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PubMedDate not supplied

Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System.

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.

Dental Care↗
PubMed1985

Comparison of polyclonal antiserum versus monoclonal antibodies for the rapid diagnosis of influenza A virus infections by immunofluorescence in clinical specimens.

A pool of monoclonal antibodies was compared with polyclonal antiserum for the rapid detection of influenza A virus in 28 clinical specimens by immunofluorescence. Monoclonal antibodies showed higher sensitivity (69 versus 46%) and accuracy (86 versus 75%) and easier slide interpretation than did polyclonal antiserum. The procedure proved useful for rapid detection of a community outbreak of influenza A virus infection.

Antibodies, Monoclonal↗
PubMed2006

[Differences in mortality in the over-65s in a health area of the community of Madrid].

OBJECTIVE: To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors. DESIGN: Observational, retrospective, and ecological-style study. SETTING: Districts and boroughs in Health Area 11 of the Community of Madrid, Spain. PARTICIPANTS: People aged 65 and over. MAIN MEASUREMENTS: The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression. RESULTS: The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated. CONCLUSIONS: The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas.

Aged↗
PubMedDate not supplied

Fourteen-year trend of tuberculosis dynamics in the northwest of Turkey.

BACKGROUND: The incidence of tuberculosis (TB) in different countries as estimated by the World Health Organization (WHO) vary from 23/100,000 and less in industrialized countries, 191/100,000 in Africa and 237/100,000 in South East Asia. OBJECTIVES: The aim of this study was to analyze the dynamics of TB in the northwest of Turkey, between 1988 and 2001. METHODS: All pulmonary TB cases reported to the National Tuberculosis Center by local TB dispensaries during 1988-2001 were analyzed. The number of new and relapsed TB cases were documented and classified according to age and type of TB (standard classification of TB patients according to disease type: pulmonary, new, smear positive; pulmonary, smear negative; relapse, and extrapulmonary). We recorded information about the prevalence of TB in different patient groups (patients with a contact history, patients who were detected in active community screening or passive case finding), TB trends in different age groups, type of TB, patients who had relapses, percentage of patients who were lost to follow-up. RESULTS: A total number of 288,996 patients were examined at Zonguldak Tuberculosis Dispensary between 1988 and 2001. Case notification rates of TB decreased over the study period. Respiratory TB was the most commonly encountered form of disease (>90%). The percentage of TB decreased in the 0- to 14-, 15- to 24-year-olds and increased in the 25- to 44- and 45- to 64-year-olds. CONCLUSION: Properly designed disease surveillance systems are critical for monitoring the TB trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease.

Adolescent↗
PubMed2005

First-episode psychosis, early intervention, and outcome: what have we learned?

OBJECTIVE: There has been increased interest in the potential of early intervention to positively influence outcome in first-episode psychosis (FEP) and, consequently, to influence mental health policy and practice. This study's objective was to examine the concept of early intervention and the evidence that currently exists to support such a shift in the delivery of care. METHOD: We examined the evidence for phase-specific treatment of FEP, looking for interventions that attempt to arrest the transition from a putative prodromal state to full psychosis, as well as for interventions that attempt to reduce delay in treatment. RESULTS: Some evidence supports specialized FEP interventions for short-term outcome in terms of symptom reduction, relapse rates, and greater adherence to and retention in treatment. As well, there is modest support for benefits to aspects of social and community functioning and satisfaction with life. Limited evidence supports a positive effect of community-wide case detection in terms of reduced delays in treatment and pharmacologic and psychological interventions in the prodromal phase. CONCLUSIONS: The field of early intervention in psychosis is young, with encouraging preliminary results, especially for improving outcome in established FEP. It requires further study, especially of longer-term outcome. Further studies need to examine the effects of a specialized approach on longer-term outcome and to explore cost-effective methods to reduce delays in treatment and provide interventions in the prodromal phase.

Cognitive Behavioral Therapy↗
PubMed2006

The effects of water treatment residues on soil respiration and microbial community structure.

