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PubMed2004

Population-based surveillance of pediatric pneumonia: use of spatial analysis in an urban area of Central Brazil.

This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.

Brazil↗

PubMed2002

An evaluation of two screening methods to identify cases with schizophrenia and affective disorders in a community survey in rural Ethiopia.

BACKGROUND: Detecting cases with psychiatric disorders in the general population is costly and it is not clear which is the method of choice for community surveys in low-income countries. AIM: To compare the performance of a standardized diagnostic layman interview instrument--the Composite International Diagnostic Interview (CIDI 2.1) versus the Key Informant method in identifying cases with schizophrenia and major affective disorders in a community survey. METHOD: Both screening methods were tested against an expert interview--the Schedule for Clinical Assessment in Neuropsychiatry (SCAN 2.1) in a rural district in Ethiopia with 25,632 inhabitants. RESULT: CIDI identified 524 and key informants 192 individuals as probable cases who were invited for a further SCAN interview. Seventy-two individuals were identified by both methods. Of those identified as probable cases by either method, a total of 481 volunteered the SCAN interviews. The Key Informant method alone detected more cases of schizophrenia, 59 vs. 29 for CIDI, whereas CIDI alone detected more cases of affective disorders, 45 vs. 30. Key informants performed better in detecting chronic cases. CONCLUSION: For community surveys, which aim at identifying cases with major mental disorders in low-income countries like Ethiopia, the combined use of both CIDI and the Key Informant method is recommended.

Adolescent↗

PubMed2003

Prolonged detection of indigenous wild polioviruses in sewage from communities in Egypt.

Environmental surveillance for polioviruses has been implemented in Egypt. This paper reports on a study in which 130 sewage samples were collected between January 2001 and December 2001 from eight provinces of Egypt. Samples were analyzed by virus isolation in L20B and RD cell cultures, and wild polioviruses were characterized by sequencing of the VP1 protein coding region. Wild type 1 polioviruses were detected in 57% of the sewage samples and 91% of the study sites, only two of which reported paralytic poliomyelitis cases in 2001. Three genetic lineages of a single indigenous type 1 poliovirus genotype were detectable in sewage, and only one lineage was also detected through surveillance for acute flaccid paralysis. Wild polioviruses persisted in the environment despite implementation of oral poliovirus vaccine immunization campaigns. Continued analysis of sewage samples, critical evaluation of immunization coverage, and performance of surveillance for acute flaccid paralysis are proposed as follow-up activities.

Adolescent↗

PubMed2001

The Mini-Cog: receiver operating characteristics with expert and naïve raters.

BACKGROUND: As elderly populations grow, dementia detection in the community is increasingly needed. Existing screens are largely unused because of time and training requirements. We developed the Mini-Cog, a brief dementia screen with high sensitivity, specificity, and acceptability. Here we describe the development of its scoring algorithm, its receiver operating characteristics (ROC), and the generalizability of its clock drawing scoring system. SAMPLE AND METHODS: A total of 249 multi-lingual older adults were examined. Scores on the three-item recall task and the clock drawing task (CDT-CERAD version) were combined to create an optimal algorithm. Receiver operating characteristics for seven alternatives were compared with those of the MMSE and the CASI using expert raters. To assess the CDT scoring generalizability, 20 naïve raters, without explicit instructions or prior CDT exposure, scored 80 randomly selected clocks as "normal" or "abnormal" (20 from each of four CERAD categories). RESULTS: An algorithm maximizing sensitivity and correct diagnosis was defined. Its ROC compared favorably with those of the MMSE and CASI. CDT concordance between naïve and trained raters was >98% for normal, moderately and severely impaired clocks, but lower (60%) for mildly impaired clocks. Recalculation of the Mini-Cog's performance, assuming that naïve raters would score all mildly impaired CDTs in the full sample as normal, retained high sensitivity (97%) and specificity (95%). CONCLUSION: The Mini-Cog algorithm performs well with simple clock scoring techniques. The results suggest that the Mini-Cog may be used successfully by relatively untrained raters as a first-stage dementia screen. Further research is needed to characterize the Mini-Cog's utility when population dementia prevalences are low.

Aged↗

PubMed1997

Human neurobehavioral research methods: impact of subject variables.

