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PubMed2007

Comparability of self-collected vaginal swabs and physician-collected cervical swabs for detection of human papillomavirus infections in Rakai, Uganda.

OBJECTIVE: The objective of this study was to compare human papillomavirus (HPV) DNA testing between self-administered vaginal swabs and physician-administered cervical swabs in women from rural Rakai District, Uganda. STUDY DESIGN: Between 2002 and 2003, women from a population-based cohort participated in an HPV study. Women collected self-administered vaginal swabs and were also offered a pelvic examination, which included physician-collected cervical samples. METHODS: Hybrid-capture 2 was used to determine carcinogenic HPV status. Polymerase chain reaction was used to determine HPV genotypes. Unweighted kappa statistics were used to determine agreement. RESULTS: Compliance with self-collected swabs was > or =86%; however, only 51% accepted a pelvic examination. Carcinogenic HPV prevalence was 19% in self-collected and 19% in physician-collected samples. Agreement among paired observations was 92% with a kappa of 0.75. Kappa between self- and physician-collected samples was similar in HIV strata (k = 0.71 and 0.75 for HIV-positive and HIV-negative, respectively). DISCUSSION: In this community-based setting, detection of carcinogenic HPV was comparable among self- and physician-administered samples. Self-collection is a feasible and accurate means of obtaining HPV samples from women in resource-poor settings or persons reluctant to undergo a pelvic examination.

Adolescent↗
PubMed2004

Biofuel cells select for microbial consortia that self-mediate electron transfer.

Microbial fuel cells hold great promise as a sustainable biotechnological solution to future energy needs. Current efforts to improve the efficiency of such fuel cells are limited by the lack of knowledge about the microbial ecology of these systems. The purposes of this study were (i) to elucidate whether a bacterial community, either suspended or attached to an electrode, can evolve in a microbial fuel cell to bring about higher power output, and (ii) to identify species responsible for the electricity generation. Enrichment by repeated transfer of a bacterial consortium harvested from the anode compartment of a biofuel cell in which glucose was used increased the output from an initial level of 0.6 W m(-2) of electrode surface to a maximal level of 4.31 W m(-2) (664 mV, 30.9 mA) when plain graphite electrodes were used. This result was obtained with an average loading rate of 1 g of glucose liter(-1) day(-1) and corresponded to 81% efficiency for electron transfer from glucose to electricity. Cyclic voltammetry indicated that the enhanced microbial consortium had either membrane-bound or excreted redox components that were not initially detected in the community. Dominant species of the enhanced culture were identified by denaturing gradient gel electrophoresis and culturing. The community consisted mainly of facultative anaerobic bacteria, such as Alcaligenes faecalis and Enterococcus gallinarum, which are capable of hydrogen production. Pseudomonas aeruginosa and other Pseudomonas species were also isolated. For several isolates, electrochemical activity was mainly due to excreted redox mediators, and one of these mediators, pyocyanin produced by P. aeruginosa, could be characterized. Overall, the enrichment procedure, irrespective of whether only attached or suspended bacteria were examined, selected for organisms capable of mediating the electron transfer either by direct bacterial transfer or by excretion of redox components.

Animals↗
PubMed1987

Viral antibodies in agricultural populations exposed to aerosols from wastewater irrigation during a viral disease outbreak.

The presence of antibodies to eight enteroviruses (echovirus types 4, 7, and 9, coxsackievirus types A9, B1, B3, and B4, and hepatitis A virus) and varicella-zoster virus was determined during a two-year period, 1980-1981, in paired blood samples of 777 persons in selected agricultural communities (kibbutzim) in Israel. These communities were divided into several categories on the basis of wastewater utilization for sprinkler irrigation and/or fish ponds. Among the nine viral antibodies studied, there was a consistent and significant excess of antibodies to echovirus type 4 only, particularly in the age group 0-5 years, in kibbutzim that had been exposed to aerosols from sprinkler irrigation with partially treated wastewater from nearby towns. This finding may be attributed to a major national echovirus type 4 epidemic, which had peaked shortly before the collection of the blood samples. The fact that no similar excess of the other viral antibodies studied was found in any of the kibbutz categories suggests that, under nonepidemic conditions, exposure to wastewater aerosols usually does not lead to an excess in enteroviral infection. No excess of clinical cases of echovirus type 4-associated disease (meningitis or encephalitis) was detected in the communities exposed to wastewater aerosol.

