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PubMed1977

The concentration of microfilariae in the skin near the eye as a simple measure of the severity of onchocerciasis in a community and as an indicator of danger to the eye.

The parsitological and ophthalmological findings in an onchocerciasis survey in 8 villages (832 persons) and 5 primary schools (285 children) in Cameroon are reportedl The use of the coneoscleral punch/microtiter plate quantitative skin snip technique greatly facilitated this study, and its advantages over the weighed skin snip method are discussed. This simple technique could be used by paramedical personnel to detect the number of people in a community who have more than 15 microfilariae in a snip near the eye. This is shown to be a measure of the intensity of infection, and a good indicator of the number of people at risk of developing ocular pathology.

Adolescent↗
PubMedDate not supplied

Public education strategies for delivering breast and cervical cancer screening in American Indian and Alaska Native populations.

A 1993 amendment to the authorizing legislation for the Center of Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program allows direct funding to tribal organizations and urban Native health centers. This study examined tribal programs' implementation of the public education and outreach component utilizing a multisite case study design implemented in partnership with tribal programs. Data were collected from 141 semistructured interviews with key informants and 16 focus groups with program-eligible women. Innovative strategies built on native iconography and personal encounters have encouraged participation and made the programs culturally relevant, providing insights for other communities with little experience in providing early detection services.

Breast Neoplasms↗
PubMed2003

Hypertension in the Parsi community of Bombay: a study on prevalence, awareness and compliance to treatment.

BACKGROUND: Uncontrolled hypertension (HT) is an established risk factor for the development of vascular diseases. Prevalence varies in different communities and no such study has been conducted in the Parsi community living in Bombay, India. The objectives of this study were to determine the prevalence, awareness, compliance to medication and control of HT in this community. METHOD: We used a 1 in 4 random selection of subjects who were > or = 20 years of age. A questionnaire was administered and the blood pressure (BP) was measured by a doctor. HT was defined as diastolic blood pressure (DBP) > or = 90 mm Hg +/- systolic pressure (SBP) > or = 140 mm Hg. Isolated systolic hypertension (ISH) was defined as SBP > or = 160 mm Hg with DBP < 90 mm Hg. Subsequently, we reanalysed the data using current definition of ISH as SBP > or = 140 mm Hg with DBP < 90 mm Hg. RESULTS: 2879 subjects > or = 20 years of age were randomly selected of which 2415 (84%) participated in the study. The overall prevalence of HT in the community was 36.4%, of whom 48.5% were unaware of their hypertensive status. Of those aware of having HT, 36.4% were non-compliant with their anti-hypertensive drugs and only 13.6% had optimally controlled HT. Prevalence of ISH using the present criteria was 19.5% and 73% of hypertensives > or = 60 years had ISH. CONCLUSION: This study shows that prevalence of HT in the Parsi community is high and nearly half are unaware of their hypertensive status. ISH is the dominant form of HT in the elderly. Compliance to treatment is poor and optimal BP control is achieved in only a small minority. The study highlights the need for regular screening coupled with educational programs to detect and optimally treat HT in the community.

Adult↗
PubMed1992

[Hypertension in the community].

Hypertension is a major risk factor for cerebral and coronary disease and its early detection is very important for the family physician. We checked the implications of a hypertension survey in the community (from the age of 10 years) on the attitude of the primary care team. We found that although the medical team was aware of the significance of early detection and treatment of hypertension, according to the "law of halves" half the hypertensives were in treatment and of them half had normal blood pressure. This fact is probably not related to the quality of medical care. High risk groups identified were hypertensive patients who smoked, Jewish men of western origin, and Jewish women of Asian-African origin (who had a high rate of strokes). These groups were targeted for active intervention by the primary care team. This survey is part of planned community-intervention by the primary care team in the field of hypertension.

Adolescent↗
PubMed1995

Molecular genetic analysis of the response of three soil microbial communities to the application of 2,4-D.

