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PubMed2003

Development of a multiplex real-time quantitative PCR assay to detect Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae in respiratory tract secretions.

Atypical pathogens such as Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae are an important cause of community-acquired pneumonia. The available detection methods (culture and serology) either lack sensitivity or give only a retrospective diagnosis. In order to improve their detection and quantification in respiratory samples, a real-time multiplex PCR, performed in two separate reactions, was developed for these three pathogens. The comparison of multiplex real-time and conventional PCR assay on 73 respiratory specimens showed an overall agreement of 98.3%, corresponding to 95.8%, 100% and 100% agreement for C. pneumoniae, L. pneumophila and M. pneumoniae, respectively. Clinical application of this multiplex real-time PCR was done on 40 respiratory samples from 38 patients with respiratory tract infections. Of 19 serology-positive patients, 14 were confirmed by the multiplex real-time PCR to be infected by either one of the three pathogens. All samples from serology-negative patients were negative with the multiplex real-time PCR.

Biotechnology↗
PubMed2001

Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia.

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia but is undoubtedly underdiagnosed. Isolation of S. pneumoniae from blood is specific but lacks sensitivity, while isolation of S. pneumoniae from sputum may represent colonization. We evaluated a new immunochromatographic test (NOW S. pneumoniae urinary antigen test; Binax, Portland, Maine) that is simple to perform and that can detect S. pneumoniae antigen in urine within 15 min. Urine samples from 420 adults with community-acquired pneumonia and 169 control patients who did not have pneumonia were tested. Urine from 315 (75%) of the pneumonia patients and all controls was tested both before and after 25-fold concentration, while the remaining 105 samples were only tested without concentration. S. pneumoniae urinary antigen tests were positive for 120 (29%) patients with pneumonia and for none of the controls. Of the urine samples tested with and without concentration, 96 were positive, of which 6 were positive only after concentration. S. pneumoniae antigen was detected in the urine from 16 of the 20 (80%) patients with blood cultures positive for S. pneumoniae and from 28 of the 54 (52%) patients with sputum cultures positive for S. pneumoniae. The absence of S. pneumoniae antigen in the urine from controls suggests that the specificity is high. Concentration of urine prior to testing resulted in a small increase in yield. The NOW S. pneumoniae urinary antigen test should be a useful adjunct to culture for determining the etiology of community-acquired pneumonia in adults.

Adolescent↗
PubMed1989

Emergency department detection and follow-up of high blood pressure: use and effectiveness of community health workers.

This study introduced trained paraprofessionals, community health workers (CHWs), into the emergency department (ED) to supplement providers' routine efforts in high blood pressure (HBP) detection, treatment, and follow-up among high-risk black men. In a demonstration project over a 2-year period, CHWs provided (1) BP and pulse measurements, and educational counseling regarding HBP and cardiovascular risk factors; (2) telephone preappointment reminders to improve ED follow-up visit rates; and (3) recontact of patients failing to show for their ED follow-up visits to improve return rates even after missed BP appointments. Results of preappointment reminders by CHWs showed a 19% improvement in appointment keeping (P less than .001). With a sample of patients who had failed to return for a follow-up visit, CHW contact was also effective, showing an overall improvement rate of 7% (P less than .001). The results reported support the idea that individuals from the community, trained as paraprofessionals, can improve appointment keeping as well as be useful in assisting in screening and counseling for chronic conditions within the ED. These CHWs are seen as having the additional advantage of enhancing the integration of the ED, the community, and continuing care sites. The approaches used in this study should be applicable and may serve as a model for the approach to other chronic conditions experienced in urban high-risk communities.

Adult↗
PubMed1970

Study on Vibrio cholerae infection in a small community in Calcutta. Joint ICMR-GWB-WHO Cholera Study Group, Calcutta, India.

The presence of a high level of latent infection in an affected community was postulated as one of the conclusions of earlier studies undertaken during cholera epidemics. A small community, consisting of 59 persons, was investigated for 100 days to determine the prevalence and persistence of infection after the occurrence of 2 index cases of cholera. In the community 39 excretors (66.1%) were detected, the 2 index cases and 37 carriers. Excretion of Vibrio cholerae was detected as much as 100 days after the occurrence of the index cases. No subsequent case of clinical cholera occurred in the community. These observations show that incidence of infection can be very high and that infection can last for a long period after an index case even in the absence of overt disease.

Adolescent↗
PubMed1981

The Mayo three-community hypertension control program. IV. Five-year outcomes of intervention in entire communities.