Land disposal of water treatment residue (WTR), a by-product of potable water production, is increasingly being considered a viable alternative to land filling. It is crucial, inter alia, that soil quality is not affected adversely. Six different WTRs obtained from South African water treatment facilities were added to Hutton and Westleigh topsoils at rates of 0, 5, 15 and 25% (m/m) to determine their impacts on soil basal respiration. In general, respiration increased with rate of addition of WTR. The Umgeni, Rand, Midvaal and Faure2 WTRs had the greatest effect on respiration. Increases in respiration became less marked with time. The Hutton topsoil was mixed with the WTRs (at 15% m/m) and, following incubation, the bacterial community structure was examined by denaturing gradient gel electrophoresis. Changes in community structure were detected after 5 d and were attributed to physico-chemical changes arising from WTR amendment. However, dominant bands associated with the Hutton soil were retained and microbial diversity was not adversely affected. The findings of this investigation suggest that WTRs can be applied to the Hutton soil at a rate of at least 15% (300 Mg ha(-1)) without having a detrimental effect on microbial indicators of soil quality.

Hydrogen-Ion Concentration↗
PubMed1992

Disease-related needs of black patients with cervical cancer.

The high incidence of cervical cancer amongst South African black women is complicated by late presentation for treatment as well as by misconceptions and ignorance which adversely affect the quality of their lives. The aim of the research was to determine the disease-related needs of patients suffering from cervical cancer which would serve as a basis for planning on providing for these needs. Needs for the following were identified: Education on early detection in the community. Education on nutrition and hygiene. Information on and assistance in obtaining financial relief by means of subsidized transport and disability pensions.

Adult↗
PubMed1998

A survey of hantavirus antibody in small-mammal populations in selected United States National Parks.

Hantavirus activity in 39 National Parks in the eastern and central United States was surveyed by testing 1,815 small mammals of 38 species for antibody reactive to Sin Nombre virus. Antibody-positive rodents were found throughout the area sampled, and in most biotic communities. Antibody was detected in 7% of 647 deer mice (Peromyscus maniculatus), 2% of 590 white-footed mice (P. leucopus), 17% of 12 rice rats (Oryzomys palustris), 3% of 31 cotton rats (Sigmodon hispidus), and 33% of 18 western harvest mice (Reithrodontomys megalotis). Antibody was also found in three of six species of voles, and in one of 33 chipmunks (Tamias minimus). Prevalence among Peromyscus was highest in the northeast. Although few cases of hantavirus pulmonary syndrome have been identified from the eastern and central regions, widespread infection in reservoir populations indicates that potential exists for human infection throughout much of the United States.

Animals↗
PubMedDate not supplied

[Use of a questionnaire for screening people with undiagnosed diabetes].

OBJECTIVE: To evaluate a screening questionnaire to identify individuals with undiagnosed diabetes. DESIGN AND METHODS: We conducted a community survey to detect people at increased risk for diabetes using a questionnaire proposed by Herman et al. (1995), that incorporates major risk factors as age, obesity, family history of diabetes, sedentary lifestyle and personal history of delivering a macrosomic infant. Blood glucose test was made by means of reagent strip and a reflectance meter system. We used the ADA recommendations and cut-points for screening programs, adjusted for fasting and random blood glucose. RESULTS: We included 360 participants older than 20 years of age. A total of 200 subjects (55.5%) were at risk for diabetes according to the questionnaire, of whom 31 (15.5%) had an abnormal glucose test compared to the 4.4% of the low-risk group (p < 0.001). The 1995 Herman et al. Questionnaire had sensitivity of 81.6%, specificity of 47.5, positive predictive value of 15.5 and negative predictive value of 95.6%. The high-risk group was older (44.9 vs. 34.6 y, p < 0.001) and heavier (30.5 vs. 24.4 kg/m2, p < 0.001) than the low-risk group. There were 38/360 (10.5%) abnormal glucose readings, of which 31 (81.5%) had a positive questionnaire (p < 0.01). The mean fasting glucose in the high-risk group was higher (90.6 vs. 84.2 mg/dL, p = 0.015) than in those with low risk by questionnaire, as well as for random blood glucose (116.1 vs. 100 mg/dL, p < 0.01). CONCLUSIONS: The questionnaire proposed by Herman et al. combined with capillary blood glucose testing performance good in mexican population to identify people at high risk for undiagnosed diabetes, and improved the detection rate.

