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Molecular approaches to microbiological monitoring: fecal source detection.

Molecular methods are useful both to monitor natural communities of bacteria, and to track specific bacterial markers in complex environments. Length-heterogeneity polymerase chain reaction (LH-PCR) and terminal restriction fragment length polymorphism (T-RFLP) of 16S rDNAs discriminate among 16S rRNA genes based on length polymorphisms of their PCR products. With these methods, we developed an alternative indicator that distinguishes the source of fecal pollution in water. We amplify 16S rRNA gene fragments from the fecal anaerobic genus Bacteroides with specific primers. Because Bacteroides normally resides in gut habitats, its presence in water indicates fecal pollution. Molecular detection circumvents the complexities of growing anaerobic bacteria. We identified Bacteroides LH-PCR and T-RFLP ribosomal DNA markers unique to either ruminant or human feces. The same unique fecal markers were recovered from polluted natural waters. We cloned and sequenced the unique markers; marker sequences were used to design specific PCR primers that reliably distinguish human from ruminant sources of fecal contamination. Primers for more species are under development. This approach is more sensitive than fecal coliform assays, is comparable in complexity to standard food safety and public health diagnostic tests, and lends itself to automation and high-throughput. Thus molecular genetic markers for fecal anaerobic bacteria hold promise for monitoring bacterial pollution and water quality.

DNA, Bacterial↗

Urinary detection of Streptococcus pneumoniae antigen for diagnosis of pneumonia.

Streptococcus pneumoniae is one of most common causes of community-acquired pneumonia. We evaluated a newly available rapid immunochromatographic test to detect S. pneumoniae in urine samples verifying its importance in the diagnosis of pneumococcal pneumonia. Our data, obtained from 104 patients with community-acquired pneumonia, show that Now S. pneumoniae Urinary Test is characterized by a sensitivity value of 77.7%, a specifity of 98.8%: positive and negative predictive values are 93.3% and 95.5%, respectively. In conclusion, Now S. pneumoniae Urinary Test should be a useful test to establish the etiology of community-acquired pneumonia.

Adult↗

Early subclinical coronary artery calcification in young adults who were pediatric kidney transplant recipients.

Coronary artery disease (CAD) is the leading cause of death in adults after successful kidney transplantation. Children who have undergone successful kidney transplantation are entering young adulthood; however, the prevalence and extent of CAD in this population is unknown. We conducted a pilot study in young adults with stable allograft function, who received kidney transplants as children to measure coronary artery calcification (CAC), a marker of coronary artery atherosclerosis and CAD. We evaluated 19 young adults after successful pediatric kidney transplantation for known CAD risk factors; these patients underwent noninvasive imaging with electron-beam computed tomography (EBCT) for measurement of CAC. Prevalence and quantity of CAC were then compared to asymptomatic individuals from the community. All patients had multiple risk factors for CAD. Mean age at evaluation was 32 years (range: 21-48 years). CAC is uncommon in individuals in the community in this age range; however, nearly half of our patients had CAC detected with the quantity of CAC comparable to asymptomatic individuals from the community 10-40 years older. These data suggest young adults who received pediatric kidney transplants are at increased risk for developing early CAC and need close monitoring to detect early CAD so as to prevent premature cardiac morbidity and mortality.

Adult↗

Sensitivity of a computer adaptive assessment for measuring functional mobility changes in children enrolled in a community fitness programme.

