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PubMed2006

Thyroid function and perchlorate in drinking water: an evaluation among California newborns, 1998.

Perchlorate (ClO4-) has been detected in groundwater sources in numerous communities in California and other parts of the United States, raising concerns about potential impacts on health. For California communities where ClO4- was tested in 1997 and 1998, we evaluated the prevalence of primary congenital hypothyroidism (PCH) and high thyroid-stimulating hormone (TSH) levels among the 342,257 California newborns screened in 1998. We compared thyroid function results among newborns from 24 communities with average ClO4- concentrations in drinking water>5 microg/L (n=50,326) to newborns from 287 communities with average concentrations 5 microg/L were observed, with 20.4 expected [adjusted prevalence odds ratio (POR)=0.71; 95% confidence interval (CI), 0.40-1.19]. Although only 36% of all California newborns were screened before 24 hr of age in 1998, nearly 80% of newborns with high TSH were screened before 24 hr of age. Because of the physiologic postnatal surge of TSH, the results for newborns screened before 24 hr were uninformative for assessing an environmental impact. For newborns screened>or=24 hr, the adjusted POR for high TSH was 0.73 (95% CI, 0.40-1.23). All adjusted odds ratios (ORs) were controlled for sex, ethnicity, birth weight, and multiple birth status. Using an assessment of ClO4- in drinking water based on available data, we did not observe an association between estimated average ClO4- concentrations>5 microg/L in drinking water supplies and the prevalence of clinically diagnosed PCH or high TSH concentrations.

California↗

PubMed1998

Antibodies to toluene diisocyanate in an environmentally exposed population.

Residents living near a polyurethane foam manufacturing facility expressed concern to health officials over chemical emissions from the plant. Environmental monitoring of ambient air near the plant indicated the presence of toluene diisocyanate (TDI), which was used in foam production. Health officials collected blood samples from 113 residents and analyzed the blood sera for antibodies to TDI and related diisocyanates. Ten of the 113 residents (9%) had elevated levels of IgG or IgE antibodies specific for one or more diisocyanates. Exposure histories were taken from antibody-positive individuals to identify possible occupational exposure to TDI or the use of diisocyanate-containing consumer products. Exposure to TDI in ambient air may be responsible for the positive antibody responses detected in some residents of the community.

Adolescent↗

PubMed1975

Evaluation of the skin test for hookworm as an epidemiological tool.

The usefulness of a skin test with larval Necator americanus antigen for assessment of hookworm prevalence was evaluated in an endemic area of Costa Rica. In comparison with standard coprologic techniques employed to survey the population, the skin test detected 83% of infections, showing a fairly satisfactory sensitivity. The overall specificity of the test was 50%, i.e., random. No correlation was found between skin reactivity and hookworm burden. The sensitivity of the test increased moderately with age, but its specificity decreased significantly at the same time. False positive reactions were more numerous among persons formerly infected with hookworm who had been negative for as long as 5 years. There was an indication of cross reactivity with intestinal nematodes other than hookworm. The test was used to detect hookworm infected persons in the community for selective treatment, in comparison with mass treatment of all the people in another village. The selective administration of an anthelminthic drug to only skin test positive persons did not achieve the same drop in community hookworm prevalence as did the indiscriminate treatment of the whole population.

Adolescent↗

PubMed1996

Breast cancer in black women.

PURPOSE: To review the current knowledge about breast cancer in black women--including epidemiology, risk factors, screening practices, pathology, clinical manifestations, treatment, and outcome--with emphasis on issues that might explain why the survival rate in this population of women is lower than that in white women. DATA SOURCES: The MEDLINE database from 1966 to 1995 and the bibliographies of all related articles. STUDY SELECTION: Review articles and clinical studies related to all aspects of breast cancer in black women. DATA SYNTHESIS: The incidence of breast cancer is lower in black women (95.8 cases per 100 000 women) than in white women (112.7 cases per 100 000 women). Differences in reproductive factors may partially explain the lower risk for breast cancer among black women in the United States. Breast tumors in black women are consistently diagnosed at a more advanced stage of disease: Forty-two percent of black women present with cancer confined to the breast compared with 53% of white women. In addition, the cancers of black women tend to be more poorly differentiated and are less likely to be estrogen receptor positive. Treatment of breast cancer in black women appears to be similar to that in white women, but little is known about systemic therapy choices and efficacy. Overall, despite their lower risk for breast cancer, black women have a mortality rate from breast cancer similar to that of white women because they have a lower 5-year disease-specific survival rate (64% in black women compared with 80% in white women). CONCLUSIONS: The discrepancy in survival rate between black and white women exists because black women have tumors that are more advanced at the time of diagnosis, because tumor biology in black women is different from that in white women (in particular, black women have a higher frequency of poorly differentiated tumors and a lower frequency of hormone receptor-positive tumors), and because of confounding comorbid conditions and socioeconomic factors. Current efforts to improve survival rates in black women with breast cancer should focus on community education, screening efforts, and early detection. As more information is gained about breast cancer treatment in black women, this may also be an important area for intervention.