Adolescent↗
PubMed1991

Effects of repeated application of carbaryl on zooplankton communities in experimental ponds with or without the predator Chaoborus.

Zooplankton communities with or without Chaoborus larvae were established in outdoor experimental ponds, to which the insecticide carbaryl was applied repeatedly at 10 or 100 microg litre(-1). In the ponds without Chaoborus, Cladocera dominated, but the species composition differed among the treatments. A large-sized Cladocera Daphnia galeata dominated the controls, the medium-sized cladocerans Diaphanosoma brachyurum and Moina micrura became dominant in the low-dose treatment, and the small-sized Bosmina fatalis increased in the high-dose treatment. These results indicated differential sensitivity to carbaryl among the cladocerans, and that smaller Cladocera were more tolerant of the chemical than the larger one. In the ponds with Chaoborus, rotifers dominated the zooplankton, probably because Chaoborus released rotifers from competition with cladocerans and calanoid copepods, which were eliminated by the Chaoborus predation. No effects of low-dose carbaryl treatment were detected on zooplankton communities in the Chaoborus ponds. The dominance by rotifers, organisms tolerant to carbaryl, minimized the effects. Thus, Chaoborus altered the zooplankton community responses to the chemical application by changing community structure. Repeated application of high-dose carbaryl did affect the rotifer community, decreasing the dominance of Polyarthra trigla and increasing that of Keratella valga. These rotifer species may differ in their sensitivity to carbaryl.

Journal Article↗
PubMed1993

[Efficacy of hemoglobin-Alc, fructosamine, and 1,5-anhydroglucitol in community screening for diabetes mellitus].

To evaluate the efficacy of hemoglobin-Alc, fructosamine, and 1,5-anhydroglucitol tests in screening for diabetes mellitus in communities, the sensitivity and the specificity of these tests were observed on the island of Ojika, Goto islands, Nagasaki prefecture Japan. A 75 gram glucose tolerance test was performed simultaneously on every participant, and WHO diabetes mellitus criteria were used to classify individuals. A total of 554 males and 820 females, older than 34 years, participated in the examination, representing a response rate of 42% and 52% respectively, and 86 were classified as diabetic. The sensitivity and the specificity of several screening levels were determined for each test. Each of the tests attained greater than 70% sensitivity and specificity simultaneously, but could not achieve greater than an 80% level simultaneously. If screening levels are selected for a sensitivity of as low as 50%, it is possible to produce a high specificity of 97-98%. These results provide valuable information for the planning of efficient diabetes mellitus detection programs in communities.

Adult↗
PubMed1991

The role of positive and negative interspecific associations in the organization of communities of intestinal helminths of bats.

Twelve populations of bats were examined to determine the extent of interspecific associations in determining the species richness of intestinal helminth infracommunities. The pool of helminth species which was available to individual bats ranged from 2 to 21. The 'summed binomial' distribution was determined to underlie the host frequency distribution of the number of helminth species per host. Overall covariation in occurrences of species in replicated communities can be detected by testing for the equality of the observed variance of the host frequency distribution to the variance expected when species are allocated to hosts at random. Where statistically significant the covariance was indicative of a majority of positive rather than negative interspecific associations. As the mean number of species per host in a host population increases not only does the number of positive associations increase but so does the proportion of species pairs which exhibit positive associations. Although there is an increase in the proportion of species pairs which exhibit positive associations as the number of species increases, the magnitude of the associations (as indicated by the mean positive or the mean negative pairwise covariances) does not. Therefore, we concluded that positive interactions are more common than negative interactions in determining the species richness of helminth infracommunities of bats. Further, positive associations become even more important as the community becomes more complex. However, the increased importance is derived from the number rather than the strength of the associations.

Animals↗
PubMed1995

[Factors related to impaired mental function of elderly in a rural community].

Factors related to impaired mental function of the elderly population living in a rural community were analyzed in a study of 573 elderly residents (238 males, 335 females) aged 70 years and over living in a village in the northeastern part of Japan. A comprehensive health and social survey including interviews and blood tests was performed in 1985. The major results obtained were as follows; 1) Mental function of the elderly declined with age and correlated with deterioration of physical function and frequencies of psychiatric symptoms. Those with deteriorated mental function tended to have histories of having cerebrovascular diseases and living with their children's household. 2) Multiple logistic regression model analysis revealed that the likeliness for impaired mental function (measured by Hasegawa's Mental Scale, a widely used scheme in Japan) was well explained by such independent variables as age, serum hemoglobin level, level of ability to feed oneself, social activities, and existence of anxiety. 3) Explanatory factors such as these are considered to be useful for public health nurses to detect in the community those who require further psychiatric attention and to facilitate early intervention to enable demented elderly to live in their own homes as long as possible.

