) but decreased sensitivity (70%), with an LR+ of 1.38. Lowering the PSA cutpoint to 2 ng/ml resulted in a sensitivity of 95%, a specificity of 20%, and an LR+ of 1.19. CONCLUSIONS: PSA testing had fair discriminating power for detecting prostate cancer in community practice. The PSA cutpoint of 4 ng/ml was sensitive but relatively non-specific and associated likelihood ratios only moderately revised probabilities for cancer. Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing.

Adult↗
PubMed2006

Hospital and community surveys reveal the severe public health problem and socio-economic impact of human echinococcosis in Ningxia Hui Autonomous Region, China.

A comprehensive study of human echinococcosis (caused by Echinococcus granulosus or E. multilocularis), including assessment of hospital records, community surveys and patient follow-up, was conducted in Ningxia Hui Autonomous Region (NHAR), China. In contrast to hospital records that showed 96% of echinococcosis cases were caused by cystic echinococcosis (CE), 56% of cases detected in active community surveys were caused by alveolar echinococcosis (AE). The AE and CE cases co-existed frequently in the same village, even occurring in the same patient. A serious public health problem caused by echinococcosis was evident in southern NHAR, typified by: a long diagnostic history for both AE and CE (7.5 years) compared with a shorter treatment history (4.7 years); a significant mortality rate (39%) caused by AE in one surveyed village, where patients had no previous access to treatment; family aggregation of CE and AE cases; a high proportion of both AE (62.5%) and CE (58%) in females; a high rate of recurrent surgery (30%) for CE demonstrated by surgical records; and frequent symptomatic recurrences (51%) because of discontinuous or sporadic access to chemotherapy for AE. The disease burden for both human AE and CE is thus very severe among these rural communities in NHAR, and this study provides the first attempt to determine the costs of morbidity and surgical intervention of human CE and AE cases both at the hospital and community level in this setting. This information may be useful for assessing the cost effectiveness of designing effective public health programs to control echinococcosis in this and other endemic areas in China and elsewhere.

Adolescent↗
PubMed2005

Contrasting microcystin production and cyanobacterial population dynamics in two Planktothrix-dominated freshwater lakes.

Microcystin concentrations in two Dutch lakes with an important Planktothrix component were related to the dynamics of cyanobacterial genotypes and biovolumes. Genotype composition was analysed by using denaturing gradient gel electrophoresis (DGGE) profiling of the intergenic transcribed spacer region of the rrn operon (rRNA-ITS), and biovolumes were measured by using microscopy. In Lake Tjeukemeer, microcystins were present throughout summer (maximum concentration 30 microg l(-1)) while cyanobacterial diversity was low and very constant. The dominant phototroph was Planktothrix agardhii. In contrast, Lake Klinckenberg showed a high microcystin peak (up to 140 microg l(-1)) of short duration. In this lake, cyanobacterial diversity was higher and very dynamic with apparent genotype successions. Several genotypes derived from DGGE field profiles matched with genotypes from cultures isolated from field samples. The microcystin peak measured in Lake Klinckenberg could be confidently linked to a bloom of Planktothrix rubescens, as microscopic and genotypic analysis showed identity of bloom samples and a toxin-producing P. rubescens culture. Toxin-producing genotypes were detected in the microbial community before they reached densities at which they were detected by using microscopy. Cyanobacterial biovolumes provided additional insights in bloom dynamics. In both lakes, the microcystin content per cell was highest at the onset of the blooms. Our results suggest that while genotypic characterization of a lake can be valuable for detection of toxic organisms, for some lakes a monitoring of algal biomass has sufficient predictive value for an assessment of toxin production.

Cyanobacteria↗
PubMed2003

Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development.