The responses of three different soil microbial communities to the experimental application of 2,4-dichlorophenoxyacetic acid (2,4-D) were evaluated with a variety of molecular genetic techniques. Two of the three soil communities had histories of prior direct exposure to 2,4-D, and one had no prior direct application of any herbicide. Dominant 2,4-D degrading strains isolated from these soils the previous year were screened for hybridization with three catabolic genes (tfdA, tfdAII, and tfdB) cloned from the well-studied 2,4-D degradative plasmid, pJP4, revealing varying degrees of similarity with the three genes. Hybridization of total community DNA from the three soils with the tfd gene probes also indicated that pJP4-like tfd genes were not harboured by a significant percentage of the community. Community level response was evaluated by the comparison of different treatments by Random Amplified Polymorphic DNA (RAPD) fingerprints and by community DNA cross-hybridization. No differences between treatments within the same soil were detected in any of the RAPD fingerprints generated with 17 primers. Community DNA cross-hybridization also indicated that the application of 2,4-D at the applied rates did not quantitatively affect the structure of the soil microbial communities present in the three soils during the time-frame studied.

2,4-Dichlorophenoxyacetic Acid↗
PubMed1982

Alcohol abuse in adolescents.

The problem of alcohol abuse among teenagers is a major health concern in this nation. The primary care provider's role in prevention, early detection and referral is diversified. This role is tailored in response to the clinician's assessment of his or her target population, the practice setting and the community resources and referral possibilities. Prevention and early detection are primary goals, with the aim of achieving health coping strategies, improving school performance, preventing accidents, increasing meaningful socialization, and preventing serious pathological changes and death as realistic outcomes for adolescents.

Adolescent↗
PubMed2006

Transgenic maize in the presence of ampicillin modifies the metabolic profile and microbial population structure of bovine rumen fluid in vitro.

Recently, transgenic crops have been considered as possible donors of transgenes that could be taken up by micro-organisms under appropriate conditions. In an in vitro rumen simulation system, effects of ampicillin on microbial communities growing either on rumen contents with transgenic maize carrying a gene that confers resistance to ampicillin or its isogenic counterpart as substrates were examined continuously over 13 d. Rate of production of SCFA was measured to determine functional changes in the rumen model and single-strand conformational polymorphism was used to detect alterations in structure of the microbial community. Rumen contents treated with ampicillin displayed a marked decrease in the rate of production of SCFA and diversity of the microbial community was reduced severely. In the presence of transgenic maize, however, the patterns of change of rumen micro-organisms and their metabolic profiles were different from that of rumen fluid incorporating maize bred conventionally. Recovery of propionate production was observed both in the rumen fluid fed transgenic and conventional maize after a delay of several days but recovery occurred earlier in fermenters fed transgenic maize. Alterations in the microbial population structures resulting from the ampicillin challenge were not reversed during the experimental run although there was evidence of adaptation of the microbial communities over time in the presence of the antibiotic, showing that populations with different microbial structures could resume a pre-challenge metabolic profile following the introduction of ampicillin, irrespective of the source of the plant material in the growth medium.

Ampicillin↗
PubMed1983

Rapid diagnosis of community-acquired bacterial pneumonia.

Rapid identification of pathogens in patients with bacterial pneumonia is important for optimal antimicrobial therapy. Coagglutination was compared with counterimmunoelectrophoresis (CIE) for sensitivity and specificity in the detection of Streptococcus pneumoniae, Hemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa antigens in sputum specimens of 101 patients with community-acquired pneumonia. Coagglutination detected the appropriate bacterial antigen in 16 of 17 (94%) definite etiology patients and CIE detected 11 (64%). In 17 probable etiology patients, bacterial antigens were detected by coagglutination in 15 (88%) and by CIE in 7 (41%). Only 1 pathogen was falsely identified in the 19 culture-negative control patients, indicating a high degree of specificity for both tests. Coagglutination was more sensitive than CIE (p less than 0.05) or sputum stained with Gram's stain (p less than 0.05) in correctly identifying the putative pathogen in sputum. Our results strongly suggest that coagglutination is a useful diagnostic technique for establishing a rapid etiologic diagnosis in community-acquired pneumonia.

Agglutination Tests↗
PubMed2002

An outbreak of hepatitis A among homosexuals linked to a family outbreak.