Adult↗
PubMedDate not supplied

[Effectiveness and duration of the immunity of the vaccine against serogroup A+C meningococcus].

BACKGROUND: In 1995 the Community of Madrid detected an increase in the number of cases of meningococcal disease caused by serogroup C. In 1997 a mass vaccination campaign was carried out in relation to the population between 18 months and 19 years of age. The purpose of this study is to ascertain the immune response produced by the vaccine and its relationship to the age of the subjects. METHODS: A sample group of 1,003 children vaccinated during the campaign was selected. A blood sample was extracted prior to vaccination and after one, six (only a under 5 years old) and twelve months had transpired. In order to assess the immune response, the levels of bactericidal and total antibodies were measured. RESULTS: The prevalence of seroconversion measured by bactericidal antibodies is 89.6%. The response is low in children under 3 (34.8%), increases with age and, from 7 years on, surpasses the 90% mark. After 6 months, the prevalence of protective levels in children under 5 years of age drops noticeably (31.3%). After one year, the prevalence drops significantly, particularly in children under 7 years of age. The proportion of individuals with total antibody response after one month is over 90%, and remains high after one year in all of the age groups (97.5%). CONCLUSIONS: The response measured by means of total antibodies contradicts the clinical response to the vaccination and the measurement by means of bactericidal antibodies underestimates the protection if it is compared with the results of vaccinal efficacy, for which reason, we need to search for biological indicators that would correlate adequately with the clinical response following immunisation.

Adolescent↗
PubMedDate not supplied

The relation of obesity to cardiovascular risk factors among children: the CARDIAC project.

West Virginia's prevalence of obesity is among the highest in the nation, contributing to an excess mortality rate from heart disease. Individuals who are overweight and obese have a greater risk for coronary artery disease. To gain insight into the impact of obesity on other modifiable cardiovascular disease (CVD) risk factors among children, 5,887 students from 27 rural West Virginia counties participated in the school-based Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project during the 1999-2002 school years. Results confirmed a very high prevalence of overweight and obese children in this rural, pre-adolescent population. Almost 43 percent of the children screened were considered to be overweight (BMI > or = 85th percentile), and over one-fourth of them were obese (BMI > or = 95th percentile). This high rate of obesity among schoolchildren in West Virginia is associated with increased prevalence of other CVD risk factors such as hypertension, dyslipidemia, and insulin resistance. Interventions for prevention of excess weight and obesity should be implemented through schools and community-based programs.

Cardiovascular Diseases↗
PubMed1992

Childhood diarrhoea due to rotavirus in a community.

The etiologic role of rotavirus in acute diarrhoeal illness in children under five years of age was studied over a period of one year in an urban slum community. Rotavirus was detected in 17.7 per cent of 376 children with diarrhoea and 4 per cent of 299 healthy children with maximum prevalence at 19-24 months of age with statistically comparable detection in 0-6 months of age. The overall prevalence was significantly higher in children below 2 yr as compared to those between 2-5 yr of age. Girls (24.1%) were more susceptible amongst the diarrhoeal group in comparison to boys (13.8%). Diarrhoea due to rotavirus was more prevalent during the cooler months (November-February) of the year and no correlation was observed with rainfall and relative humidity. Rotavirus as the sole pathogen was observed in 9 per cent children with diarrhoea and in the rest, association of Cryptosporidium (3%) was observed for the first time with this virus along with other known enteropathogenic bacteria and parasites, enterotoxigenic Escherichia coli being the commonest organism.

Age Factors↗
PubMed1992

[Prehospital fibrinolysis: a priority objective?].

