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The clinical skills of the medical profession can be used to identify unsuspected HIV infection in a cost-effective way. However, other strategies are needed to optimise the detection of HIV infection and achieve the benefits to patients and the community that result from detection.
OBJECTIVES: This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. METHODS: In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older, were either Black or White, and had blood pressure greater than or equal to 140/90 mm Hg and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. RESULTS: The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual care. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. CONCLUSIONS: Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure detected during community measurement who followed up with medical care.
Stools of 646 healthy children between zero and five years of age who live in 3 communities of slightly different economic levels and sanitary conditions were investigated for enteropathogenic Escherichia coli (EPEC), enteroinvasive E. coli (EIEC), Shigella and Salmonella. Cultures were positive for enterophatogens in 82 (12.69%) of the children. EPEC was the most frequent isolate (6.04%) followed by Shigella (4.18%) and Salmonella (2.17%). Invasive E. coli (EIEC) was detected only twice. According to our results, the frequency of isolation of enterophatogenic bacteria decreases where the economic level and sanitary conditions improve. The percentage of 12.69% positive cultures among normal children shows that the healthy carrier plays an important role in the dissemination and maintenance of the agents of the enteric diseases.
Much debate has taken place on the use of Doppler ultrasound in the community setting. A sequential study of patients attending a community ulcer clinic was undertaken to identify community nurses' ability to detect arterial disease by palpation of pedal pulses and to compare these figures with the recording of a resting pressure index. A total of 462 patients (553 limbs) were studied; 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with a reduced resting pressure index (< 0.9), 37% had detectable pulses. Of the 440 with a normal resting index (> or = 0.9), 25% had no detectable ankle pulses. A number of risk factors were identified. Palpation of pedal pulses alone by community nurses is a poor prediction of arterial disease and should be accompanied by the recording of a resting pressure index.
Postoperative wound infections were evaluated in 1271 patients who had 1389 surgical procedures. There were 49 postoperative wound infections identified, of which 26 (53%) were discovered after discharge. Wound infections varied from 2.5% for clean wounds up to 13.3% for dirty wounds. Among the specialties, the infection rate ranged from no infection for otolaryngologists and urologists to 8.6% for general surgeons. With routine hospital surveillance, the overall infection rate was 1.8% or 2.2%, including readmissions for infection, but less than the actual rate of 3.8%. Persons who had three procedures had no infection rate of 27.3%; for two procedures, 8.1%; and for one procedure, 3.2%. Most postoperative wound infections detected after discharge were based on clinical grounds and not positive cultures. Rehospitalization was required for seven patients because of infection. This study demonstrates that postoperative wound infection surveillance must be continued after discharge.
A postal survey of a random sample of the population living near St Mary's Hospital, Paddington was taken to determine earlier experience in these people of blood pressure measurement and treatment. Eighty-five per cent of those who could return their questionnaires did so; eighty per cent of the respondents said they had had their blood pressure measured in the past, and 60% reported such a measurement during the previous three years. The respondents aged between 40 and 59 years were invited for a blood pressure screening measurement and 52% responded. Seventy-seven per cent of those found to be hypertensive on screening (systolic greater than or equal to 160 mmHg and/or diastolic greater than or equal to 100 mmHg) said they had had their blood pressure measured during the preceding three years. The reason for the poor control of hypertension in a community, therefore, is more likely to be a failure of doctors to take action on hypertension than a failure to detect it in the first place.
The extensive deterioration of coral reefs worldwide highlights the importance of creating efficient monitoring methods to best assess their state of health. At present, several suggested parameters serve such indicators. None of these, however, is well accepted as reliably representing reef community health. In the present study we examine a new approach based on the ratio between mortality and recruitment rates of branching corals, which we term 'Deterioration Index' (DI). It aims at providing a quantitative indication of the state of health of reef-building coral communities. The method was developed and tested on 16 coral communities on artificially laid rocks along the coast of Eilat, Red Sea (Gulf of Aqaba). In contrast to frequently used indices (i.e. mortality rate, abundance and species richness), which did not demonstrate a consistent result in comparing disturbed vs. undisturbed coral communities, the DI revealed significant differences between these communities. Our results suggest that the use of the DI may enable the detection of disturbed coral communities in one instance monitoring, where the other parameters had failed. The DI, therefore, may provide a comparable quantitative assessment of the deterioration process and its intensity in a coral community. We propose the DI approach as an efficient and applicable tool for coral reef monitoring.