OBJECTIVE: To examine the relative sensitivity to detect functional mobility changes with a full-length parent questionnaire compared with a computerized adaptive testing version of the questionnaire after a 16-week group fitness programme. DESIGN: Prospective, pre- and posttest study with a 16-week group fitness intervention. SETTING: Three community-based fitness centres. SUBJECTS: Convenience sample of children (n = 28) with physical or developmental disabilities. INTERVENTIONS: A 16-week group exercise programme held twice a week in a community setting. MAIN MEASURES: A full-length (161 items) paper version of a mobility parent questionnaire based on the Pediatric Evaluation of Disability Inventory, but expanded to include expected skills of children up to 15 years old was compared with a 15-item computer adaptive testing version. Both measures were administered at pre- and posttest intervals. RESULTS: Both the full-length Pediatric Evaluation of Disability Inventory and the 15-item computer adaptive testing version detected significant changes between pre- and posttest scores, had large effect sizes, and standardized response means, with a modest decrease in the computer adaptive test as compared with the 161-item paper version. Correlations between the computer adaptive and paper formats across pre- and posttest scores ranged from r = 0.76 to 0.86. CONCLUSIONS: Both functional mobility test versions were able to detect positive functional changes at the end of the intervention period. Greater variability in score estimates was generated by the computerized adaptive testing version, which led to a relative reduction in sensitivity as defined by the standardized response mean. Extreme scores were generally more difficult for the computer adaptive format to estimate with as much accuracy as scores in the mid-range of the scale. However, the reduction in accuracy and sensitivity, which did not influence the group effect results in this study, is counterbalanced by the large reduction in testing burden.

Adolescent↗

General practice recruitment for people at risk of schizophrenia: the Buckingham experience.

OBJECTIVE: The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. METHODS: A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. RESULTS: General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. CONCLUSIONS: It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

Family Practice↗

The contribution of community health surveys to aboriginal health in the 1990s.

Community health surveys take place in many Aboriginal communities. We considered these surveys to determine their potential to contribute to Aboriginal health in the 1990s. Community health surveys--also known as health audits, community health screenings or check-ups--usually consist of a team of health professionals travelling to an Aboriginal community to measure a wide variety of parameters on as many of the people in the community as possible. For the individual participant, community health surveys represent a sporadic screening program which should meet the World Health Organization's criteria for screening. From the population health perspective, these surveys represent prevalence surveys which may contribute little new knowledge regarding Aboriginal health and do not, of themselves, change the urgent need for preventive health programs. Community health surveys should meet minimum scientific standards (i.e. have a clearly stated aim and use valid measurements and statistical techniques) and should incorporate practically feasible protocols and services for the follow-up of individuals with screen-detected abnormalities. They must have ethical and community approval and incorporate genuine consultation and feedback of results to the Aboriginal communities involved, in order for them to be justified.

Australia↗

[Epidemiology and prognosis of cervix cancer. Experience of the University Gynecology and Obstetric Clinic Ignace Deen of Conakry in 10 years: 1982-1991].

The cancer of the cervix is a tumor that can be detected at an early stage. Unfortunately, it is still detected lately in our service. Thus, it is the underlying cause of death by gynecological affection. After a preliminary work in 1982 about 35 case histories, the authors undertake a 10 years retrospective study where they showed that: the cancer of the cervix is the primary gynecological cancer (78.7%), it obtains between 25 and 65 years, the most often associated factors are early sex, (28%), poor living conditions (22%), cercivitise (17%), metrorrhagias (24%) and leucorrhoea are the most frequent signs. buding lesions are the dominant macroscopic form (68%) epidermoid carcinoma is the most important histological type, 98.7% cancer cases are detected at advanced stages (T3 and T4), the prognosis is dramatic: most patients die at home. This is a great public health issue the solution of which implies the collective action of decision-markers, health personnel and the communities themselves in order to promote early detection.

Adolescent↗

Asymptomatic coronary heart disease detected on epidemiological survey of urban population of Delhi.

