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PubMed1988

The effect of a community hypertension control program.

A hypertension detection and control program sponsored by the Pan-American Health Organization and the World Health Organization (PAHO/WHO) was carried out in an urban health district of Havana City, Cuba. A baseline (initial) survey was conducted on a random sample of the population (greater than or equal to 15 years of age) to assess the problem of hypertension in that community. Subsequently, we extended the program in the same area by taking the blood pressure of as many people as we could, and a health education program on hypertension was developed and implemented. All hypertensive persons were treated. We surveyed about 90% of the adult population (29,640) over a 5-year period. We then conducted a final survey on a second random sample of the population to assess the effect of the program. The response rate to the letter of invitation to visit the hypertension clinic was 50%; 30% of the recall appointments were missed, and the dropout rate was 18.6%. Seventy percent of the hypertensive persons had Stage I disease (PAHO/WHO) with normal electrocardiograms. Before the program, 15.7% of the total number of hypertensive persons surveyed in the area had the disease under good control, and this increased to 31% after the program. Mortality due to cerebrovascular disease was reduced from 11/10,000/yr to 7/10,000/yr, whereas mortality caused by myocardial infarction did not change.

Adult↗
PubMed2000

Clinical and community strains of Klebsiella pneumoniae: multiple and increasing rates of antibiotic resistance in Abha, Saudi Arabia.

Klebsiella pneumoniae is the most commonly isolated bacterial species in a maternity hospital in Saudi Arabia. Here, 380 strains isolated in 1997 and 480 strains in 1999 were studied for their resistance antibiograms, using the standardised disc diffusion test. Of 16 antibiotics tested, four in 1997 and six in 1999 were ineffective against > 50% of the respective isolates, and resistance rates to 11 antibiotics increased over the two-year period (P = 0.05-< 0.0001). With resistance rates of < 20%, imipenem, ciprofloxacin, gentamicin and cefotaxime were more effective in 1997; only imipenem and ciprofloxacin remained as effective in 1999. In addition, 105 community strains were tested and > 50% were resistant to four antibiotics. Resistance rates to most antibiotics were lower than those of clinical strains (P = 0.0285-< 0.0001). Imipenem resistance was detected among both clinical and community isolates. Multiresistance was 64.5% in 1997 and 79.2% in 1999 (P < 0.0001), and 83.8% in community strains in 1999. Using the double-disc synergy test, extended-spectrum beta-lactamase (ESBL) was detected in 27.5% of ceftazidime-resistant clinical strains isolated in 1999. Among the clinical strains, seven (65%) and 11 (67.9%) resistance antibiograms occurred frequently in 1997 and 1999, respectively. Such frequency was not observed among community isolates. These findings confirm the alarmingly high rates of multiresistance and the emergence of ESBL-producing strains, highlighting the urgent need to restrict over-the-counter availability of antibiotics, and increase awareness in the local medical community.

Drug Resistance, Microbial↗
PubMed2000

Development and validation of a questionnaire to assess disabling foot pain.

This study outlines the design and validation of a new self-administered instrument for assessing foot pain and disability. The 19-item questionnaire was tested on 45 rheumatology patients, 33 patients who had attended their general practitioner with a foot-related problem and 1000 responders to a population survey of foot disorders. Levels of reported disability were found to be greatest for rheumatology patients and least for community subjects. In addition, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a health care professional and those who did and did not have a history of past and current foot pain. A good level of agreement was found when items on the questionnaire were compared with similar items on the ambulation sub-scale of the Functional Limitation Profile questionnaire. A Cronbach's alpha value of 0.99 and item-total correlation values between 0.25 and 0.62 confirmed the internal consistency of the instrument. Finally the results of a principal components analysis identified three constructs that reflected disabilities that are associated with foot pain: functional limitation, pain intensity and personal appearance. The design of the foot disability questionnaire makes it a suitable instrument for assessing the impact of painful foot conditions in both community and clinical populations.

Adult↗
PubMed1998

Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes.