Adenosine, adenine, cyclic adenosine monophosphate (AMP), AMP, nicotinamide adenine dinucleotide, adenosine diphosphate, and adenosine triphosphate (ATP) were recovered quantitatively from aqueous portions of lipid extracts of microfouling, detrital, and sedimentary microbial communities. These could be detected quantitatively in the picomolar range by forming their 1-N-etheno derivatives and analyzing by high-pressure liquid chromatography with fluorescence detection. Lipid extraction and subsequent analysis allowed the simultaneous measurement of the microbial community structure, total microbial biomass with the quantitative recovery of the adenine-containing cellular components, which were protected from enzymatic destruction. This extraction and fluorescent derivatization method showed equivalency with the luciferin-luciferase method for bacterial ATP measurements. Quick-freezing samples in the field with dry ice-acetone preserved the ATP and energy charge (a ratio of adenosine nucleotides) for analysis at remote laboratories. The metabolic lability of ATP in estuarine detrital and microfouling communities, as well as bacterial monocultures of constant biomass, showed ATP to be a precarious measure of biomass under some conditions. Combinations of adenosine and adenine nucleotides gave better correlations with microbial biomass measured as extractable lipid phosphate in the detrital and microfouling microbial communities than did ATP alone. Stresses such as anoxia or filtration are reflected in the rapid accumulation of intracellular adenosine and the excretion of adenosine and AMP into the surrounding milieu. Increases in AMP and adenosine may prove to be more sensitive indicators of metabolic status than the energy charge.
In the first 4 months of 1974, 140 gauze pad samples of sewage collected in the Ottawa area were analysed by the BS-C-1 cell system for the presence of viruses pathogenic for humans. Viruses were isolated from 111 (79%) of the samples. Of the 72 (65%) isolates identified by serology and electron microscopic examination, 56 (78%) were reoviruses and 16 (22%), enteroviruses. The enterovirus isolates included one coxsackievirus B4, one vaccine strain of poliovirus type 3, nine vaccine strains of poliovirus type 1 and five strains of poliovirus type 1 that proved by serodifferentiation and temperature marker tests to be different from vaccine strains. The fact that these strains were present in the community sewage in readily detectable concentrations at a time when immunity against polioviruses is declining in such communities is a cause for concern.
Type 1 diabetes affects 3,000 individuals annually, whereas type 2 diabetes attacks about 60,000 people, which qualifies the illness to be the number 9 "killer" among Polish citizens. World health organisation prognoses that in the years of 2000-2025 the number of type 2 diabetes patients is going to double. This prognosis gives rise to a conclusion that diabetes prevention is becoming one of the priority tasks of all medical professionals and requires the necessity of changing and elaborating of effective, interdisciplinary prevention programs. The main aim of the study was a description of the tasks awaiting the community nurse in the process of an early diagnosis of diabetes. In the research, the analysis of the data included in the community nurse documentation--the family questionnaire, was used. The questionnaire is the document in which nurses in charge register the data concerning patients acquired in the community interview as well as the results of basic study values.
Diazotrophic community structure in microbial mats from Guerrero Negro (GN), Baja California, Mexico, was studied using polymerase chain reaction amplification of the nifH gene and a newly developed nifH oligonucleotide microarray. Ninety-six oligonucleotide probes designed for nifH sequences from cultivated isolates and the environment were printed on glass microarrays. Phylogenetic analysis showed that the probes represented all of the main nifH clusters. Specificity was tested by (i) evaluation of cross hybridization using individual targets, and (ii) comparison of the observed hybridization signals and those predicted from the sequences cloned from microbial mats. Signal intensity had a positive relationship with target concentration and the percentage identity between probe and target. Under moderate stringency and high target concentration, specificity of the probes varied from 77% to 100% with the individual targets tested. At the end of a 7-month long nutrient manipulation experiment in GN microbial mats, no expression of nitrogen fixation under nitrogen loading was detected, although a diverse community of diazotrophs was detected. The diversity in diazotrophic population present was higher than in the population expressing the nifH gene, and there were taxa specific differences in response to nutrients. The nifH microarray is a powerful tool for diazotroph community analysis in the marine environment.