Behavioral tests are used in work site and community research to detect and characterize the effects of neurotoxic chemical exposures in human populations, but the influence of subject variables on test performance has not been well studied in normal adult populations. This research sought to evaluate the impact of two variables, education and cultural group, on 18 widely used tests of neurotoxic insult. Behavioral tests from the two consensus neurotoxicity test batteries (established by the World Health Organization and the U.S. Agency for Toxic Substances and Disease Registry) were administered to 715 people aged 26-45 with 0-18 years of education, drawn from European descent United States majority, American Indian, African American, and Latin American populations. Education, cultural group, age, and gender affected the outcome of behavioral tests as revealed by ANOVA, MANOVA, and multiple regression techniques. Education, followed by cultural group, accounted for the most variance in the tests studied. More importantly, years of education and cultural group had 13-25% shared variance on the cognitive tests and highly significant interactions derived from ANOVA tests. This suggests that these factors should be controlled in the design of a study rather than in the statistical analysis. Because these factors can mimic a neurotoxic insult, failure to adequately control and analyze them could lead to inaccurate conclusions about the association between poor performance and neurotoxic insult.

Adult↗

PubMed1994

Genetic mapping of the gene for Usher syndrome: linkage analysis in a large Samaritan kindred.

Usher syndrome is a group of autosomal recessive disorders associated with congenital sensorineural deafness and progressive visual loss due to retinitis pigmentosa. Sixteen members of the small inbred Samaritan isolate with autosomal recessive deafness were studied in 10 related sibships. DNA samples from 59 individuals including parents and affected and nonaffected sibs were typed for markers on chromosomes 1q and 11q for which linkage has recently been established for Usher syndrome types II and I. Statistically significant linkage was observed with four markers on 11q (D11S533, D11S527, OMP, and INT2) with a maximum six-point location score of 11.61 at the D11S533 locus. Analysis of haplotypes supports the notion that the mutation arose only once in an ancestral chromosome carrying a specific haplotype. The availability of markers closely linked to the disease locus allows indirect genotype analysis and identifies all carriers of the gene within the community. Furthermore, the detection of complete linkage disequilibrium between the D11S533 marker and the Usher gene suggests that these loci are either identical or adjacent and narrows the critical region to which physical mapping efforts are currently directed.

Chromosome Mapping↗

PubMed2001

Cholesterol screening among children and their parents.

BACKGROUND: The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project is designed to test the hypothesis that universal cholesterol screening of prepubertal schoolchildren is effective in identifying children and their parents at risk of developing premature coronary heart disease (CHD) in a high-risk rural population. METHODS: Seven hundred nine fifth-grade schoolchildren from seven rural Appalachian counties participated in a school-based cholesterol screening program. Family history of premature CHD, anthropometric and blood pressure measurement, tobacco smoke exposure, dietary history, and physical activity levels were collected. RESULTS: One-fourth (174) of the children were "presumptively" dyslipidemic upon measurement of nonfasting finger-stick blood cholesterol (FSC). Subsequent fasting lipid profile obtained for 63 of these children and 79 of their parents confirmed the presence of dyslipidemia in 37 children (59%) and 52 parents (66%). Among confirmed dyslipidemic children, family history was not a good predictor of dyslipidemia (sensitivity 21.6%). FSC levels were significantly correlated with fasting total cholesterol of children and their parents. CONCLUSIONS: Universal nonfasting FSC screening of prepubertal schoolchildren is effective in identifying dyslipidemic children and their parents, whereas family history has low sensitivity in predicting children with elevated blood cholesterol concentrations.

Adult↗

PubMed1979

The impact of a maternal and child health care program on the quality of prenatal care: an analysis by risk group.

A typical maternal and child health care program was implemented in an American Indian reservation community, and its impact on the effectiveness of prenatal care was assessed. Evaluation included examination from both the provider perspective (care provided to program users) and the population perspective (care received by a sample of all prenatal patients in the community), as well as examination of outcomes of prenatal care. The study cohorts were sorted into relatively high and average risk as a function of age, gravidity, and history of abortion or miscarriage. The study results suggest that such a program will improve the quality of prenatal care, although the program has a greater impact on the average risk group. Standard methods of assessing program effectiveness, which examine the care provided by the program as opposed to the care received by the community, will not detect this phenomenon.