Clinical trials strongly suggest that the sooner thrombolysis is applied after the onset of chest pain, the greater are the derived benefits. Time delay between onset chest pain and initiation of therapy possesses three fundamental components: 1) the call for help; 2) the transportation to the hospital, and 3) the in-hospital delay for diagnosis and initiation of therapy. On the other hand, pre-hospital thrombolysis has been shown feasible and safe; more importantly, it has resulted in early identification of patients eligible for fibrinolysis, greatly accelerating the process of drug administration. A critical look at all measures that could result in more rapid treatment is now indicated. This include early identification of eligible patients, prompt clinical and electrocardiographic diagnosis, rapid transportation to hospital and undelayed drug administration by competent personnel. Every clinical center should investigate the practice in its community area to detect where, when and why time is lost between onset of pain and treatment application to institute the appropriate corrective measures.

Clinical Trials as Topic↗
PubMedDate not supplied

Factors associated with the use of over-the-counter medications in cases of acute gastroenteritis in Hamilton, Ontario.

BACKGROUND: Monitoring over-the-counter (OTC) medication sales may provide an accurate, reliable way to observe trends and detect aberrations in community health status. This study assessed demographic and symptomatic factors associated with the use of OTC anti-nauseants (AN), anti-diarrheals (AD), and rehydration therapies (RT) in cases of acute gastroenteritis (GE). METHODS: Data on 351 cases of self-reported, acute GE obtained from a population-based telephone survey were analyzed. The four outcomes of interest were use of an OTC 1) AD, 2) AN, 3) RT, and 4) use of at least one of the three. The association between each factor of interest and the use of OTC treatments was assessed. RESULTS: Of the 351 cases, 110 (31%) used at least one OTC AD, AN, or RT for their illness. The most significantly associated factor was primary symptom group: cases with both vomiting and diarrhea were 3.6 times more likely to use at least one of the three OTC medications than cases with either vomiting or diarrhea only. Other factors associated with the use of at least one OTC were being female (OR=1.97), being 10-14 years of age iOR=l 1.22), and use of antacids in the 28 days prior to illness (OR=2.31). CONCLUSION: This study provides the first published assessment of factors associated with the use of OTC medications by community cases of GE. Those who use OTC medications for their illness appear to differ from those who do not. This information can inform health officials, and aid development of pharmacy-based syndromic surveillance.

Acute Disease↗
PubMed1991

The role of folk healers in the malaria volunteer program in Thailand.

In the Malaria Control Program of Thailand, villagers were recruited as village malaria volunteers to assist and participate in passive case detection at the community level by preparation of blood smears and provision of presumptive treatment to suspected cases. Among these volunteers, there were some folk healers. This study was intended to investigate the role of the folk healer volunteer in the Malaria Control Program in the northern area under the responsibility of the Malaria Zone 1, Region 2 in Fang, Mae Ai and Chiang Dao Districts of Chiang Mai Province. The combination of qualitative and quantitative research methodologies (participant and non-participant observations and structured questionnaires) were used to get information from 246 volunteers, of whom 113 were folk healers. Most of the volunteers were male and more than half were in the age group 30-50 years. Almost all volunteers had completed the compulsory education and farming was their main occupation. Folk healer volunteers were older and had been in the service longer than the non-folk healer volunteers. Both groups of volunteers shared some negative attitudes towards the Malaria Control Program, such as the interference with their occupation and the waste of time. However, the folk healer volunteers had more positive attitudes towards the program in terms of gaining social respect and the willingness to stay on. It was also found that the folk healer volunteers performed their assignment better than the non-folk healer volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Cell-mediated and humoral immune responses to BCG and rubella vaccinations and to recall antigens in onchocerciasis patients.