Activities of Daily Living↗
PubMed1988

Asbestos-contaminated drinking water: its impact on household air.

Asbestos contamination in excess of 10 billion fibers per liter was detected in a community's drinking water. To assess the possibility of waterborne asbestos becoming airborne, air samples were collected from impacted houses receiving contaminated water from three control houses. Collected within each house were three samples on 0.6-micrometer-pore Nuclepore filters and three samples on 0.8-micrometer-pore Millipore filters. In addition, bulk samples of suspect material and water samples were collected. Mean waterborne asbestos concentrations were 24 million fibers per liter (MFL) in the impacted houses versus only 1.1 MFL in the control houses. Transmission electron microscopy revealed that airborne asbestos concentrations were highest in impacted houses, with airborne asbestos concentrations positively correlated with waterborne concentrations. For fiber and mass measurements on both filter types, airborne asbestos concentrations were significantly higher in the impacted houses: mean concentrations in impacted houses were 0.12 fibers/cm3 and 1.7 ng/m3 on Nuclepore filters and 0.053 fibers/cm3 and 2.3 ng/m3 on Millipore filters versus only 0.037 fibers/cm3 and 0.31 ng/m3 on Nuclepore filters and 0.0077 fibers/cm3 and 0.14 ng/m3 on Millipore filters from control houses. Also detected in the air samples from impacted houses were clusters of chrysotile, often with several hundreds of fibers. When estimates of these individual fibers were added to the total fiber count, the difference between the impacted and control houses became even greater. The increased concentrations in impacted houses were due primarily to short (less than 1 micrometer) fibers. Bulk samples did not reveal likely materials within the impacted houses to account for these differences. Thus high levels of waterborne asbestos were apparently the source of increased concentrations of airborne asbestos within these houses.

Air Pollutants↗
PubMed1998

Detection of p53 point mutations by single strand conformation polymorphism: analysis by capillary electrophoresis.

We have analyzed five p53 single point mutations by single strand conformation polymorphism using capillary electrophoresis (CE-SSCP) and have compared these measurements to measurements obtained by slab gel electrophoresis (SG-SSCP). PCR primers were used for amplification of specific exons for mutation detection. 5' Primers were labeled with FAM (5-carboxyfluorescein) and 3' primers were labeled with JOE (2',7'-dimethoxy-4',5'-dichloro-6-carboxyfluorescein). CE-SSCP was performed using the Perkin Elmer ABI PRISM 310 Genetic Analyzer with GeneScan Software and the Beckman P/ACE 5510 CE equipped for laser-induced fluorescence detection. Although the shifts in migration times for the p53 mutations relative to the corresponding wild-type strands could be successfully detected by either SG or CE analysis, the individual electrophoresis run times were about tenfold faster and more automated with capillary electrophoresis. The CE-SSCP measurements were performed at temperatures ranging from 10 to 60 degrees C on a prototype instrument. For mutations measured at ambient temperature (25 degrees C), characteristic shifts in direction and magnitude were observed in the migration times of both strands of all mutations relative to the wild type. This demonstrated the ability of CE at ambient temperature to resolve these mutations. However, the magnitude and direction of shifts in migration time varied with temperature in a discrete pattern for each mutation and resulted in a temperature-specific profile for each mutation. This demonstrated that extended temperature control will be an important advantage in resolving single point mutations by CE-SSCP. In addition, by using CE, discrete intra-strand isoforms could be easily observed at different temperatures. The combination of mutation-specific temperature profiling and analysis of isoforms by CE-SSCP should be of help to the diagnostic community in the detection of genetic mutations.

DNA Mutational Analysis↗
PubMed2003

Diversity of nitrifying bacteria in full-scale chloraminated distribution systems.