The cervical cancer screening programs (CCSP) have not been very efficient in the developing countries. This explains the need to foster changes on policies, standards, quality control mechanisms, evaluation and integration of new screening alternatives considered as low and high cost, as well as to regulate colposcopy practices and the foundation of HPV laboratories. Cervical cancer (CC) is a disease most frequently found in poverty-stricken communities and reflecting a problem of equity at both levels gender and regional, and this, is not only due to social and economic development inequalities, but to the infrastructure and human resources necessary for primary care. For this reason, the CCSP program must be restructured, a) to primarily address unprivileged rural and urban areas; b) to foster actions aimed at ensuring extensive coverage as well as a similar quality of that coverage in every region; c) to use screening strategies in keeping with the availability of health care services. In countries with a great regional heterogeneity, a variety of screening procedures must be regulated and standardized, including a combination of assisted visual inspection, cervical cytology and HPV detection; d) regional community intervention must be set up to assess the effectiveness of using HPV detection as an strategy in addition to cervical cytology (pap smear); e) the practice of colposcopy must be regulated to prevent the use of it in healthy women at a population level, thus preventing unnecessary diagnosis and treatment which not only are expensive but also causes unnecessary anxiety to women at risk; f) the operation of those clinical laboratories using HPV as a detection strategy must likewise be accredited and regulated and g) the CCSP program for assuring health care quality should meet the expectations of its beneficiaries, and increase the knowledge in cervical cancer related matters. Finally, though a variety of clinical tests on prophylactic and therapeutic vaccines against HPV are recently being developed worldwide; it will take at least from 5 to 10-years time to have them available in the market. For this reason, it will be necessary to intensify the CCSP programs. All these reasons lay emphasis on the need to reinforce actions for CCSP programs. This paper is available too at: http://www.insp.mx/salud/index.html.

Developing Countries↗
PubMed2001

Treatment outcome and impact of leprosy elimination campaign in Sokoto and Zamfara states, Nigeria.

A Leprosy Elimination Campaign (LEC) was implemented in 37 districts of Sokoto and Zamfara states, Nigeria from 13 August to 30 November 1998. The campaign utilized intensive community mobilization and training of local health personnel to detect hidden leprosy cases. During 8 weeks of case finding, 160,127 persons were screened; 353 new cases of leprosy were detected and placed on MDT; 236 (67%) of new cases detected were classified as MB, 64 cases (18%) suffered visible deformities and 24 patients (6.8%) were children. Follow-up in December 1999 of patients placed on MDT revealed 97% PB and 96% MB cure rates, respectively. Detection of cases in communities led some community leaders to ask for repeat surveys in their communities. Repeat surveys continue to yield new cases. The authors recommend that LECs be maintained for 3 years to accelerate leprosy elimination in the region. The cost effectiveness and impact of LEC in Sokoto-Zamfara are discussed.

Adolescent↗
PubMed1994

Accuracy, reproducibility, and interpretation of Fatty Acid methyl ester profiles of model bacterial communities.

We determined the accuracy and reproducibility of whole-community fatty acid methyl ester (FAME) analysis with two model bacterial communities differing in composition by using the Microbial ID, Inc. (MIDI), system. The biomass, taxonomic structure, and expected MIDI-FAME profiles under a variety of environmental conditions were known for these model communities a priori. Not all members of each community could be detected in the composite profile because of lack of fatty acid "signatures" in some isolates or because of variations (approximately fivefold) in fatty acid yield across taxa. MIDI-FAME profiles of replicate subsamples of a given community were similar in terms of fatty acid yield per unit of community dry weight and relative proportions of specific fatty acids. Principal-components analysis (PCA) of MIDI-FAME profiles resulted in a clear separation of the two different communities and a clustering of replicates of each community from two separate experiments on the first PCA axis. The first PCA axis accounted for 57.1% of the variance in the data and was correlated with fatty acids that varied significantly between communities and reflected the underlying community taxonomic structure. On the basis of our data, community fatty acid profiles can be used to assess the relative similarities and differences of microbial communities that differ in taxonomic composition. However, detailed interpretation of community fatty acid profiles in terms of biomass or community taxonomic composition must be viewed with caution until our knowledge of the quantitative and qualitative distribution of fatty acids over a wide variety of taxa and the effects of growth conditions on fatty acid profiles is more extensive.

Journal Article↗
PubMed2001

Changes in activity and community structure of methane-oxidizing bacteria over the growth period of rice.