Beginning in 1974, the Mayo three-community hypertension control program initiated intervention studies in three southeastern Minnesota communities. This paper reports on the blood pressure outcomes 5 years after the inception of graduated programs involving public and professional education, detection, referral, and, in one community, systematic stepped care. Despite differences in local physician-population ratios and organization of medical care, perseverant long-term reductions of blood pressure were noted in all communities. However, the mean diastolic pressures were lower and the number of individuals at goal (diastolic blood pressure 90 mm Hg or less) was higher in the community offering categorical care. These data suggest that while programmatic efforts to control hypertension resulted in favorable blood pressure declines, the outcomes were particularly impressive in the community with a categorical hypertension clinic model offering systematic management of hypertensive patients.

Adult↗
PubMed2006

Real-time polymerase chain reaction assay for detection of Streptococcus pneumoniae in sputum samples from patients with community-acquired pneumonia.

BACKGROUND AND PURPOSE: A quantitative real-time polymerase chain reaction (PCR) method targeting the pneumolysin gene of Streptococcus pneumoniae in sputum specimens from patients with community-acquired pneumonia (CAP) was evaluated for the identification of pneumococci. METHODS: The applicability of the assay to clinical samples was evaluated by studying 140 sputum specimens from patients with CAP. Of the specimens, 96 (68.6%) were found to be positive by real-time PCR. The results were compared to culture findings. RESULTS: The sensitivity and specificity of the real-time PCR assay developed in this study as compared to those of the culture method were 97.2% and 60.9%, respectively. CONCLUSION: Real-time PCR assay was found to be a rapid and sensitive method for the detection of pneumococci.

Adult↗
PubMed1980

Effects of alkaline phosphatase activity on nucleotide measurements in aquatic microbial communities.

Alkaline phosphatase (APase) activity was detected in aquatic microbial assemblages from the subtropics to Antarctica. The occurrence of APase in environmental nucleotide extracts was shown to significantly affect the measured concentrations of cellular nucleotides (adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, guanosine triphosphate, uridine triphosphate, and cytidine triphosphate), adenylate energy charge, and guanosine triphosphate/adenosine triphosphate ratios, when conventional methods of nucleotide extraction were employed. Under the reaction conditions specified in this report, the initial rate of hydrolysis of adenosine triphosphate was directly proportional to the activity of APase in the sample extracts and consequently can be used as a sensitive measure of APase activity. A method was devised for obtaining reliable nucleotide measurements in naturally occurring microbial populations containing elevated levels of APase activity. The metabolic significance of APase activity in microbial cells is discussed, and it is concluded that the occurrence and regulation of APase in nature is dependent upon microscale inorganic phosphate limitation of the autochthonous microbial communities.

Journal Article↗
PubMed1977

Blood pressure studies in 14 communities. A two-stage screen for hypertension.

the Hypertension Detection and Follow-up Program (HDFP) is a community-based national trial to determine whether special programs can improve the treatment for persons with uncontrolled hypertension and reduce morbidity and mortality in wide strata of these patients. A total of 158,906 persons, aged 30 to 69 years, were screened to identify those with a diastolic blood pressure (DBP) of 95 mm Hg or higher. Age-sex-race means and distributions of DBP at a first and a second screen and prevalence rates or actual hypertension by sex, race, and level of control suggest a recently increased awareness of hypertension with more widespread and effective treatment, especially among women, although blacks under treatment had their DBP controlled less frequently. The response to this program of screening and initial follow-up offers encouragement for improved community control of high blood pressure.

Adult↗
PubMed2003

Risk factors for failure to detect a cancer during clinical breast examinations (United States).

BACKGROUND: Although clinical breast examinations (CBEs) provide important opportunities to detect breast cancer, little is known about factors that affect cancer detection during CBEs performed in community settings. To evaluate several potential factors, we analyzed data from 1,056,153 cancer screening records reported to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: Using case-series methods, we compared 2159 cancers missed during CBEs with 3161 cancers detected during CBEs. Cancers missed during CBE were found by mammography and confirmed by biopsy or fine needle aspiration. RESULTS: After controling for cancer stage, tumor size, and breast symptoms at time of CBE, we found that patient age and CBE history were significantly associated with the likelihood of cancer detection. Compared to women 50-59, women 40-49 were more likely to have their cancer detected during CBE (odds ratio (OR) = 1.84, 95% confidence interval (95% CI) 1.47-2.29), while women 70 and older were less likely to have it detected (OR = 0.74, 95% CI: 0.55-1.00). Among women receiving their first NBCCEDP-funded CBE, 67.5% had their cancer detected by CBE. Among women receiving their second or third CBE, the values were 59.3 and 48.8%, respectively. In an adjusted logistic model, a significant inverse relationship was observed between number of prior CBEs and percent of cancers detected in the index CBE (OR = 0.79, 95% CI: 0.72-0.88). CONCLUSIONS: Among women diagnosed with breast cancer, older women and those who have had multiple CBEs were more likely to have their cancer missed during CBE.