Adolescent↗

PubMed1981

Severely uncontrolled diabetes in the over-fifties.

Between 1969 and 1976, 317 adults were admitted to hospital in Nottingham with severely uncontrolled diabetes (plasma glucose over 33 mmol/l and/or venous bicarbonate less than 14 mmol/l). A third of episodes were in patients over the age of 50 years, of which 43% were fatal. In contrast, only 3.4% of episodes in patients under 50 years were fatal. In the older group, 65% of deaths occurred within 48 h of admission and in 44% no cause was found other than uncontrolled diabetes. Later deaths were due to underlying disease, infection or thromboembolism. Amongst older patients 38% were not previously known to have diabetes. Presentation to hospital was late and we conclude that many deaths were potentially avoidable by earlier detection in the community.

Age Factors↗

PubMed2005

Changes in bacterial community structure correlate with initial operating conditions of a field-scale denitrifying fluidized bed reactor.

High levels of nitrate are present in groundwater migrating from the former waste disposal ponds at the Y-12 National Security Complex in Oak Ridge, TN. A field-scale denitrifying fluidized bed reactor (FBR) was designed, constructed, and operated with ethanol as an electron donor for the removal of nitrate. After inoculation, biofilms developed on the granular activated carbon particles. Changes in the bacterial community of the FBR were evaluated with clone libraries (n = 500 partial sequences) of the small-subunit rRNA gene for samples taken over a 4-month start-up period. Early phases of start-up operation were characterized by a period of selection, followed by low diversity and predominance by Azoarcus-like sequences. Possible explanations were high pH and nutrient limitations. After amelioration of these conditions, diversification increased rapidly, with the appearance of Dechloromonas, Pseudomonas, and Hydrogenophaga sequences. Changes in NO3, SO4, and pH also likely contributed to shifts in community composition. The detection of sulfate-reducing-bacteria-like sequences closely related to Desulfovibrio and Desulfuromonas in the FBR have important implications for downstream applications at the field site.

Bacteria↗

PubMed2005

Screening for cystic echinococcosis in an endemic region of Peru using portable ultrasonography and the enzyme-linked immunoelectrotransfer blot (EITB) assay.

Cystic echinococcosis (CE) caused by the larval form of Echinococcus granulosus is a major public health problem in sheep-raising regions of the World. This study compared portable ultrasound with the enzyme-linked immunoelectrotransfer blot (EITB) assay as screening methods to estimate the prevalence of human CE in a remote village in the Peruvian Andes. Three hundred eighty-nine villagers were examined by portable ultrasound and blood samples were drawn by venipuncture. Sera were collected and tested for antibodies against CE using an EITB assay. Cystic lesions were classified based on their ultrasound morphologic characteristics. The prevalence of human CE using portable ultrasound and the EITB assay were 4.9% and 2.6%, respectively. Fifty-three percent of subjects with CE were EITB positive. Portable ultrasound was well received by the community, augmented CE detection and allowed a faster estimate of human infection than the EITB assay.

Adolescent↗

PubMed1984

Fate and effects of 3,4-dichloroaniline (DCA) in marine plankton communities in experimental enclosures.

The fate and effects of single doses of 3,4-dichloroaniline (DCA) on North Sea coastal plankton communities enclosed by large plastic bags (contents 1.5 m3) were studied in two experiments lasting 5 and 6 weeks, respectively. The biodegradation of DCA was also studied in laboratory experiments, which were carried out simultaneously, using water from the enclosed model ecosystems. DCA was not degraded in the laboratory tests and probably also not degraded in the enclosed plankton communities, although concentrations in the water decreased during the experiments. This decrease appeared to be partly caused by diffusion of DCA through the walls of the enclosures. After the addition of single doses of 2, 10, and 25 microgram liter-1 DCA no effects on the enclosed plankton community could be detected. The addition of 0.1 mg liter-1 DCA had a clear influence on the species composition and the biomass development of the phytoplankton, changed the relative species composition of the zooplankton, and resulted in lower numbers of bacteria. In addition to these effects 1 mg liter-1 DCA limited the phytoplankton growth and resulted in mortality and inhibition of growth of the copepods.

Aniline Compounds↗

PubMed1995

Epidemic methicillin-resistant Staphylococcus aureus: controlling the spread outside hospital.