The activity and community structure of methanotrophs in compartmented microcosms were investigated over the growth period of rice plants. In situ methane oxidation was important only during the vegetative growth phase of the plants and later became negligible. The in situ activity was not directly correlated with methanotrophic cell counts, which increased even after the decrease in in situ activity, possibly due to the presence of both vegetative cells and resting stages. By dividing the microcosms into two soil and two root compartments it was possible to locate methanotrophic growth and activity, which was greatest in the rhizoplane of the rice plants. Molecular analysis by denaturing gradient gel electrophoresis and fluorescent in situ hybridization (FISH) with family-specific probes revealed the presence of both families of methanotrophs in soil and root compartments over the whole season. Changes in community structure were detected only for members of the Methylococcaceae and could be associated only with changes in the genus Methylobacter and not with changes in the dominance of different genera in the family Methylococcaceae. For the family Methylocystaceae stable communities in all compartments for the whole season were observed. FISH analysis revealed evidence of in situ dominance of the Methylocystaceae in all compartments. The numbers of Methylococcaceae cells were relatively high only in the rhizoplane, demonstrating the importance of rice roots for growth and maintenance of methanotrophic diversity in the soil.

Colony Count, Microbial↗
PubMed1988

Rapid detection of pneumococcal antigens in sputa in patients with community-acquired pneumonia by coagglutination.

This paper introduces the clinical use of coagglutination as a method for the rapid detection of pneumococcal antigens in patients with community-acquired pneumonia and compares it with the sputum Gram stain and culture methods. Among 105 patients, 50 (48%) were diagnosed as having pneumococcal pneumonia by at least one of the three methods. Of 95 sputa tested, 44 (46%) were found to be positive by the coagulation test, 26 (27%) by Gram staining and only 16 (17%) by the bacterial culture method. The rate of detection of pneumococcal antigens was thus greater with coagulation than with either of the other two methods. The differences were very significant (both P less than 0.01). Our study indicates that the advantages of coagglutination over the traditional bacteriological methods are its speed, sensitivity, convenience and also its relative independence of antibiotic therapy. It thus provides a new dimension in the aetiological diagnosis of pneumococcal pneumonia.

Adult↗
PubMed1998

A cocktail of recombinant Onchocerca volvulus antigens for serologic diagnosis with the potential to predict the endemicity of onchocerciasis infection.

We report here the evaluation of the potential of a serologic test to determine the endemicity of onchocercal infection in hyper, meso, and hypoendemic communities by the detection of antibodies to a cocktail of recombinant antigens. Parasitologic parameters of infection prevalence and intensity were compared with serologic results. Infection prevalence by serology was consistently but not significantly higher than that defined by parasitology. Differences between the communities defined by microfilarial load (CMFL) and a measurement of Onchocerca volvulus-specific antibody levels (serologic index [SI]) were similar. When stratified by age, differences were more significant in the younger age groups. If a sentinel population of 5-15-year-old individuals was used to compare communities, all could be equally ranked by serologic and parasitologic parameters. The SI of the sentinel population gave a better distinction between each community than the SI of the whole and would be sufficiently sensitive to measure the changes in endemicity that would be required for onchocerciasis control programs.

Adolescent↗
PubMed2003

Do community based self-reading sphygmomanometers improve detection of hypertension? A feasibility study.

BACKGROUND: Hypertension is a major risk factor for stroke and ischaemic heart disease. Most hypertension is detected opportunistically by general practitioners. Those who rarely use medical services are less likely to have their blood pressure (BP) measured. We hypothesized that open access self-reading BP measurement would detect previously unrecognized hypertension. METHODS: Self-reading sphygmomanometers were placed at 13 public sites in Exeter, Devon, United Kingdom. Machine use was determined by users completing a proforma and by direct observation of sites. Users whose BP reading was above an action level of 135/85 mmHg were asked to attend their general practice. General practitioner records were reviewed 6 months after machine use to identify diagnoses of hypertension. A random sample of users was interviewed, and local general practices were asked about effects on their workload. RESULTS: A total of 758 first time users completed a proforma fully, although direct observations suggested total use was much higher. Of the total, 221 (29.2 per cent) readings were above the action level. Eleven new hypertensives were found, 1.4 per cent (95 per cent confidence interval (CI 0.7-2.5) of the total users. User acceptability was high. All general practice replies were supportive. CONCLUSION: Open access sphygmomanometry for detection of hypertension is feasible. This scheme led to the diagnosis of hypertension in 1.4 per cent of users, and allowed many people to measure their BP in a way convenient to them. Before recommending wider implementation we suggest a study examining if our results are transferable to other settings, and if this approach reduces inequalities and is cost-effective.

Adult↗