Adult↗
PubMed2005

False-positive results of a Plasmodium falciparum histidine-rich protein 2-detecting malaria rapid diagnostic test due to high sensitivity in a community with fluctuating low parasite density.

The persistence of parasite histidine-rich protein 2 (HRP2) in the circulation after parasite clearance has been considered a drawback for rapid diagnostic tests (RDTs) targeting HRP2 and a major cause of false-positive results. This paper reports results of a study into whether a proportion of RDT HRP2 false-positive cases carried parasites using polymerase chain reaction analysis as the gold standard rather than microscopy. The high rate of RDT false-positive parasitemia results in comparison with microscopy was shown to predominantly represent cases that had a parasite density below the threshold for detection by microscopy. Despite the generally low disease-endemic prevalence of malaria in the area, there was a high prevalence of chronic infections with low, fluctuating, parasite densities that were better detected by RDT. Our results suggest that in areas known to have low-density parasitemias, RDTs targeting HRP2 may increase diagnostic sensitivity in comparison with microscopy. While microscopy remains the standard for comparison of malaria diagnostic accuracy, the limitations of microscopy, and the possibility that RDTs may have superior accuracy in some circumstances, should be taken into account when interpreting results of diagnostic trials.

Animals↗
PubMed2003

An analysis of consanguinity and social structure within the UK Asian population using microsatellite data.

We analysed microsatellite genotypes sampled from the Pakistani and Indian communities in Nottingham, UK, to investigate the genetic consequences of substructuring mediated by traditional marriage customs. The application of a recently developed likelihood approach identified significant levels of population substructure within the Pakistani community as a whole, as well as within the finer divisions of castes and biradheri. In addition, high levels of cryptic or unacknowledged consanguinity were detected within subgroups of this community, including biradheri. The Indian sample showed no significant evidence of either substructure or consanguinity. We demonstrate that estimates of disease gene frequencies can be inaccurate unless they are made jointly with estimates of population substructure and consanguinity ((theta congruent to FST) and C). The magnitude of these estimates also highlights the importance of accounting for the finer scale of social structuring when making decisions regarding the risk of recessive disorders in offspring.

Analysis of Variance↗
PubMed2003

[Early detection of sickle cell anemia and other hemoglobinopathies in neonates in the Autonomous Community of Madrid. A pilot study].

OBJECTIVE: To determine the incidence of sickle cell anemia and other hemoglobinopathies in the neonatal population of the Autonomous Community of Madrid and to determine the need for a screening program. METHODS: The study was performed with the same blood spot specimen dried on filter paper used for congenital hypothyroidism and congenital adrenal hyperplasia screening. All neonates born in the public and private hospitals of the Autonomous Community of Madrid were included and universal-type screening was performed. High-performance liquid chromatography (HPLC) was used to detect variant hemoglobins. The variant automated system was used to separate and identify hemoglobin F, A1c, A, S, C, A2/E and D. To confirm variant hemoglobins, specific HPLC for -thalassemia (ion exchange) and globin chains (reversed phase) with a more expanded gradient were used. RESULTS: A total of 29 253 specimens were screened and 98 cases of variant hemoglobins were detected. The overall incidence was 1/299. There were five cases of sickle cell disease (HbFS and HbFS(tal), with an incidence of 1/5.851, and 71 cases of sickle cell traits (1/412). CONCLUSIONS: These results confirm the need to include screening for sickle cell disease and other hemoglobinopathies in our neonatal program.

Age Factors↗
PubMed1981

Evaluation of a pilot program for rheumatic disability in an urban community.

A program for the systematic detection and management of arthritis disability was developed for an urban population. A survey identified 601 persons with rheumatic disability in a population of 9,500-10,550. Seventy-eight persons were evaluated and given recommendations. An ombudsman assisted the clients in obtaining health services and coordinated care. An evaluation 6-8 months later showed increased utilization of and referrals to relevant services but, on the whole, little improvement in functional capacity was noted. However, the small numbers do not definite conclusions.

Arthritis↗
PubMed2000

[Identifying the elderly at risk for falling and accompanying protocols].