Chloramination for secondary disinfection of drinking water often promotes the growth of nitrifying bacteria in the distribution system due to the ammonia introduced by chloramine formation and decay. This study involved the application of molecular biology techniques to explore the types of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) present in several full-scale chloraminated systems. The results of AOB community characterization indicated the ubiquitous detection of representatives from the Nitrosomonas genus, with Nitrosospira constituting a negligible or small fraction of the AOB community in all but one sample. Cloning and sequencing demonstrated the presence of AOB representatives within the Nitrosomonas oligotropha cluster, a phylogenetic subgroup of AOB from which isolates demonstrate a high affinity for ammonia. For the NOB communities, Nitrospira were detected in most of the samples, while Nitrobacter were only detected in a few samples. These results provide insight into the types of AOB responsible for nitrification episodes in full-scale chloraminated systems, which should help direct future studies aimed at characterizing relevant AOB growth and inactivation properties. Furthermore, the detection of NOB in most of the samples suggests a need to evaluate the contribution of biological nitrite oxidation relative to chemical oxidation in these systems.

Ammonia↗
PubMed2004

Application of group specific amplified rDNA restriction analysis to characterize swine fecal and manure storage pit samples.

Group specific amplified ribosomal-DNA restriction analysis was evaluated as a method to rapidly assess microbial community structure in swine fecal and manure storage pit samples. PCR primer sequences were evaluated for their specificity to ribosomal DNA from selected bacterial groups by optimizing annealing temperatures and determining specificity using a set of primer target and non-target organisms. A number of primer sets were identified targeting the following groups: Bacteroides-Prevotella, clostridial clusters I and II, clostridial clusters IX and XI, clostridial clusters XIVa and XIVb, Lactobacillus, Desulfovibrionaceae and Streptococcus-Lactococcus, as well as an universal primer set to represent total populations. Each bacterial group was digested with at least three restriction enzymes. We applied the group specific amplified ribosomal-DNA restriction analysis to swine fecal and manure storage pit samples obtained on two separate occasions. Fecal and manure storage pit samples obtained on the same day were more similar to each other than to any other samples. Results were consistent with 16S ribosomal DNA sequencing data from bacterial isolates and clones obtained from swine feces and manure storage pit. The group specific amplified ribosomal-DNA restriction analysis technique was able to rapid detect gross bacterial community differences among swine fecal and manure storage pit samples and determine groups of interest for more detailed examination.

Journal Article↗
PubMed2003

Monitoring change in mountainous dry-heath vegetation at a regional scale using multitemporal Landsat TM data.

Vegetation cover-change analysis requires selection of an appropriate set of variables for measuring and characterizing change. Satellite sensors like Landsat TM offer the advantages of wide spatial coverage while providing land-cover information. This facilitates the monitoring of surface processes. This study discusses change detection in mountainous dry-heath communities in Jämtland County, Sweden, using satellite data. Landsat-5 TM and Landsat-7 ETM+ data from 1984, 1994 and 2000, respectively, were used. Different change detection methods were compared after the images had been radiometrically normalized, georeferenced and corrected for topographic effects. For detection of the classes change--no change the NDVI image differencing method was the most accurate with an overall accuracy of 94% (K = 0.87). Additional change information was extracted from an alternative method called NDVI regression analysis and vegetation change in 3 categories within mountainous dry-heath communities were detected. By applying a fuzzy set thresholding technique the overall accuracy was improved from of 65% (K = 0.45) to 74% (K = 0.59). The methods used generate a change product showing the location of changed areas in sensitive mountainous heath communities, and it also indicates the extent of the change (high, moderate and unchanged vegetation cover decrease). A total of 17% of the dry and extremely dry-heath vegetation within the study area has changed between 1984 and 2000. On average 4% of the studied heath communities have been classified as high change, i.e. have experienced "high vegetation cover decrease" during the period. The results show that the low alpine zone of the southern part of the study area shows the highest amount of "high vegetation cover decrease". The results also show that the main change occurred between 1994 and 2000.

Ecosystem↗
PubMed1994

[Antimicrobial activities of cefuroxime against recent clinical isolates].