We evaluated the Binax NOW rapid immunochromatographic membrane test (ICT) for detection of Streptococcus pneumoniae urinary antigen in a population-based prospective study of adults with community-acquired pneumonia (CAP). ICT was performed with urine samples obtained from 452 (91.7%) of 493 patients enrolled. Pneumococcal antigen was detected in 19 (70.4%) of 27 patients with pneumococcal pneumonia. The test results were more frequently positive for patients who had not received antibiotics before testing (26.6% vs. 12.1%; P=.002). Only 16 (10.3%) of 156 samples obtained from patients with nonpneumococcal pneumonia yielded a positive result. Of the 269 patients who had pneumonia with no pathogen identified, antigen was detected in 69 (25.7%). With conventional microbiological criteria used as the "gold standard," the test had a sensitivity of 70.4% and a specificity of 89.7%. Testing concentrated urine samples with the ICT may be a useful technique for rapid diagnosis of pneumococcal pneumonia in adults with CAP.
OBJECTIVE: A great deal of evidence indicates that persistent infections of the root canal of human teeth play an important role in the failure of the root canal treatment. The present study was undertaken to apply the PCR-DGGE fingerprinting approach to examine the structure of the bacterial population infecting previously treated root canals of humans associated with persistent periradicular lesions. STUDY DESIGN: Samples were taken from 14 filled root canals, DNA was extracted, and part of the 16S rDNA of all bacteria was amplified by PCR and separated by DGGE, generating banding patterns representative of the community structure. Species-specific PCR for the detection of Enterococcus faecalis was also performed. RESULTS: The mean number of bands detected in the 16S rDNA community profiles was about 6, ranging from 1 to 26 bands. Each sample showed a unique structure of the microbial community. The species-specific PCR assay revealed the presence of E. faecalis in 10 of 14 samples, but DGGE analysis revealed it was not the dominant species. CONCLUSIONS: Results revealed that the intraradicular bacterial community associated with failed endodontic treatment significantly varied in composition from teeth to teeth. Persistent intraradicular infections were present in all root-filled teeth.
Control of hypertension encompasses primary prevention, early detection and adequate treatment of high blood pressure. Primary prevention involves action at the community level to reduce obesity, alcohol and salt consumption, and increase physical activity. Management of hypertension involves diagnostic work-up, assessment of overall CVD risk, nonpharmacological and pharmacological treatment. The concept of community control was introduced to WHO's cardiovascular programme in the late 1960s, with hypertension as a spearhead. Once it had been demonstrated that the community approach was feasible, activities were extended to other cardiovascular, and later to noncommunicable, diseases. Outcome and process evaluations were made. A decrease in mortality and morbidity from stroke and myocardial infarction was demonstrated in most studies. As a result of these programmes, hypertension awareness, treatment and control rates increased remarkably and mean blood pressure levels decreased. The WHO/WHL Hypertension Management Audit Project attempted more complex analyses in various European populations. The majority of community control programmes emphasized detection and treatment, rather than primary prevention. Therefore, despite a decline in age-adjusted average blood pressures in various populations, the incidence of hypertension did not follow this trend. The decline observed in average blood pressure was achieved mainly by widespread drug treatment. Since cardiovascular risk grows with increasing blood pressure continuously and progressively, events occurring in the "normotensive' blood pressure range escape control. Developing countries will encounter the problem of prohibitive costs of care and drug treatment for hypertension. Therefore greater emphasis must be put on primary prevention in community control programmes.
Pneumonia is a leading cause of death among children world wide but those at highest risk in developing countries have limited access to clinical services; effective and low-cost alternatives are a global public health priority. We have done a controlled intervention trial among 13,404 children under five in Jumla, Nepal, which relied exclusively on indigenous community health workers to detect and treat pneumonia according to the World Health Organisation decision strategy, with a five-day home-treatment course of oral co-trimoxazole. No other health services were provided, and referral of children to hospital was not practicable. During the three-year study, 2101 deaths were recorded. The programme led to a 28% reduction in the risk of death from all causes by the third year of services (relative risk 0.72, 95% confidence interval 0.63-0.82), with a significant trend (p less than 0.02) of lower mortality with greater duration of the programme. The greatest benefit was among infants. In addition to reduction in deaths due to pneumonia, there was a significant reduction in deaths due to diarrhoea and measles, indicating that reduction in pneumonia morbidity had considerable carry-over effect. Our findings show that indigenous community workers can effectively detect and treat pneumonia, and reduce overall child mortality, even without other primary care activities.