Black or African American↗

PubMedDate not supplied

[The clinico-epidemiological characteristics of HIV infection in 93 adults in the Republic of Moldova].

We have examined 93 adults HIV serum-positive (citizens of Moldova Republic), admitted in 1994-1998 (months I-VIII) to the Hospital of Infections Diseases 'T. Ciorba'--Kishinev. Since 1996 the number of HIV infected people began to grow up rapidly. Most affected group was those of 16-29 years old people--78.4%. The major way of the HIV transmission was the use of intravenous drugs (81.7%). Number of men i.v. drug users was two time greater then women's (88.9%/66.7%). At the time of HIV infection diagnosis 77.9% of patients were in the clinical category A, 16.9% in B and 5.2% in C (1993 classification system, CDC-Atlanta). During the control period seven persons were redistributed from the clinical category A to B and two from A to C. A high prevalence value for tuberculosis in AIDS (71.4%) has been observed, this infection being the first manifestation of stadium C in 57.1% of cases. The circulation of hepatitis viruses is high in the drug users community: the markers of VHC were detected in 84.2%, HBsAg in 17.1% and VHD antibodies in 9.2%.

Adolescent↗

PubMed1999

Plasmodium falciparum clinical malaria: lessons from longitudinal studies in Senegal.

Development of new antimalaria strategies and particularly vaccines, needs an in-depth understanding of the relationships between transmission, infection, immunity, morbidity and mortality. The intensive and longitudinal collection of entomological, parasitological and clinical data from the Senegalese populations of Dielmo (250-300 inhabitants), exposed to a perennial and intense transmission (about 200 infective bites/person/year) and of Ndiop (300-350 inhabitants) exposed to a seasonal transmission (about 20 infective bites/person/year), allows to respond to many questions about this subject. The acquisition of an antimalaria immunity as one gets older appears to reduce parasite density, complexity of infection, risk of new patent infection after a suppressive treatment but does not reduce the prevalence (as assessed by PCR) of infection which is commonly chronic and asymptomatic. The existence of a pyrogenic threshold effect of parasitaemia allows the individual diagnosis of malaria attacks. P. falciparum genotyping suggests that successive malaria attacks are due to distinct recently inoculated parasite populations that multiply initially without restriction, a dominant population is generally responsible of the clinical manifestations and all new populations do not trigger systematically attacks. The initial intensity of clinical manifestations does not differ perceptibly among children and adults, is not related to the duration of the attacks, does not allow the distinction between several types of attacks, is not predictive of their severity, and the clearance of parasites and manifestations is longer among youngest persons. The risk of malaria attacks is lower as one gets older and among carriers of AS haemoglobin, is higher when transmission increases and during pregnancy up to three months after delivery, and vary between children. The risk of malaria attack per infective bite is negatively related to the intensity of transmission. Because of their high sensitivity in malaria case detection, this type of small community-based studies are powerful and useful for the identification of protective immunological mechanisms as well as for testing rapidly and cheaply the clinical efficacy of any intervention such as antimalarial vaccines and drug therapy or prophylaxis. As a lot of vaccine candidates and drug combinations will be screened or tested in the perspective of the 'Roll-Back Malaria' programme, more attention must be given to longitudinal studies of this type.

Adult↗

PubMed1978

Enteric infections in Singapore with special reference to typhoid.

A review of the epidemiological features of the more important enteric infections in Singapore was given. Enteric fevers (typhoid and paratyphoid), Salmonella gastroenteritis and Shigellosis remained endemic at a rather constant level in spite of vast improvement in environmental sanitation, but amoebic dysentery showed marked decline. Vibrio parahaemolyticus is an important cause of food poisoning since it was first reported in 1973. El tor cholera is believed to be introduced through regional trade and travel. Control measures directed mainly at typhoid include detection of typhoid carriers in the community responsible for transmission of infection, control and licensing of public food handlers and health education.

Adolescent↗

PubMed2000

High root concentration and uneven ectomycorrhizal diversity near Sarcodes sanguinea (Ericaceae): a cheater that stimulates its victims?