Antimicrobial activity of cefuroxime axetil (CXM-AX) was compared with those of other cephem antibiotics against clinically isolated strains obtained mainly from outpatients of our center in a period from January to September of 1990 and 1993. Minimum inhibitory concentrations were determined and the following results were obtained. 1. The results suggested that, compared with reports of studies conducted with clinical isolates in early 1980's, MIC80 of CXM were equal to or lower against Staphylococcus spp., Streptococcus pyogenes, Escherichia coli, Klebsiella spp., Proteus mirabilis, Haemophilus influenzae, Moraxella subgenus Branhamella catarrhalis, Neisseria gonorrhoeae, Peptostreptococcus spp., and Propionibacterium acnes, except for Streptococcus pneumoniae, MIC80 which was slightly higher. 2. MIC90 of comparator drugs reflected those of new resistant organisms recently appeared, such as benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP), cephem-resistant E. coli and Klebsiella spp., new quinolone-resistant H. influenzae and N. gonorrhoeae. Methicillin-resistant Staphylococcus aureus (MRSA) was detected also from specimens of community acquired infections. From the nature of MRSA detected in those situations MRSA appeared to present a continuing problem. 3. MIC90 against strains obtained from patients with community acquired infections was a good index of increases of multidrug-resistant organisms in the past. Therefore, the determination of MIC90 is important in examining changes with time of sensitivities or resistances of clinically isolated strains to antimicrobial drugs. 4. Antimicrobial activities of CXM against recent clinical isolates showed the existence of problems as mentioned above. However, MIC of CXM as well as those of comparator drugs indicated that antimicrobial activities of CXM against Staphylococcus spp., Streptococcus spp., H. influenzae appeared to be relatively strong, and it is concluded that cefuroxime axetil still is one of the clinically useful oral antimicrobial drugs in the 1990's.

Bacteria↗
PubMed2005

Detection of hypermethylated genes in women with and without cervical neoplasia.

BACKGROUND: DNA methylation changes are an early event in carcinogenesis and are often present in the precursor lesions of various cancers. We examined whether DNA methylation changes might be used as markers of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer (ICC). METHODS: We used methylation-specific polymerase chain reaction (PCR) to analyze promoter hypermethylation of 20 genes, selected on the basis of their role in cervical cancer, in 319 exfoliated cell samples and matched tissue biopsy specimens collected during two studies of Senegalese women with increasingly severe CIN and ICC (histology negative/atypical squamous cells of undetermined significance [ASCUS] = 142, CIN-1 = 39, CIN-2 = 23, CIN-3/carcinoma in situ [CIS] = 23, ICC = 92). Logic regression was used to determine the best set of candidate genes to use as disease markers. All statistical tests were two-sided. RESULTS: Similar promoter methylation patterns were seen in genes from exfoliated cell samples and corresponding biopsy specimens. For four genes (CDH13, DAPK1, RARB, and TWIST1), the frequency of hypermethylation increased statistically significantly with increasing severity of neoplasia present in the cervical biopsy (P<.001 for each). By using logic regression, we determined that the best panel of hypermethylated genes included DAPK1, RARB, or TWIST1. At least one of the three genes was hypermethylated in 57% of samples with CIN-3/CIS and in 74% of samples with ICC but in only 5% of samples with CIN-1 or less. The estimated specificity of the three-gene panel was 95%, and its sensitivity was 74% (95% confidence interval [CI] = 73% to 75%) for ICC and 52% (95% CI = 49% to 55%) for CIN-3/CIS. By extrapolation, we estimated that, among Senegalese women presenting to community-based clinics, detection of the DAPK1, RARB, or TWIST1 hypermethylated gene would reveal histologically confirmed CIN-3 or worse with a sensitivity of 60% (95% CI = 57% to 63%) and a specificity of 95% (95% CI = 94% to 95%). CONCLUSIONS: Aberrant promoter methylation analysis on exfoliated cell samples is a potential diagnostic tool for cervical cancer screening that potentially may be used alone or in conjunction with cytology and/or human papillomavirus testing.

Adult↗
PubMed2006

Association between commensal bacteria and opportunistic pathogens in the dental plaque of elderly individuals.