Falling is one of the main problems affecting the health of the elderly. A community project was carried out to detect elderly people at high risk for falls. One of its aims was also to develop tools allowing primary care professionals to detect the elderly at risk for falling. Such a screening test in the community-dwelling elderly (EFST) and a protocol for diagnosis and treatment of the elderly at risk for falls is presented.

Accidental Falls↗
PubMed2005

Harmonisation of the acute respiratory infection reporting system in the Czech Republic with the European community networks.

Respiratory virus activity is detected in Europe each winter, yet the precise timing and size of this activity is highly unpredictable. The impact of influenza infection and/or acute respiratory infection in European countries is continuously monitored through a variety of surveillance systems. All of these sources of information are used to assess the nature and extent of activity of influenza and other respiratory viruses, and to offer guidance on the prevention and control of morbidity and mortality due to influenza at a local, national and international level. The early warning system for a forthcoming influenza epidemic is mainly based on the use of a set of thresholds. In the Czech Republic, the acute respiratory infection (ARI) reporting system, with automated data processing, uses a statistical model for the early detection of unusual increased rates of the monitored indicators. The collected data consists of the number of ARI, the number of complications due to ARI and the population registered with the reporting general practitioners and paediatricians, all collected separately in five age groups. To improve the reporting system in the Czech Republic, clinical data on the weekly incidence of influenza-like illness (ILI) within the same population and the same age groups was started in January 2004. These data fit the European Commission's recently adopted ILI case definition and allows a better comparison of data with other countries in Europe, in particular those participating in EISS (European Influenza Surveillance Scheme).

Adolescent↗
PubMed1990

An epidemiologic study of acute intermittent porphyria in Maheshwari community of Sri-Dungargarh municipal area.

Fifteen patients of acute intermittent porphyria (AIP) were detected out of 2500 persons of Maheshwari community surveyed. These 15 patients belonged to 11 families. The prevalence of AIP in Maheshwari population came out to be 1:640 which is considerably higher than the figures reported from many other areas of our country. AIP was more common in females than males, the ratio being 9:6. Maximum number of cases (6) were encountered in the age group of 11-20 years. AIP was observed to be inherited as an autosomal dominant disease in 3 families. Spontaneous mutation of gene may be considered to be the mode of inheritance in the remaining 8 families. The disease was found to be more common in Daga and Tapadia subcastes. There were 5 cases belonging to Daga subcaste and 3 belonging to Tapadia subcaste.

Acute Disease↗
PubMed1993

Rheumatic fever and chronic rheumatic heart disease in Yarrabah aboriginal community, north Queensland. Establishment of a prophylactic program.

OBJECTIVE: To establish a program for the prevention of rheumatic fever and rheumatic heart disease in a semi-isolated Aboriginal community in far north Queensland and to test its efficacy. DESIGN: A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted in the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever. SETTING: The Yarrabah Aboriginal community in north Queensland (latitude 17 degrees S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division. PARTICIPANTS: The whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4-16 year olds) were examined. INTERVENTIONS: After the 1985 survey, all community members aged 4-16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found. RESULTS: Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three-month period. CONCLUSIONS: These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of its success and this can be obtained by community education.

Adolescent↗
PubMed2006

Use of local community hospital data for surveillance of antimicrobial resistance.

We sought to determine whether antimicrobial susceptibility data from a nonteaching community hospital could be used to detect statistically significant local increases in resistance among Streptococcus pneumoniae over a 5-year period. Minimum inhibitory concentrations (MICs) of penicillin and ceftriaxone from 1997-1998 were compared with those from 2000-2001. MICs of penicillin and ceftriaxone for organisms collected in a nonteaching community hospital in central Illinois were used for analysis. The hospital has 224 beds and a catchment area of approximately 40 miles. There were significant increases in MICs of penicillin and ceftriaxone between 1997-1998 and 2000-2001. The MIC of penicillin increased from 0.042 to 0.121 microg/mL (P = .001; 95% confidence interval, -1.713 to -0.388), and the MIC of ceftriaxone increased from 0.028 to 0.071 microg/mL (P = .005; 95% confidence interval, -1.353 to -0.188). There were no significant changes in the percentage of S. pneumoniae isolates that were resistant, intermediate, or susceptible to penicillin and ceftriaxone. MIC data from a community hospital can be used to detect local increases in the rate of resistance before antibiogram data show significant changes. This information is important for demonstrating to physicians the need to review local antibiotic use in the attempt to slow the development of resistant organisms in the community.

Adolescent↗