Over a 21-month period an outbreak of methicillin-resistant Staphylococcus aureus infection occurred in east Northamptonshire. The outbreak was caused by a novel phage-type (EMRSA-16) and affected 400 patients. It was centred on three hospitals but spread was also detected in the community, particularly among clients of nursing and residential homes. Three hundred and fifty residents in 15 care homes were screened for MRSA. Cross-infection of MRSA was demonstrated in 14 patients in six different homes. A key aspect of the overall containment of the outbreak was the implementation of infection control measures in the community, together with treatment and screening of known positive patients following their discharge from hospital.

Community-Acquired Infections↗

PubMed2005

Sensitivity of diagnostic tests for influenza varies with the circulating strains.

BACKGROUND: Effective strategies to combat the spread of influenza viruses rely on accurate diagnosis of the infection, which is greatly affected by the sensitivity of the assays used. OBJECTIVES: To determine if the sensitivity of assays used to detect influenza varies with the viral strains. STUDY DESIGN: This prospective study used 142 respiratory specimens submitted to the clinical virology laboratory during the 2003/2004 influenza season, when the H3N2 Fujian strain was first detected in our community, to assess sensitivities of rapid immunoassay (RIA), shell-vial (SV), hemadsorption (HA)-, and fluorescent antibody (FA)-based conventional tissue culture (TC). Results were compared with similar evaluations performed in 2002/2003 or earlier seasons. RESULTS: Sensitivities of RIA, SV, HA-TC, and FA-TC were 44, 70, 82, and 100%, respectively for influenza virus circulating in 2003/2004. The comparison with results obtained in previous influenza seasons showed a significantly decreased sensitivity of HA-TC (p=0.02) and lower sensitivity of RIA but without reaching statistical significance (44% versus 72%, p=0.2). CONCLUSIONS: This report underscores the importance of determining the accuracy and sensitivity of diagnostic tests against emerging influenza variant strains.

Antigens, Viral↗

PubMed2026

Unraveling anaerobic indole degradation in an acclimated sludge consortium: Candidate pathways and microbial division of labor inferred from metagenomic and metatranscriptomic analyses.

Indole is a widespread nitrogen-containing heterocyclic compound in manure, sludge, and wastewater systems, yet the enzymes and microbial populations involved in its anaerobic transformation remain poorly resolved. Here, we established a long-term acclimated anaerobic sludge consortium and combined degradation assays, metabolite profiling, metatranscriptomics, and genome-resolved metagenomics to investigate the functional basis of anaerobic indole degradation. After 120 days of acclimation, the consortium stably degraded 100 mg/L indole, whereas skatole was not effectively removed under the same strategy, indicating substrate-specific adaptation of the microbial community. Metabolite profiling detected oxindole, dioxindole, isatin, and anthranilic acid, supporting a putative transformation route involving pyrrole-ring oxidation and ring cleavage toward anthranilate-like intermediates. Metatranscriptomic analysis identified 16,660 differentially expressed genes after indole addition, with strong transcriptional responses involving oxidoreductases, hydrolases, cofactor-dependent redox metabolism, aromatic-CoA-related metabolism, and methane metabolism-associated pathways. Transcriptional responses highlighted the xanthine dehydrogenase-like molybdenum-enzyme system and isatin hydrolase as candidate contributors to upstream indole transformation, whereas those of abmG-like, bcrC, and oah genes were consistent with possible anthranilic acid activation and downstream CoA-type processing. MAG-resolved analysis further suggested that these candidate functions may be distributed among populations affiliated with Bacteroidota, Chloroflexota, Desulfobacterota, and Methanobacterium. Together, these findings establish a stable anaerobic indole-degrading consortium and provide a testable functional framework for syntrophic interactions linking upstream indole transformation, aromatic-CoA metabolism, and methanogenesis-associated carbon flow.

Anaerobic degradation↗

PubMed2002

Home and eating environments are associated with saturated fat intake in children in rural West Virginia.