OBJECTIVE: To describe the characteristics and outcomes of doctors whose drug authorities were withdrawn as a result of self-administering opioids for non-medical purposes. DESIGN: Retrospective review of New South Wales Health Department information relating to all doctors whose authorities to possess, supply, prescribe or administer drugs of addiction had been withdrawn in the period 1985 to 1994 as a result of confirmed self-administration of opioids. OUTCOME MEASURES: Age, sex, geographical location and practice category at the time of intervention; drugs used; period of opioid use before authority withdrawal; means of detection; and registration status as at August 1995. RESULTS: From 1985 to 1994, 79 doctors had their drug authorities withdrawn (0.4% of the NSW medical profession in 1994). The groups significantly over-represented were general practitioners and those aged 30-39 years. Pethidine was the main drug used (66 doctors; 84%). Drug use for more than two years before detection was reported by 34 (43%) doctors. Community pharmacists were the source of reports leading to detection of 28 (35%) doctors. As at August 1995, 27 (34%) of the study group were not practising; 10 (13%) had died. CONCLUSION: Outcomes for these doctors were poor. There was substantial attrition from practice and a high mortality rate.

Adult↗
PubMed2001

Opening the black box. The impact of inpatient treatment services on client outcomes.

This study examined the effects of specific services provided in therapeutic communities (TCs) to treatment outcomes. Findings are compared to prior analyses of treatment outcomes from the District of Columbia Treatment Initiative (DCI) that did not utilize the treatment service information. A subsample of DCI clients randomly assigned to two TC programs, who had remained in inpatient treatment for at least 60 days, were included in the analyses (n = 371). Logistic regression results illustrated that the level of vocational education services received was positively associated with completing treatment, and participation in group services was associated with decreases in postdischarge arrest. In addition, clients who received a greater number of all inpatient services were more likely to complete treatment and were less likely to be arrested after discharge. Findings suggest that TC programs should consider offering more vocational education and group treatment services to enhance prosocial behavior following treatment discharge.

Adult↗
PubMed1997

Assessment of behavioral symptoms in community-dwelling dementia patients.

The authors compared the CERAD Behavior Rating Scale for Dementia (CBRSD) with the Cohen-Mansfield Agitation Inventory (CMAI) for their ability to detect behavioral symptoms in community-dwelling dementia patients with mild-to-moderate global impairment. Both instruments were administered to caregivers of 33 cognitively impaired patients seen in a dementia clinic at initial evaluation or follow-up visit. Endorsement of a higher percentage of items on the CBRSD than the CMAI suggests greater sensitivity of this instrument to the behavioral symptoms seen in community-dwelling patients. There was good correlation between the number of items endorsed on both scales but not between subscales of the CMAI and factors of the CBRSD that appeared related to agitation. Thus, the CBRSD and CMAI both seem to measure behaviors that occur in dementia patients, but the CBRSD's two agitation-related factors do not appear to measure agitation as defined by the CMAI.

Activities of Daily Living↗
PubMed1995

Clinical validity of the Mattis Dementia Rating Scale in detecting Dementia of the Alzheimer type. A double cross-validation and application to a community-dwelling sample.

OBJECTIVE: To assess the clinical validity of the Dementia Rating Scale (DRS) in detecting patients with dementia of the Alzheimer type (DAT). BACKGROUND: The DRS is widely used to evaluate cognitive functioning in older adults. Adequate normative data are unavailable; studies addressing the clinical validity of the DRS are limited by small sample sizes. DESIGN AND METHODS: Administered the DRS to 254 outpatients with DAT and 105 healthy elderly subjects. Performed (1) multiple regressions of demographic factors on the DRS and its subscales; (2) derivation of optimal DRS cutoff scores using receiver operating characteristic curves; (3) double cross-validation with stepwise logistic regressions; and (4) application of results to a community-dwelling sample. RESULTS: Age- and education-adjusted DRS scores were computed. The optimal DRS cutoff score for DAT of 129 or less revealed a sensitivity of 98% and a specificity of 97%. The logistic regressions resulted in a combination of the Memory and Initiation/Perseveration subscales that correctly classified 98% of all subjects, 92% of a subsample of 76 patients with mild DAT, and 100% of the 51 patients with autopsy-confirmed DAT. The resultant equation was then applied to a community-dwelling sample (238 healthy elderly subjects and 44 patients with DAT): 91% of patients and 93% of normal subjects were correctly classified. Of an additional 77 individuals with questionable DAT, 43 were classified as demented and 34 were classified as nondemented. CONCLUSIONS: The DRS is a clinically valid psychometric test for the detection of DAT. The Memory and Initiation/Perseveration subscales are its best discriminative indexes for an abbreviated version.

Aged↗
PubMed2002

Diagnosis of community-acquired pertussis infection: comparison of both culture and fluorescent-antibody assays with PCR detection using electrophoresis or dot blot hybridization.