A community based epidemiological study of coronary heart disease (CHD) was carried out in a random sample of 13723 adults in the age group of 25-64 years in the urban population of Delhi. The electrocardiogram (ECG) of all clinically detected CHD cases and of a sample of 5621 persons (selected on the basis of alternate household screened) without clinical manifestations of CHD, was obtained. Out of 5621 persons labelled as asymptomatic, CHD evidence of Q wave myocardial infarction (MI) was present in 80 ECGs (1.4%). Another 296 ECGs had ST & T changes vide Minnesota Code 4-1-1, 4-1-2, 5-1 and 5-2 acceptable as evidence of probable CHD. The overall prevalence rate of asymptomatic CHD was 6.7% (male 5.6%, female 7.6%). Silent MI was more common in the male patients (1.7% vs 1.1%, p < 0.001). However, ST-T changes were more common in female patients (6.5% vs 3.9%, p < 0.001). The ST-T changes showed a steady factor in asymptomatic CHD cases was hypertension in both sexes (male-45.2%, female-43.5%) p = NS. Obesity was present in 24% of male & 46.1% of female patients (p < 0.001). Family history was found in 20% cases of both sexes. Smoking was recorded in 34.9% male and 10.9% female patients with asymptomatic CHD (p < 0.001).

Adult↗

Accurately quantifying low-abundant targets amid similar sequences by revealing hidden correlations in oligonucleotide microarray data.

Microarrays have enabled the determination of how thousands of genes are expressed to coordinate function within single organisms. Yet applications to natural or engineered communities where different organisms interact to produce complex properties are hampered by theoretical and technological limitations. Here we describe a general method to accurately identify low-abundant targets in systems containing complex mixtures of homologous targets. We combined an analytical predictor of nonspecific probe-target interactions (cross-hybridization) with an optimization algorithm that iteratively deconvolutes true probe-target signal from raw signal affected by spurious contributions (cross-hybridization, noise, background, and unequal specific hybridization response). The method was capable of quantifying, with unprecedented specificity and accuracy, ribosomal RNA (rRNA) sequences in artificial and natural communities. Controlled experiments with spiked rRNA into artificial and natural communities demonstrated the accuracy of identification and quantitative behavior over different concentration ranges. Finally, we illustrated the power of this methodology for accurate detection of low-abundant targets in natural communities. We accurately identified Vibrio taxa in coastal marine samples at their natural concentrations (<0.05% of total bacteria), despite the high potential for cross-hybridization by hundreds of different coexisting rRNAs, suggesting this methodology should be expandable to any microarray platform and system requiring accurate identification of low-abundant targets amid pools of similar sequences.

Oligonucleotide Array Sequence Analysis↗

Drug-resistant Neisseria gonorrhoeae in Michigan.

The increasing prevalence of quinolone-resistant Neisseria gonorrhoeae (QRNG) in the United States is a cause for concern. Detecting resistance is complicated by the widespread use of molecular tests that do not provide isolates for susceptibility testing. The Michigan Department of Community Health developed a sentinel surveillance program to detect antimicrobial drug resistance in N. gonorrhoeae. Sentinel surveillance from 11 laboratories submitted 1,122 isolates for antimicrobial drug susceptibility testing and detected 2 clusters of QRNG from January 2003 to September 2004. These clusters were epidemiologically distinct: one involved young, heterosexual youth, and the other involved older men who have sex with men. This finding led to changes in local treatment recommendations that limited spread of resistant strains. Development of the sentinel program, collection of data, and epidemiologic analysis of the clusters are discussed.

Adolescent↗

Bowel cancer. Positive expectations for improvements in outcomes.

BACKGROUND: Colorectal cancer continues to be a major cause of mortality and morbidity in people over 50 years of age in the Western world. Age standardised incidence and mortality rates are high in Australia and too many patients with colorectal cancers are first diagnosed with advanced stage disease. OBJECTIVE: The aim of this overview of colorectal cancer is to present the clinical epidemiology of colorectal cancer in Australia, review screening strategies and demonstrate the benefits of early diagnosis. DISCUSSION: While little change has been noted in the cure rate within Australia during the past two decades, there are now promising signs that more colorectal cancers are being detected in the early stage due to greater community awareness of the disease. The movement to establish an effective screening program for colorectal cancer will further add to the ability to detect colorectal cancers at the early stages. These developments, coupled with improvements in surgical technique and adjuvant therapy, will provide real scope to improve treatment, survival and quality of life outcomes.

Australia↗

Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults.