Several outbreaks of hepatitis A occurred in Norway in 1995-8. Molecular epidemiology was used to follow the spread of hepatitis A virus in the population. Distinct strains of hepatitis A virus (HAV) were detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and subsequent sequencing in serum from patients in different communities at risk of infection. Two HAV strains were detected in an outbreak among 26 men having sexual contact with other men. One of these strains was also detected in a geographically limited family outbreak. The family outbreak was first believed to be acquired abroad. The sequence information linked the two outbreaks, and epidemiological and serological analyses revealed the transmission route. This study demonstrates the importance of molecular epidemiology in outbreak investigation, surveillance and monitoring of hepatitis A in the population.

Disease Outbreaks↗
PubMed2006

Recent study lauds automated surveillance.

ADEs detected at a rate 3.6 times that of voluntary reporting at a university hospital and 12.3 times that at a community hospital. Goal of system is not just to detect ADEs, but to measure whether they are being reduced. Automated surveillance is much less costly than computerized physicians order entry.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Redox transformations of arsenic oxyanions in periphyton communities.

Periphyton (Cladophora sp.) samples from a suburban stream lacking detectable dissolved As were able to reduce added As(V) to As(III) when incubated under anoxic conditions and, conversely, oxidized added As(III) to As(V) with aerobic incubation. Both types of activity were abolished in autoclaved controls, thereby demonstrating its biological nature. The reduction of As(V) was inhibited by chloramphenicol, indicating that it required the synthesis of new protein. Nitrate also inhibited As(V) reduction, primarily because it served as a preferred electron acceptor to which the periphyton community was already adapted. However, part of the inhibition was also caused by microbial reoxidation of As(III) linked to nitrate. Addition of [14C]glucose to anoxic samples resulted in the production of 14CO2, suggesting that the observed As(V) reduction was a respiratory process coupled to the oxidation of organic matter. The population density of As(V)-reducing bacteria within the periphyton increased with time and with the amount of As(V) added, reaching values as high as approximately 10(6) cells ml(-1) at the end of the incubation. This indicated that dissimilatory As(V) reduction in these populations was linked to growth. However, As(V)-respiring bacteria were found to be present, albeit at lower numbers (approximately 10(2) ml(-1)), in freshly sampled periphyton. These results demonstrate the presence of a bacterial population within the periphyton communities that is capable of two key arsenic redox transformations that were previously studied in As-contaminated environments, which suggests that these processes are widely distributed in nature. This assumption was reinforced by experiments with estuarine samples of Cladophora sericea in which we detected a similar capacity for anaerobic As(V) reduction and aerobic As(III) oxidation.

Aerobiosis↗
PubMed1995

New fears in gynecologic cancer.

BACKGROUND: A review of the psychosocial oncology literature indicates the paucity of psychological services available in early detection programs, yet there is an increasing awareness of the need to attend to the psychosocial distress of women whose mothers have had ovarian cancer. The explosion of information transmitted to the public through the news media about ovarian cancer, early detection, and genetic susceptibility should heighten the scientific community's sensitivity to the apprehensions of women who are first-degree relatives of women with ovarian cancer. METHOD: The emotional fragility of participants in the early detection ovarian cancer screening program at Yale University is addressed through an initial counseling session. An open-ended, unstructured interview was designed to enable participants to express their concerns about ovarian cancer. This experience is being evaluated. RESULTS: Through psychosocial assessment and evaluation, the authors observed that life cycle events, unresolved episodic grief, cognitive adaptation to loss, and interpersonal relationships contribute to the importance of total care and medical responsibility for the gynecologic cancer patient. Psychosocial counseling has been an integral component of the Yale Early Detection Program since its inception. Preliminary results suggest the necessity of continued counseling intervention to address women's increased anxieties about gynecologic cancers. CONCLUSION: Special attention must be paid to the psychological needs of vulnerable subjects in disease-screening programs. Medical providers of early detection screening should rigorously explore the psychosocial aspects of early detection and provide appropriate intervention to meet women's needs.

Counseling↗
PubMed1996

Nonradioactive method to study genetic profiles of natural bacterial communities by PCR-single-strand-conformation polymorphism.