OBJECTIVE: To determine the proportion of older adults with Alzheimer's disease presenting to a geriatric clinic with low body mass index (BMI), the proportion of these individuals recognized by clinicians as malnourished, and what patients' characteristics and caregivers' and clinicians' impressions are associated with low BMI. DESIGN: Cross-sectional study. SETTING: An outpatient geriatric clinic located in a university-affiliated teaching hospital. PARTICIPANTS: 340 patients with Alzheimer's disease, average age 75 years. MEASUREMENTS: Individuals with a BMI below 21 were considered at risk of malnutrition. Physical examination and medical information were obtained from patients and caregivers by clinicians using a standardized assessment protocol. Clinicians' impression regarding evidence of malnutrition was obtained. RESULTS: Forty-six patients (16%) had a BMI below 21. Clinicians reported evidence of potential malnutrition in 11 patients, 8 of whom had a BMI below 21. Using logistic regression, we found that women were five times more likely to have a BMI below 21 than men, and that individuals with low cognition were twice as likely to have a BMI below 21 than individuals with higher cognition. CONCLUSION: The proportion of patients with Alzheimer's disease with a BMI below 21 is similar to that encountered in the general population aged 65+. However, clinicians have difficulty identifying persons at risk of malnutrition according to BMI status. Women with low cognition were at increased risk of having a low BMI. Improvement in the detection of malnutrition is desirable. Further exploration of causal links between cognition and malnutrition is required.
Gene transfer of the conjugative plasmid pBF1 from Pseudomonas putida to indigenous bacteria in seawater was investigated with a detection system for gene transfer based on the green fluorescent protein (GFP) (C. Dahlberg et al., Mol. Biol. Evol. 15:385-390, 1998). pBF1 was tagged with the gfp gene controlled by a lac promoter which is down regulated in the donor cell by a chromosomal repressor (lacIq). The plasmid donor cells (Pseudomonas putida KT2442) subsequently do not express gfp. Transfer to recipient strains lacking the repressor results in expression of gfp. The transconjugant can subsequently be detected by epifluorescence microscopy on a single-cell level. By using this method, transfer of pBF1::gfp and expression of the gfp gene were first shown to occur during nutrient-limiting conditions to several defined recipient bacteria in artificial seawater. Second, we measured transfer of pBF1 from P. putida to the marine bacterial community directly in seawater samples, on a single-cell level, without limiting the detection of gene transfer to the culturable fraction of bacteria. Plasmid transfer was detected on surfaces and in bulk seawater. Seawater bacteria with different morphologies were shown to receive the plasmid. Gene transfer frequencies of 2.3 x 10(-6) to 2.2 x 10(-4) transconjugants per recipient were recorded after 3 days of incubation.
A prospective cohort study of adult patients hospitalized due to community-acquired pneumonia was carried out for 1 year in a Brazilian university general hospital to detect the incidence of community-acquired pneumonia by Legionella pneumophila serogroups 1-6. During a whole year, a total of 645 consecutive patients who were hospitalized due to a initial presumptive diagnosis of respiratory disease by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened to detect the patients with community-acquired pneumonia. Fifty-nine consecutive patients hospitalized due to community-acquired pneumonia between July 19, 2000 and July 18, 2001, were included in the study. They had determinations of serum antibodies to L. pneumophila serogroups 1-6 by indirect immunofluorescence antibody test at the Infectious Diseases Laboratory of University of Louisville (KY, USA) and urinary antigen tests for L. pneumophila serogroup 1. Three patients had community-acquired pneumonia by L. pneumophila serogroups 1-6, two patients being diagnosed by seroconversion and positive urinary antigen tests; the other had negative serologies but strongly positive urinary antigen test. The incidence of community-acquired pneumonia by L. pneumophila serogroups 1-6 in our hospital was 5.1%.