OBJECTIVES: To explore the potential of using step activity monitoring to detect differences in ambulatory activity associated with advancing age and declining function in community-dwelling seniors. DESIGN: Cross-sectional pilot study. SETTING: General communities of Seattle, Washington; Catonsville, Maryland; and Durham, North Carolina. PARTICIPANTS: Thirty healthy younger adults, 28 healthy older adults, and 12 older adults reporting functional limitations. MEASUREMENTS: Ambulatory activity data were collected over 6 days with the StepWatch 3. Average daily values were calculated for number of steps, number of minutes of activity, number of activity bouts, variability of minute-to-minute activity, and randomness of minute-to-minute activity fluctuations. RESULTS: Healthy older adults engaged in fewer bouts of activity (P=.03) and displayed less-variable activity (P=.02) than younger adults. Older adults reporting functional limitations not only engaged in fewer bouts of activity (P=.009) and less variable activity (P<.001) than younger adults, but also accumulated fewer total steps (P=.003) and minutes of activity (P=.008) and had less-random minute-to-minute activity fluctuations (P=.02). CONCLUSION: Step activity monitoring data were useful for detecting differences in ambulatory activity according to age and functional limitation. Monitor-based measures reflecting patterns of ambulatory activity show promise for use in studies of physical functioning.

Activities of Daily Living↗

Post-treatment of a slaughterhouse wastewater: stability of the microbial community of a sequencing batch reactor operated under oxygen limited conditions.

Slaughterhouse wastewater is a complex effluent with an important content of organic nitrogen. After an anaerobic treatment where most of the organic matter is removed, the nitrogen, remains as ammonium and post-treatment of the effluent is necessary. Sequencing batch reactor (SBR) technology has been developed to completely remove nitrogen in one single reactor combining aerobic and anoxic stages. Under oxygen limited conditions only nitrite is produced with concomitant energy saving. The stability and diversity of the microbial community from a nitrifying denitrifying SBR operated under oxygen limited conditions were studied using molecular and respirometric methods. The AOB (ammonia oxidizing bacteria) community was relatively stable Nitrosomonas being the dominant genera although Nitrosospira and Nitrosococcus were detected in low proportions. Nitrite oxidizing bacteria were out competed during the operation under oxygen-limited conditions. After an increase of the DO in the reactor Nitrobacter spp were detected suggesting that they remained in the system. Changes in the AOB and denitrifying communities were observed after the DO increase. Sedimentation problems were detected during operation, this could be related to the predominance of Thauera spp detected by FISH and T-RFLP.

Abattoirs↗

[The School of Medical Sciences of the University of Santiago de Chile].

The Medical Sciences School of the University of Santiago de Chile, is an institution inserted in the occidental culture and therefore on its conceptions and traditions. It subscribes the Principles defined in the Universal Declaration of the Human Rights of the United Nations and especially the importance of the human person, as an entity irrepetible, different to others. The human rights are over the institutions, the society and the laws of science. The Faculty considers the family as the cell or natural and fundamental element for the development of the human being in the society. It defines its historic mission as the search of the truth and the achievement of a society in pro of the welfare and health of the people in a frame of excellence, justice, humanism, efficiency and participation. As an expression of the cultural patrimony it should create and transfer knowledge. As guarantor of the ethical principles it should protect the dignity that emanates from the transcendent nature of the person and its moral principles and therefore its right to life, justice, freedom, equality, health, education, and happiness. As a paradigm of progress it must be involved in modernization and should impulse the development. As an entity committed with Society it should participate in the search of solutions for politics and programs looking for a higher level of life and a better model of health. The profile of our graduated students will identify them due to their profound spirit of welfare of the person, his family, his community, ethical sense, solidarity, justness and humanity, their orientation to the community and the environment with a solid professional formation in the strategy of Primary Health Care. They will provide education in health for the whole family in order to improve a better way of life. They will be trained to detect and solve the risks of individual, communities and environment. Research is also a priority of the Faculty in order to contribute to solve the problems of health of the Nation, since there is no development without education and there is no education neither development without health. For the Faculty the achievement of these purposes is mandatory and we will make them reality through the Prometeo Project 1997-2001.