We describe a new method for studying the structure and diversity of bacterial communities in the natural ecosystem. Our approach is based on single-strand-conformation polymorphism (SSCP) analysis of PCR products of 16S rRNA genes from complex bacterial populations. A pair of eubacterial universal primers for amplification of the variable V3 region were designed from the 16S rRNA sequences of 1,262 bacterial strains. The PCR conditions were optimized by using genomic DNAs from five gram-positive and seven gram-negative strains. The SSCP analysis of the PCR products demonstrated that a bacterial strain generated its characteristic band pattern and that other strains generated other band patterns, so that the relative diversity in bacterial communities could be measured. In addition, this method was sensitive enough to detect a bacterial population that made up less than 1.5% of a bacterial community. The distinctive differences between bacterial populations were observed in an oligotrophic lake and a eutrophic pond in a field study. The method presented here, using combined PCR amplification and SSCP pattern analyses of 16S rRNA genes, provides a useful tool to study bacterial community structures in various ecosystems.

Bacteria↗
PubMed2001

Serology of typhoid fever in an area of endemicity and its relevance to diagnosis.

Currently, the laboratory diagnosis of typhoid fever is dependent upon either the isolation of Salmonella enterica subsp. enterica serotype Typhi from a clinical sample or the detection of raised titers of agglutinating serum antibodies against the lipopolysaccharide (LPS) (O) or flagellum (H) antigens of serotype Typhi (the Widal test). In this study, the serum antibody responses to the LPS and flagellum antigens of serotype Typhi were investigated with individuals from a region of Vietnam in which typhoid is endemic, and their usefulness for the diagnosis of typhoid fever was evaluated. The antibody responses to both antigens were highly variable among individuals infected with serotype Typhi, and elevated antibody titers were also detected in a high proportion of serum samples from healthy subjects from the community. In-house enzyme-linked immunosorbent assays (ELISAs) for the detection of specific classes of anti-LPS and antiflagellum antibodies were compared with other serologically based tests for the diagnosis of typhoid fever (Widal TO and TH, anti-serotype Typhi immunoglobulin M [IgM] dipstick, and IDeaL TUBEX). At a specificity of > or =0.93, the sensitivities of the different tests were 0.75, 0.55, and 0.52 for the anti-LPS IgM, IgG, and IgA ELISAs, respectively; 0.28 for the antiflagellum IgG ELISA; 0.47 and 0.32 for the Widal TO and TH tests, respectively; and 0.77 for the anti-serotype Typhi IgM dipstick assay. The specificity of the IDeaL TUBEX was below 0.90 (sensitivity, 0.87; specificity, 0.76). The serological assays based on the detection of IgM antibodies against either serotype Typhi LPS (ELISA) or whole bacteria (dipstick) had a significantly higher sensitivity than the Widal TO test when used with a single acute-phase serum sample (P < or = 0.007). These tests could be of use for the diagnosis of typhoid fever in patients who have clinical typhoid fever but are culture negative or in regions where bacterial culturing facilities are not available.

Adolescent↗
PubMed1990

Cancer of the female breast. Improving the public's health through early detection.

Decision makers who represent the public need to understand the extent of the breast cancer problem, the potential for improvement, and the actions needed to achieve this potential. Informed, dedicated physicians, individually and collectively, are instrumental and can be most effective leaders in this process. There are several evidences of the fine tradition of the medical profession to advocate practices and policies in the interest of the best health of our patients. The North Carolina Medical Society recently adopted a position statement encouraging the provision of screening mammograms and pap smears by both private and self-insured third party payors; the North Carolina Academy of Family Practice recently adopted a position statement urging priority be placed on allocating resources for efficacious preventive services; the multiple specialty organizations developed the widely recognized national guidelines for early breast cancer detection; and the ACR continues its efforts to assure quality mammography services. To the end that this paper has informed and stimulated further sharing, discussion or debate about the extent of the breast cancer problem, the potential for improvement, and the actions needed to achieve this potential, it has accomplished its purpose. To the end that the physician community acts to improve early breast cancer detection, we will have fulfilled the common purpose that binds us as physicians to one another and to the people we are privileged and bound to serve.

Adult↗
PubMed1988

Antisecretory drugs. Safe and effective?

Surveillance of takers of the antisecretory drug cimetidine has failed to reveal any disturbing trends. This pattern is reassuring but the difficulties of detecting drug-induced disease mimicking ordinary community complaints deserve emphasis. Experience since the surveillance study began has not revealed any disturbing trends. Observed mortality rates have fallen to match population expectation, both for ordinary disease and for cancer. The pattern is generally reassuring and suggests that significant drug-induced disease is not being missed. Nevertheless the ability of this or any other surveillance study to detect drug-induced illness mimicking ordinary disease is likely to be low.