OBJECTIVE: To describe sociodemographic, environmental, and knowledge factors in relation to self-reported, energy-adjusted saturated fat consumption among children in rural West Virginia. PARTICIPANTS: Three hundred twenty-five 5th graders who participated in the Coronary Artery Risk Detection in Appalachian Communities Project conducted in 3 rural counties in West Virginia in 1998-1999. METHODS: A cross-sectional survey based on self-reported information collected using a food frequency questionnaire, a nutrition knowledge questionnaire, and a family composition questionnaire. STATISTICAL ANALYSES: Descriptive statistics and multiple linear regression analysis. RESULTS: The mean percentage of energy from total fat was 31.8% +/- 4.9 and from saturated fat was 11.8% +/- 2.3. Energy-adjusted saturated fat intake was significantly higher among children with higher frequencies of breakfast and late-night snacks prepared away from home, and in households with single mothers. Variables associated with higher energy-adjusted saturated fat intake with marginal statistical significance (P=.05-.10) included attendance at schools with a higher percentage of students receiving free or reduced-price lunch, usual breakfast location other than home or school, and less knowledge about low-fat, low-sodium foods. Frequent late-night snacks prepared away from home and living with single mothers remained as significant correlates of energy-adjusted saturated fat intake independent of other hypothesized determinants. CONCLUSION: Efforts to reduce saturated fat intake among children in rural areas should focus on food prepared away from home. Nutrition-related behaviors of single mothers should be explored further.

Child↗

PubMed2000

Paralytic shellfish toxins in the freshwater cyanobacterium Aphanizomenon flos-aquae, isolated from Montargil reservoir, Portugal.

Montargil reservoir, located in a dry flat area in the centre of Portugal, was filled in 1958 to fulfil agricultural, electric and industrial requirements. In May 1996, an intensive bloom of phytoplankton was detected. The algal community was strongly dominated by cyanobacteria with predominance of Aphanizomenon flos-aquae from May to June and Microcystis aeruginosa from July to August. Extracts of samples collected during the bloom period showed high toxicity by mouse bioassay. During the M. aeruginosa predominance period, the toxicity was ascribed to the presence of hepatotoxins, but clear symptoms of paralytic shellfish poison were observed when A. flos-aquae was the dominant species. In order to confirm the production of neurotoxins a strain of A. flos-aquae was isolated and established in culture. In this manuscript, we show the morphological characteristics and confirm paralytic shellfish toxins production by the strain isolated and maintained in culture. Identification of the saxitoxin analogs was achieved using high performance liquid chromatography with postcolumn fluorescence derivatization (HPLC-FLD) and liquid chromatographic mass spectrometry technique (LC-MS). The toxins found in the culture extract were GTX5 (64.5 mol%), neoSTX (23.0 mol%), dcSTX (6.1 mol%), STX (5.4 mol%) and GTX6 (1.1 mol%). This is, to our knowledge, the first report of unambiguous evidence of paralytic shellfish toxins produced by freshwater cyanobacteria in Portugal. The toxin profile is rather different from the previously reported PSP producing A. flos-aquae and demonstrates its diversity in terms of toxin production.

Animals↗

PubMed2001

Aerobic biological treatment of a pharmaceutical wastewater: effect of temperature on cod removal and bacterial community development.

The effect of temperature was studied on the efficiency of soluble COD removal and bacterial community development during the aerobic biological treatment of a pharmaceutical wastewater. Using wastewater and bacterial inoculum obtained from the full-scale facility treating this wastewater, batch laboratory cultures were operated at 5 degrees C intervals from 30 degrees C to 70 C. Following four culture transfers to allow for bacterial acclimation, residual soluble COD levels were measured and bacterial community fingerprints were obtained by denaturing gradient gel electrophoresis (DGGE) of polymerase chain reaction (PCR)-amplified 16S rRNA gene fragments. Soluble COD removal efficiency declined as temperature increased from 30 degrees C (62%) to 60 degrees C (38%). Biological treatment of this wastewater failed to occur at temperatures higher than 60 C. Gradual shifts in bacterial community structure were detected as temperature increased, including a concomitant reduction in the number of different bacterial populations. The impact of temperature on a two-stage biological treatment process was also compared. Better soluble COD removal was achieved when both reactors were operated at 30 degrees C compared to a system where the two stages were consecutively operated at 55 degrees C and 30 degrees C. These results indicate that operation of aerobic biological wastewater treatment reactors at elevated temperatures can have adverse effects on process performance.

DNA, Bacterial↗