Sarcodes sanguinea is a nonphotosynthetic mycoheterotrophic plant that obtains all of its fixed carbon from neighboring trees through a shared ectomycorrhizal fungus. We studied the spatial structuring of this tripartite symbiosis in a forest where Sarcodes is abundant, and its only fungal and photosynthetic plant associates are Rhizopogon ellenae and Abies magnifica, respectively. We found disproportionately high concentrations of Abies roots adjacent to Sarcodes roots compared to the surrounding soil. Rhizopogon ellenae colonizes the vast majority of those Abies roots (86-98%), and its abundance tends to decrease with increasing distance from Sarcodes plants. At 500 cm from Sarcodes plants we did not detect R. ellenae, and the ectomycorrhizal community instead was dominated by members of the Russulaceae and Thelephoraceae, which are commonly dominant in other California pinaceous forests. The highly clumped distribution of Abies-R. ellenae ectomycorrhizas indicates that Sarcodes plants either establish within pre-existing clumps, or they stimulate clump formation. Several lines of evidence favor the latter interpretation, suggesting an unexpected mutualistic aspect to the symbiosis. However, the mechanism involved remains unknown.

Journal Article↗

PubMed2000

Natural history of Plasmodium falciparum malaria and determining factors of the acquisition of antimalaria immunity in two endemic areas, Dielmo and Ndiop (Senegal).

Adolescent↗

PubMed2001

Applying molecular biological techniques to detecting biological agents.

Recent efforts in the civilian and military health care and public health communities are directed at strengthening surveillance systems and our national laboratory capabilities for early detection of infectious disease outbreaks. These new systems will address proper specimen collection, transport, nucleic acid processing, molecular assay diagnostic reagent and equipment development, and standardization for sensitive and rapid detection of bioagents in blood and other clinical samples. A greater understanding of the genetic diversity and virulence factors for each organism that could be used for bioterrorism would aid design of rapid molecular detection strategies. Combinations of appropriate diagnostic technologies (culture, immunoassay, and molecular assay) can provide rapid diagnostic response capabilities to microbial threats with antimicrobial resistant organisms, new emerging infectious disease agents, and possible agents of bioterrorism.

Animals↗

PubMed2002

High prevalence of Fasciolopsis buski in an endemic area of liver fluke infection in Thailand.

There is a high prevalence of Fasciolopsis buski in Sawasdee Village in the Nam Som District, Udonthani Province in northeastern Thailand, an endemic area of liver fluke infection. From stool examination of 183 villagers participating in the study, the authors detected a fluke parasitic infection rate of 14.8% (27 cases). Of interest, the authors found a similar high prevalence of both Opisthorchis viverrini (16 cases, 8.7%) and F buski (13 cases, 7.1%). This region is the endemic area of liver fluke, not of F buski. The surrounding environment is the hill area of Nayoong Namsom mountain, which is not a suitable area for F buski larvae. However, the village has been inhabited by a number of immigrants from various regions of Thailand over the past few years. The F buski can be carried by these people, possibly explaining the migration of the fluke parasite to this setting. The nonendemic parasite infection was also detected at high prevalence in the community. Wide spectrum control for various parasitic infections in villages like Sawasdee is necessary.

Animals↗

PubMed1975

M.E.D.D.--Medical Examinations for Disease Detection.

Explore the source record for details and available documents.

Aged↗

PubMed1992

The selection of communities for treatment of onchocerciasis with ivermectin.

In areas endemic for onchocerciasis, active community-based treatment with ivermectin is preferred to individual diagnosis and treatment. Ideally, all infected persons should be treated, although initially priorities may have to be set at local or national levels. We suggest that all communities with a prevalence of O. volvulus infection of 20% or more in adult males aged 20 years or over should be treated; and that elsewhere facilities for passive treatment should be provided. In some areas, for logistical reasons, treatment may first have to be started in communities with the highest prevalences (perhaps above 40% or even 60%) and then expanded to all endemic communities. The available data suggest that a rapid assessment method based on the examination for nodules will give a simple, acceptable, non-invasive and reasonably reliable method of identifying the communities that should be treated. If a nodule is detected in at least three men from a sample of 30 men aged 20 years or over, the community can be assumed to have a true prevalence of infection of 20% or more and should be included in community-based treatment.

Adult↗

PubMed2003

Screening for left ventricular systolic dysfunction: the use of B-type natriuretic peptide.