Anti-Ulcer Agents↗
PubMed2003

Incidence and importance of Clostridium difficile in paediatric diarrhoea in Brazil.

Clostridium difficile strains were detected in 14 of 210 (6.7 %) faecal samples from children in Rio de Janeiro, Brazil, by cultivating faeces on cycloserine/cefoxitin/fructose agar after alcohol-shock. Two main groups of children were studied: inpatients (n = 96) and outpatients (n = 114). The inpatient group consisted of children on antibiotics or immunosuppressors who presented with diarrhoea and other children who did not present with diarrhoea and were not under an antibiotic or chemotherapeutic regimen. Among the outpatients, two groups were examined: namely, a group that comprised children who presented with diarrhoea and were occasionally under an antibiotic regimen and another group that comprised patients who were not taking antibiotics. After cytotoxic assay, toxigenic C. difficile (Cd tox+) strains were detected in 4.2 % of inpatients and 3.5 % of outpatients. Exclusion of other infectious causes of diarrhoea indicated a typical case of C. difficile-associated paediatric diarrhoea in the community. Among Cd tox+ isolates, no variations were detected by PCR for toxin A that employed primers NK9 and NKVO11. No resistance was found to metronidazole or vancomycin among strains that were isolated from children who presented with diarrhoea, but the MIC(50) and MIC(90) values for clindamycin were 6-8 and 16 microg ml(-1), respectively. Resistance to clindamycin seems to be more disseminated in strains from outpatients than in those from inpatients (P < 0.05). In conclusion, these data suggest that investigation for C. difficile infection should be taken into account in paediatric diarrhoea in both inpatients and outpatients in developing countries.

Brazil↗
PubMed1997

Analysis of ammonia-oxidizing bacteria of the beta subdivision of the class Proteobacteria in coastal sand dunes by denaturing gradient gel electrophoresis and sequencing of PCR-amplified 16S ribosomal DNA fragments.

Denaturing gradient gel electrophoresis (DGGE) is a powerful and convenient tool for analyzing the sequence diversity of complex natural microbial populations. DGGE was evaluated for the identification of ammonia oxidizers of the beta subdivision of the Proteobacteria based on the mobility of PCR-amplified 16S rDNA fragments and for the analysis of mixtures of PCR products from this group generated by selective PCR of DNA extracted from coastal sand dunes. Degenerate PCR primers, CTO189f-GC and CTO654r, incorporating a 5' GC clamp, were designed to amplify a 465-bp 16S rDNA region spanning the V-2 and V-3 variable domains. The primers were tested against a representative selection of clones and cultures encompassing the currently recognized beta-subdivision ammonia oxidizer 16S rDNA sequence diversity. Analysis of these products by DGGE revealed that while many of the sequences could be separated, some which were known to be different migrated similarly in the denaturant system used. The CTO primer pair was used to amplify 16S rDNA sequences from DNA extracted from soil sampled from Dutch coastal dune locations of differing in pH and distance from the beach. The derived DGGE patterns were reproducible across multiple DNA isolations and PCRs. Ammonia oxidizer-like sequences from different phylogenetic groupings isolated from gene libraries made from the same sand dune DNA samples but prepared with different primers gave DGGE bands which comigrated with most of the bands detected from the sand dune samples. Bands from the DGGE gels of environmental samples were excised, reamplified, and directly sequenced, revealing strong similarity or identity of the recovered products to the corresponding regions of library clones. Six of the seven sequenced clusters of beta-subdivision ammonia oxidizers were detected in the dune systems, and differences in community structure between some sample sites were demonstrated. The most seaward dune site contained sequences showing affinity with sequence clusters previously isolated only from marine environments and was the only site where sequences relate to Nitrosomonas genes could be detected. Nitrosospira-like sequences were present in all sites, and there was some evidence of differences between Nitrosospira populations in acid and alkaline dune soils. Such differences in community structure may affect physiological differences within beta-subdivision ammonia oxidizers, with consequent effects on nitrification rates in response to key environmental factors.

Ammonia↗