In seven Liberian villages of different endemicity for onchocerciasis 629 persons were tested for tuberculin reactions using 5 i.u. purified protein derivative or old tuberculin. No correlation between infection with Onchocerca volvulus and reactivity to tuberculin was detected on a community level, but a direct comparison of results of infected and non-infected individuals in two neighboring villages revealed a lower responsiveness in persons with onchocerciasis. The conversion rate three months after BCG vaccination was significantly lower in children with onchocerciasis (48%) than in controls (85%). The possible impact of this finding on the efficacy of BCG vaccinations is discussed. Girls aged 2-16 years were screened for rubella antibodies using a latex agglutination test. Sera from 74 girls, who showed no antibodies, were examined before and four months after rubella vaccination by haemagglutination-inhibition-test and haemolysis-in-gel-test. No difference in the humoral immune response of girls with or without onchocerciasis was found. Seroconversion rates were 98% and 100%. Delayed cutaneous hypersensitivity (DCH) to seven ubiquitous recall antigens was tested in 147 persons infected with O. volvulus and compared to the results of 142 non-infected controls. A reduced responsiveness was seen in persons with onchocerciasis, the difference being greatest in young children 2-7 years of age. In connection with the results of tetanus vaccinations reported earlier, these findings verify the existence of a reduced in vivo responsiveness of cell-mediated immunity to non-specific antigens in onchocerciasis in the rain forest of West Africa. Humoral immune responses however appeared to be unaffected.

Adolescent↗
PubMed1983

Impact of network organization on head and neck cancer control.

Prior to the Northern California Head and Neck Cancer Network, there had been no organized community effort regarding detection, management, and rehabilitation of head and neck cancers. Organization depended upon endorsement by the newly formed Northern California Cancer Program (NCCP) and membership of major treatment centers. Important developmental steps included financial support, a principal investigator, a representative multidisciplinary Steering Committee and By-laws. The organization established a support staff and subcommittees of volunteer professionals for the following areas: standards of care (state-of-the-art); patient management guidelines; epidemiology and evaluation; pre-treatment conferences; screening programs and dental hygienist training; demonstration of rehabilitation techniques; and professional education. Assessment of the contract period with a baseline year indicated beneficial and progressive standards of care, improved referral patterns, and areas of weakness useful in guiding future educational efforts. Utilizing a large target population of almost 9 million and 72 institutions responsible for more than 80% of the cancer patients yielded data on 1,790 patients that was meaningful and realistic regarding cancer control. The pre-treatment conferences in four different geographic locations are continuing, as well as rehabilitation programs in each area. The cooperative multidisciplinary, multi-institutional efforts developed during the contract are continuing in educational and research programs. Screening programs were shown not to be cost effective.

California↗
PubMedDate not supplied

[Cervical cancer of the uterus. Analytic epidemiology].

BACKGROUND: Malignant tumour in cervix is an important cause of death in young women. Through community programmes of detection and early diagnosis, a significant reduction in the incidence of invading forms and mortality due to this cause has been achieved. Knowing the Prevalence of premalignant lesions and cancer in the sexually active women population, establishing the frequency of risk to different factors and associated risk to these ones in this population, constitutes a part of this study objectives. METHODS: A transversal study is carried out, with a sample of population older than 20 years or younger, but sexually active, constituted by 4262 women, selected at random from a population of 7222 persons cared in family planning centers and distributed in 15 localities. In every case, the colposcopy has been made in a systematic way, associated to the cytology with a biopsy of every atypical image. Among the risk factors studied, the expositions to Rx, sexual promiscuity, genital infections, mycosis and infertility are included. The existence, as a clinical discovery, of a suspected lesion or an atypical colposcopy are includes as risk markers. The test of, the calculation of Odds Ratio, and 95% confidence interval, the etiological fractions, the multivariant analysis and the calculation of OR, adjusted to qualitative variables and the comparison of means for quantitative variables, are used in the analysis. The programme SAS is used as a software. RESULTS: The prevalence of cancer found was 0.938 per one thousand women and the frequency of precursory lesions was 38.2 per one thousand. The comparative study with regard to different variables between women with benign deteriorations or normality and women presenting a diagnosis of premalignant lesions or carcinoma, proves that, without existing differences in relation to age, beginning of sexual relations ans number of pregnancies, the risk of suffering from cervix cancer increases with sexual promiscuity, exposition to Rx, genital infections, mycosis and infertility. CONCLUSIONS: On the basis of the prevalence detected, it is considered necessary keep and to increase the coverage of actions of cervix cancer prevention in women, increasing the participation of the whole of sexually active women in the programmes. The presence of risk factor would modify the number and periodicity of gynecological controls.

Adult↗