Congestive heart failure (CHF) is a disease condition that is increasing in prevalence and is associated with significant morbidity and mortality. Left ventricular systolic dysfunction (LVSD) is a treatable precursor of CHF, but remains asymptomatic in about half of the individuals afflicted. This observation has spurred interest in screening for LVSD. Plasma B-type natriuretic peptide (BNP) is a widely accepted test for the diagnosis of overt CHF. In this review, we examine the potential role for plasma BNP as a screening tool for asymptomatic LVSD. The performance of any screening test depends on its accuracy, the prevalence of the disease condition screened for, and the availability of resources for follow-up of individuals in whom the disease was detected. In the context of community-wide screening for LVSD, a test with high specificity would be important so as to minimize the costs of expensive definitive follow-up tests (i.e. echocardiography). The prevalence of significant LVSD (ejection fraction 20.40) is low, limiting the enthusiasm for a screening program targeting the general population. This is especially true for women, in whom the condition is rare, and the performance characteristics of plasma BNP are sub-optimal. In men, plasma BNP may be a useful screening test in high-risk individuals in whom there are no other clinical indications for echocardiography. The choice of the appropriate plasma BNP threshold that triggers further work-up in such high-risk individuals may vary according to the availability of resources, and with the healthcare priorities of a community.

Biomarkers↗

PubMedDate not supplied

Incidence and prevalence of hepatitis C virus infection in Chile.

UNLABELLED: Chronic hepatitis C is a major cause of liver-related morbidity and mortality. Epidemiological data regarding this infection in developing countries is scanty. METHODS: Prevalence of hepatitis C (HCV) infection was investigated in a random sample of Chilean general adult population older than 20 years of age. Additionally, frequency of HCV infection was assessed in group of native Chilean Amerindians (Mapuche Indians) living in an isolated locality of the Southern Chile. Incidence of HCV infection was estimated using serum samples separated by 7 years (1993-2000). RESULTS: Among 959 subjects, prevalence of anti-HCV antibodies was 1.15% (95% CI 0.48-1.82%) and 0.83% when only RIBA-confirmed cases were considered. Among these subjects, 62.5% had detectable HCV RNA in serum and 40% of them had a history of blood transfusion. Age distribution of cases showed a steadily increasing prevalence with age. Estimated incidence of new HCV infections was 15 per 100,000 subjects per year in the period 1993-2000. No cases were detected among the 145 Mapuche subjects studied. CONCLUSIONS: HCV infection is a prevalent disease in the Hispanic population of Chile with a low incidence in the last decade, whereas it was not detected in an isolated Mapuche Indian community. Age distribution of prevalence suggests that the peak of infection in Chile occurred 30 to 50 years ago.

Adult↗

PubMed2005

The International HIV Dementia Scale: a new rapid screening test for HIV dementia.

OBJECTIVE: HIV dementia is an important neurological complication of advanced HIV infection. The use of a cross-cultural screening test to detect HIV dementia within the international community is critical for diagnosing this condition. The objective of this study was to evaluate the sensitivity and specificity of a new screening test for HIV dementia, the International HIV Dementia Scale (IHDS) in cohorts from the US and Uganda. DESIGN: Two cross-sectional cohort studies designed to evaluate for the presence of HIV dementia. METHODS: Sixty-six HIV-positive individuals in the US and 81 HIV-positive individuals in Uganda received the IHDS and full standardized neurological and neuropsychological assessments. The sensitivity and specificity of varying cut-off scores of the IHDS were evaluated in the two cohorts. RESULTS: In the US cohort, the mean IHDS score for HIV-positive individuals without dementia and with dementia were 10.6 and 9.3 respectively (P < 0.001). Using the cut-off of < or = 10, the sensitivity and specificity for HIV dementia with the IHDS were 80% and 57% respectively in the US cohort, and 80% and 55% respectively in the Uganda cohort. CONCLUSIONS: The IHDS may be a useful screening test to identify individuals at risk for HIV dementia in both the industrialized world and the developing world. Full neuropsychological testing should then be performed to confirm a diagnosis of HIV dementia.

AIDS Dementia Complex↗

PubMed1992

Influenza surveillance in general practice.

This paper describes a survey of influenza conducted in general practice from July to October 1990. The study demonstrates how interested general practitioners can be involved in community based surveillance for the early detection of influenza outbreaks.

Adolescent↗

PubMed2005

Understanding poison control and protecting its future.

Poison centers save money and lives. Individual patients and their doctors benefit from local poison center availability, as do healthcare facilities and insurance companies. All have a stake in a stable poison control system. It is likely that the greatest contribution of poison control centers to society has yet to be realized. Poison control centers already possess an efficient, realtime surveillance mechanism (TESS). With increased funding, this can be expanded and made more available outside the poison control community. TESS can be used to detect chemical releases or attacks and environmental and infectious disease outbreaks as they occur - long before individual healthcare providers could connect the dots. In conclusion, while the value of a nationwide poison control system to society is well recognized, its future is not as clear. Establishing a stable system to monitor and treat poisonings in the US will take political will at the local, state, and federal levels to ensure full funding for years to come.

Comprehension↗