Diagnosis of Bordetella pertussis infection has been difficult due to the low sensitivity of culture. PCR tests have been shown to be more sensitive than culture, but the reported sensitivity of PCR is variable. We evaluated PCR product detection by using either agarose gel electrophoresis (PCR-gel) or dot blot hybridization with (32)P-labeled oligonucleotide probes, and we compared these methods to both culture and direct fluorescent-antibody (DFA) assays with microscopy for the detection of pertussis. This was done with 225 nasopharyngeal swab specimens collected in community clinic settings. The multiplexed PCR amplified the multiply repeated IS481 B. pertussis sequence and a sequence from the human globin gene as a positive control for specimen adequacy. Of 225 specimens, 179 were judged to be adequate for PCR analysis. Among the adequate specimens, 9, 4, and 10 were culture, DFA, and PCR-gel positive, respectively. The sensitivity of PCR-gel versus culture was 89% while the sensitivity of culture versus PCR-gel was 80%. DFA had the lowest sensitivity. Thirty specimens were positive by PCR with dot blot hybridization; no negative control specimens showed a signal above the background. Among the 79 (44%) adequate specimens with clinical data available, the rates of reported cough or persistent cough were similar for persons who were pertussis positive by each assay. The IS481 PCR, with either electrophoresis or dot blot hybridization, is a sensitive assay; however, at this time it cannot completely replace culture without an overall loss in sensitivity for the detection of pertussis. Further study is required to understand the clinical significance of B. pertussis PCR products detected by dot blot hybridization alone.

Bacteriological Techniques↗
PubMed2004

Diagnostic test for etiologic agents of community-acquired pneumonia.

Diagnostic tests for the detection of the etiologic agent of pneumonia are neither recommended nor done for most outpatients with CAP (Table 4).Most of these patients have no clear diagnosis but seem to do well with empiric antibiotic treatment, which often costs less than the diagnostic tests. For hospitalized patients, a pre-treatment blood culture and an expectorated sputum gram stain and culture should be done. Testing for Legionella spp is appropriate in hospitalized patients, especially those who are seriously ill. New tests that merit use in selected patients are the urinary antigen assay for S pneumoniae and the PCR test for L pneumophila. Anticipated developments in the near future are PCR tests for detection of C pneumoniae and M pneumoniae.

Bacteriological Techniques↗
PubMed1999

Characterization of metal-resistant soil eubacteria by polymerase chain reaction--denaturing gradient gel electrophoresis with isolation of resistant strains.

Contamination of soils with heavy metal ions is a major problem on industrial and defense-related sites worldwide. The bioavailability and mobility of these contaminants is partially determined by the microbial biomass present at these sites. In this study, we have assessed the effect of the addition of a mixture of toxic metal salts on the prokaryotic community of microcosms consisting of sandy-loam soil using direct molecular analysis of the recoverable eubacterial 16S rDNA molecules by polymerase chain reaction--denaturing gradient gel electrophoresis (PCR-DGGE) and limited phospholipid fatty acid analysis (PLFA). Addition of toxic metals (nonradioactive surrogates of Sr, Co, Cs, Cd) resulted in rapid (ca. 1 week) changes in the DGGE profile of the indigenous eubacterial community when compared with pristine controls. These changes were stable over the course of the experiment (8 weeks). No changes in the eubacterial population of control microcosms were detected. The major changes in community structure in metal-contaminated microcosms consisted of the appearance of four novel bands not detected in controls. Sequence analysis of these bands suggested that two organisms related to the genus Acinetobacter and two related to the genus Burkholderia carried a selective advantage over other indigenous eubacteria under heavy metal induced stress. The Burkholderia spp. were then cultured and further characterized using lipid analysis.

Acinetobacter↗
PubMed1993

Direct detection of wild poliovirus circulation by stool surveys of healthy children and analysis of community wastewater.

Cartagena, Colombia, was one of the last cities in the Americas known to have endemic poliomyelitis. After 3 cases were identified in 1991, two approaches for detecting continued silent transmission of wild polioviruses within a high-risk community were used: stool surveys of healthy children and virologic analysis of community sewage. Wild type 1 polioviruses were isolated from 8% of the children studied and from 21% of sewage samples. The proportions of wild polioviruses, vaccine-related polioviruses, and nonpolio enteric viruses were similar for both approaches. Wild poliovirus sequences were also amplified directly from processed sewage samples by the polymerase chain reaction using primer pairs specific for the indigenous type 1 genotype. The last reported cases associated with wild polioviruses in the Americas occurred in Colombia (8 April 1991) and Peru (23 August 1991). Direct sampling for wild polioviruses in high-risk communities can provide further evidence that eradication of the indigenous wild polioviruses has been achieved in the Americas.