Opportunistic infections in the oral cavity of the elderly may increase the incidence of systemic disease. The objective of this study was to investigate the differences in the oral bacterial flora between dependent elderly (inpatients) and independent elderly (community-dwelling residents). After multiple variables were taken into account, inpatients had significantly lower detection rates than community-dwelling residents for alpha-streptococci (p < 0.001) and Neisseria (p 0.004), and higher detection rates for Pseudomonas aeruginosa (p 0.024), methicillin-resistant Staphylococcus aureus (MRSA) (p 0.011) and Actinomyces spp. (p 0.005). Among inpatients, the requirement for a high degree of care was related negatively to detection of alpha-streptococci, but was related significantly to detection of P. aeruginosa (p 0.018) or MRSA (p 0.004). Tube-fed inpatients had a significantly lower detection rate for alpha-streptococci (p 0.041) and a higher detection rate for P. aeruginosa (p 0.004) than those who did not require tube feeding. Inpatients with a history of antibiotic use had a significantly lower detection rate for alpha-streptococci (p 0.049) and a higher detection rate for MRSA (p 0.007) than those without a history of antibiotic use. The detection rates for P. aeruginosa or MRSA in inpatients without alpha-streptococci were higher than in inpatients with alpha-streptococci after controlling for age and gender (P. aeruginosa, p 0.006; MRSA, p 0.001). Overall, detection of alpha-streptococci had an inverse correlation with the detection of P. aeruginosa and MRSA in the oral cavity and is likely to be an indicator of pathogenic bacterial infection.

Aged↗
PubMed1999

Breast cancer screening in relation to access to health services.

PURPOSE/OBJECTIVES: This study examined mammography screening and breast self-examination (BSE) in relation to perceived access to health services to identify persistent barriers to earlier detection. DESIGN: Community-based, cross-sectional, survey, and interview. SETTING: More than 80 nonhealthcare-related, women's group settings in northern California. SAMPLE: Convenience sample of 838 black/African American, Latina/Hispanic, and Caucasian/Anglo women varying in age, annual family income, sexual orientation, and educational history. METHODS: Survey and interview (in English or Spanish) by on-site research assistants facilitating participation of women with limited reading capability. MAIN RESEARCH VARIABLES: Perceived access to services, breast cancer screening behaviors, acculturation and spoken language, habits of use, perceived prejudice in health delivery, available economic resources, and other social and behavioral variables reported elsewhere. FINDINGS: Healthcare habits, the perception of prejudicial treatment in health service delivery, spoken language, and three different measures of financial capability explained a large degree of perceived access to services. Perceptions of a lack of access to services were related to decreased mammography screening participation and to decreased BSE behavior. CONCLUSIONS: Participation in cancer screening depends on real economic access and previous health service delivery experience. BSE behavior may be influenced by lack of money to pay for healthcare services, and experienced prejudice in healthcare delivery appears to have a lasting influence on mammography screening behavior. IMPLICATIONS FOR NURSING PRACTICE: Tolerance and culturally sensitive service delivery coupled with economic access to both screening and necessary treatment will be vital to eliciting women's complete participation in attaining desired earlier detection goals for breast cancer.

Adult↗
PubMed1999

The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test.

AIM: To assess cognitive function in elderly subjects with clinically probable Parkinson's disease (PD). METHODS: A community sample of 126 patients with probable PD completed the CAMCOG, which is the cognitive section of the Cambridge Examination for Mental Disorders, and the Mini-Mental State Examination (MMSE). The performance of the CAMCOG and the MMSE in detecting dementia in this subject group was compared with the results of applying the DSM-IV criteria for dementia to this population. RESULTS: A total of 44% of the group met DSM-IV criteria for dementia, which is higher than most previous prevalence figures for dementia in PD. The CAMCOG was more sensitive than the MMSE in detecting cognitive impairment and more specific than the MMSE in detecting dementia as defined by DSM-IV criteria. Poorer performance on the CAMCOG was related to gender, social class and age (P<0.05). Among subjects with PD, those with dementia, as defined by DSM-IV criteria, were significantly older, had greater depressive symptomatology and had greater motor deficits. A greater proportion of the group with dementia were living in residential care (P<0.05). CONCLUSION: The CAMCOG appears to be a useful screening instrument for dementia and cognitive impairment in PD. Furthermore, it may prove helpful in detecting those with PD who may be at risk of developing dementia and in longitudinal studies of cognitive function in PD.

Aged↗
PubMedDate not supplied

Early detection is the key to successful treatment.

In the United States today, healthcare reform is prompting an increase in education, community awareness, and early detection, as well as a decrease in healthcare costs and days missed at work due to illness. A program like the HVE Program accomplishes all of these things. People are starting to take a more active role in their healthcare. The advantages and benefits of preventive and alternative medicine are now recognized as a way to lower the cost of healthcare and as a way to minimize the loss of human life via early detection and treatment of disease. Continuous improvement, support from hospital administration, dedication of staff members, and community participation have enabled the Heart and Vascular Evaluation Program to evolve into the valuable service it is today--and the kind of service that will lead us into the future of healthcare.

Aged↗