Chile↗

Stochastic simulation and the detection of immunity to schistosome infections.

In this paper we address the question of detecting immunity to helminth infections from patterns of infection in endemic communities. We use stochastic simulations to investigate whether it would be possible to detect patterns predicted by theoretical models, using typical field data. Thus, our technique is to simulate a theoretical model, to generate the data that would be obtained in field surveys and then to analyse these data using methods usually employed for field data. The general behaviour of the model, and in particular the levels of variability of egg counts predicted, show that the model is capturing most of the variability present in field data. However, analysis of the data in detail suggests that detection of immunity patterns in real data may be very difficult even if the underlying patterns are present. Analysis of a real data set does show patterns consistent with acquired immunity and the implications of this are discussed.

Adolescent↗

Optimization of terminal-restriction fragment length polymorphism analysis for complex marine bacterioplankton communities and comparison with denaturing gradient gel electrophoresis.

The potential of terminal-restriction fragment length polymorphism (T-RFLP) and the detection of operational taxonomic units (OTUs) by capillary electrophoresis (CE) to characterize marine bacterioplankton communities was compared with that of denaturing gradient gel electrophoresis (DGGE). A protocol has been developed to optimize the separation and detection of OTUs between 20 and 1, 632 bp by using CE and laser-induced fluorescence detection. Additionally, we compared T-RFLP fingerprinting to DGGE optimized for detection of less abundant OTUs. Similar results were obtained with both fingerprinting techniques, although the T-RFLP approach and CE detection of OTUs was more sensitive, as indicated by the higher number of OTUs detected. We tested the T-RFLP fingerprinting technique on complex marine bacterial communities by using the 16S rRNA gene and 16S rRNA as templates for PCR. Samples from the Northern and Middle Adriatic Sea and from the South and North Aegean Sea were compared. Distinct clusters were identifiable for different sampling sites. Thus, this technique is useful for rapid evaluation of the biogeographical distribution and relationships of bacterioplankton communities.

Animals↗

Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years.

An ultrasonography screening programme for detecting abdominal aortic aneurysm (AAA) in the community is described in which 7200 men and women aged between 65 and 80 years were contacted by letter. Of these, 4237 were screened; the aorta was visualized in 4122 and 179 AAAs of 3 cm or more in diameter were detected (4.3 per cent). Criteria for surgery are suggested and the results of their application prospectively over 6 years are discussed. Using these criteria, under 10 per cent of patients with ultrasonographically-detected AAA should require surgery for this condition provided ultrasonography follow-up is used.

Aged↗

Fecal occult blood screening--trial evidence, practice and beyond.

Colorectal cancer is a leading cause of morbidity and mortality in Western countries. Primary prevention and early detection of this malignancy has been shown in multiple research set-ups, and using different modalities, to be effective in reducing the incidence and mortality rates of this disease. Three randomized controlled trials have been conducted over the last 30 years to evaluate the efficacy of periodic screening with fecal occult blood tests (FOBT). These studies have consistently demonstrated mortality reduction with biennial as well as annual testing after 8-18 years of follow-up. A significant primary prevention effect through reduction of colorectal cancer incidence was also reported. The results of the Israeli population-based screening program using Hemoccult Sensa show that it is possible to achieve a high detection rate in a well-organized community set-up and, in addition, also a shift in tumor stage towards smaller tumors, a low positivity rate, and an acceptable false positivity rate. FOBT is cheap and performs very well in cost effectiveness analyses evaluating the cost of detecting one cancer. This is quite a rare situation where mortality reduction can be achieved with a simple rather than a sophisticated technology. Research to further enhance the cancer detection capabilities of FOBT through the incorporation of molecular testing of the stool for tumor genes is underway. Multiple policymakers are already recommending this procedure for routine screening of average risk population. Taking their recommendations into action is of major importance.

Clinical Trials as Topic↗