Child, Preschool↗
PubMedDate not supplied

Screening school personnel for cardiovascular disease risk factors: short-term impact on behavior and perceived role as promoters of heart health.

BACKGROUND: Few controlled studies have evaluated the impact of community-based screening to detect risk factors for cardiovascular disease (CVD) on behavior change. This study examined the short-term impact of school-based screening on smoking, leisure time exercise, and fat consumption of personnel working in schools offered CVD risk factor screening. Also, the impact of screening on the perceptions that teachers have of their role in promoting heart health at school and the frequency of discussing heart health issues with students was investigated. METHODS: The impact of screening was investigated in a before-after study design comparing behaviors of staff working in eight inner-city elementary schools offered the screening with those of staff working in eight matched comparison schools. Data were collected in self-administered questionnaires 2 weeks before and 4 months after screening. RESULTS: A total of 209 subjects in the intervention schools completed the baseline questionnaire. Of these, 125 (59.8%) participated in the screening and completed the 4-month follow-up questionnaire. In the comparison schools, 135 of 177 subjects who completed the baseline questionnaire (76.3%) also completed the follow-up questionnaire. Multivariate analysis of covariance detected no changes in cigarette or fat consumption, but subjects exposed to the screening significantly increased their level of physical activity. Also, teachers exposed to screening increasingly supported the notion that teachers have a role in promoting heart-healthy behaviors among their students. CONCLUSIONS: Although several methodological limitations might have influenced the results, these data suggest that screening and counseling for CVD risk factors is an effective strategy to positively influence level of physical activity. If screening does increase motivation and interest among teachers to become heart-health role models or educators, the benefits of school-based screening could extend well beyond those who actually participate.

Adult↗
PubMed1988

Silent ischemia: a relevant problem in patients with coronary artery disease?

Awareness of silent myocardial ischemia has greatly increased during the last few years in the medical community. Methods for its detection include exercise testing, Holter monitoring, and, more specifically, Thallium-201 scintigraphy, 2D-echocardiography, and multigated radionuclide ventriculography with phase analysis, all during rest and exercise. Cohn's classification of silent ischemia has proven very useful in highlighting the magnitude of the problem. It can be estimated that about 2% to 4% of apparently healthy middle aged males in industrialized European countries are prone to asymptomatic ischemic episodes. Prognosis of silent myocardial ischemia has been evaluated in prospective and retrospective studies. Most authors come to the conclusion that ischemia is the key finding, whether painful of asymptomatic. Even present understanding of pain perception from the ischemic myocardium is incomplete; the high prevalence and the relation with myocardial infarction and sudden cardiac death make silent myocardial ischemia one of today's most relevant problems.

Coronary Disease↗
PubMed2003

Vegetation composition, dynamics, and management of a bracken-grassland and northern-dry forest ecosystem.

We investigated differences in vegetation composition and dynamics for two globally rare ecosystems, bracken-grasslands and northern-dry forests of northern Wisconsin. These ecosystems commonly have been viewed as degraded pine barrens. Bracken-grasslands contained a high dominance of exotic species, low native richness, and no obvious prairie species, suggesting logging-era anthropogenic origins. Differences in cover for common plants among ecosystems were examined using Mann-Whitney U tests of equivalence. Cover of all 8 graminoid species, 4 of 5 Ericaceae and Myricaceae species, and 10 of 17 species of forbs were significantly different between ecosystems. Vegetation changes over a 4-year period were examined through detrended correspondence analysis (DCA) and analysis of variance (ANOVA) repeated measures. DCA analyses of community composition failed to detect significant temporal trends within individual management units, although differences were apparent between ecosystems, regardless of sample year. In addition, no apparent patterns could be detected between years when comparing dominant individual species to management history (prescribed fire). This is contrary to what would be expected for a degraded pine barrens and questions the efficacy of using repeated prescribed fire as a management tool in bracken-grasslands. Methods for conservation and restoration of xeric ecosystems of northern Wisconsin have historically relied heavily on single species (e.g., sharp-tailed grouse) wildlife models, without full consideration of other factors. We suggest that stakeholders involved in these restoration projects examine historic processes and reference conditions prior to formulating management goals. Greater attention to the differentiation and individual management needs of pine barrens, northern-dry forests, and bracken-grasslands is needed.

Animals↗
PubMed1985

Drug treatment trials in hypertension: a review.

Thirteen controlled clinical trials (11 randomized) reporting morbidity and mortality results during 1960-1982 are summarized. Given the diverse design features, results are presented both for individual trials and for several combinations of similar studies, to provide more stable estimates of effects. Two of three trials in severe hypertension, while lacking enough events to evaluate effect on mortality, found significant reductions in "hypertensive" events, with the overall estimate being an 80% reduction. Similarly, combining six trials in less severe hypertension with untreated controls showed a 54% reduction in such events. The favorable trend in all-causes mortality from these trial results, whether viewed separately or in combination, was not significant. However, the findings from a large randomized trial with community controls, the Hypertension Detection and Follow-up Program, indicated significant reduction of all-causes mortality, the magnitude of which was consistent with the other trials. Outcomes of hypertensive participants in the Multiple Risk Factor Intervention Trial raised questions about mortality benefits in certain subgroups. These and other issues about patient benefit are further addressed with trial data and reference to the 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. We note also 1) that evidence for reduction of coronary heart disease death or nonfatal myocardial infarction with antihypertensive drug treatment is weak, perhaps due to inadequate power to detect such a difference, and that data are limited regarding effects on quality of life. Nevertheless, the overall trial results provide strong support for drug treatment of severe hypertension, and for most individuals with less severe hypertension, when nonpharmacologic treatment will not suffice.

Adult↗
PubMed1992

Image processing system for interpreting motion in American Sign Language.

In this paper, an image processing algorithm is presented for the interpretation of the American Sign Language (ASL), which is one of the sign languages used by the majority of the deaf community. The process involves detection of hand motion, tracking the hand location based on the motion and classification of signs using adaptive clustering of stop positions, simple shape of the trajectory, and matching of the hand shape at the stop position.

Algorithms↗
PubMed1993

Introduction of laboratory based ward liaison surveillance of hospital infection into six district general hospitals.

A previous study demonstrated that laboratory based ward liaison surveillance (LBWLS) of hospital infection was an effective and efficient method. The method involved the follow-up of positive microbiology reports by the review of patient records and liaison with ward nursing staff to consider whether any patients had infection. Here we report the introduction of LBWLS into six district general hospitals to determine whether it is feasible to use this method on an everyday basis. The time required for data collection was assessed and the method was compared with a reference method in one hospital to check its ability to detect infections. To assess reproducibility two infection control nurses (ICNs) performed LBWLS independently, but concurrently, for 5 weeks. The method could be used in all hospitals studied; however, the time for data collection ranged from 3.0 to 6.8 h/100 beds per week. In comparison with the reference method, LBWLS detected 15/41 (37%) of community acquired infections and 30/43 (70%) of hospital acquired infections. In the reproducibility assessment 72 patients were identified by both ICNs. There was agreement about the infected/non-infected status of 65 of these patients. The mean pair agreement and Kappa statistic were 0.88 and 0.72. Laboratory based ward liaison was readily used in all hospitals and was reproducible.

Adolescent↗
PubMed1989

The economics of mild hypertension programmes.

The recently reported results from several controlled randomised trials of the drug treatment of mild hypertension suggest that such treatment may be expected to exert a small effect toward the primary prevention of stroke disease. In order that the economic implications of these results might be examined, two hypothetical programmes of anticipatory care are considered according to the principles of cost-effectiveness analysis. Each notional 5 year programme is set in a defined population, residents of Stockport, Greater Manchester, aged between 35 and 64 years, and each is addressed toward the detection and treatment of mild hypertension in the community. The programmes differ with respect to their detection processes: one programme is based upon the screening method conducted under the aegis of health visitor staff employed by a District Health Authority, the other upon opportunistic case finding conducted by general practitioners. It is likely that the screening programme would prevent about 13 strokes over a 5 year period; if set in leisure time total programme costs are estimated to be 309,500 pounds at 1986 prices. Discounting future costs and future prevented strokes provides for the development of a present value total cost per prevented stroke of 25,000 pounds. Alternately, the 5 year opportunistic programme, costing 252,650 pounds, would be expected to prevent about 15 strokes at a present value of 17,050 pounds per prevented stroke. The prevention of stroke disease attributable to these programmes can only be achieved in the presence of group compliance to drug treatment. This clearly depends upon the perception of the value of treating hypertension according to each individual subject. The respective merits of the two programmes are examined with particular reference to their sensitivity to this issue, as well as to their likely feasibility and practicability.

Adult↗