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PubMed1988

Evaluation of two commercially available test methods to determine the feasibility of testing for respiratory syncytial virus in a community hospital laboratory.

The feasibility of performing respiratory syncytial virus (RSV) testing in a community hospital laboratory was assessed. The Abbott RSV EIA Kit, an enzyme immunoassay (EIA), and the Ortho Respiratory Syncytial Virus Identification Reagent, a direct fluorescent antibody (DFA) technique, were evaluated in terms of technologist time, result time, cost, and agreement of results. There was little difference in the amount of technologist time required for either method. The DFA technique was shown to be much less expensive than the EIA method and also required at least 50% less time to generate a final result. When compared with an indirect fluorescent antibody technique, the EIA technique was more sensitive (87%) than the DFA method (81%). Both methods showed 100% specificity. Based on the findings of this study, the DFA technique was determined to be the more feasible method for a community hospital laboratory to use for the rapid detection of RSV.

Child↗
PubMed2004

Application of temperature gradient gel electrophoresis to the study of yeast diversity in the estuary of the Tagus river, Portugal.

Temperature gradient gel electrophoresis (TGGE) was employed for the assessment of yeast diversity in the estuary of the Tagus river (Portugal). The molecular detection of yeasts was carried out directly from water samples and, in parallel, a cultivation approach by means of an enrichment step was employed. A nested PCR was employed to obtain a fungal amplicon containing the D2 domain of the 26S rRNA gene. For identification the TGGE bands were extracted, re-amplified, and sequenced. Fourteen fungal taxa were detected and all except one were yeasts. Most yeast sequences corresponded to members of the Ascomycota and only three belonged to the Basidiomycota. Five yeasts (four ascomycetes and one basidiomycete) could not be identified to the species level due to the uniqueness of their sequences. The number of species detected after enrichment was higher than the number of taxa found using the direct detection method. This suggests that some yeast populations are present in densities that are below the detection threshold of the method. With respect to the analysis of the yeast community structure, our results indicate that the dominant populations belong to Debaryomyces hansenii, Rhodotorula mucilaginosa, Cryptococcus longus, and to an uncultured basidiomycetous yeast phylogenetically close to Cr. longus. The combined analysis of direct detection and cultivation approaches indicates a similar community structure at the two sampled sites since nine species were present at both localities.

Base Sequence↗
PubMed2005

Role of community risk factors and resources on breast carcinoma stage at diagnosis.

BACKGROUND: The current study investigated the individual and community determinants of breast carcinoma stage at diagnosis (BCSAD) using multiple data sources merged with cancer registry data. The literature review yielded 5 studies that analyzed cancer registry data merged with community-level variables (1995-2004). METHODS: Community variables constructed for the current study reflected social and economic risk factors, physician supply, and health maintenance organization penetration. Multivariate logistic regression was used to identify the significant predictors of increasingly progressive BCSAD. RESULTS: Disparities remained for black and Hispanic females in California, who were least likely to be diagnosed early compared with their white counterparts. Younger (< 40 years) and middle-aged (40-64 years) females were less likely to be diagnosed with early BCSAD, compared with older females (> or = 65 years). Utilizing services at hospitals serving a lower volume of patients with breast carcinoma was associated with later BCSAD. After controlling for individual-level factors, community-level variables constructed at the census block group and county level were tested. If a woman resided in a neighborhood with greater percentages of female-headed households, persons living below the poverty level, less educated people, and more recent immigrants, then her chances of being diagnosed at an earlier stage were diminished. If, conversely, she resided in a neighborhood with greater percentages of females > or = 65 years (a proxy for Medicare coverage), her access to medical care and the probability of earlier BCSAD increased. County-level insurance rates and residing in counties where greater percentages of women ever had a mammogram were associated with in situ and early-stage diagnosis. Similarly, the supply of primary care physicians and radiologists was associated positively with earlier BCSAD. CONCLUSIONS: Results confirmed community-level predictors of socioeconomic and delivery system context matter, although the individual-level predictors showed a stronger effect. Nevertheless, analysis of community variables is promising for guiding and evaluating the effects of health policy and developing community and delivery system interventions for earlier detection and treatment of breast carcinoma.

Adult↗
PubMed2002

The changing incidence and mortality of melanoma in Australia.

For many years Australia has had the highest incidence and mortality rates in the world for melanoma. The incidence rate has been increasing at around 5% per year and the mortality rate, at a rate slightly lower than that. Epidemiology studies have shown clearly that there is both a constitutional and an environmental contribution to melanoma risk, with sunlight being the major risk factor in the environment. The data also clearly show that the thickness of a melanoma at the time it is removed is one of the major determinants of the likelihood of metastasis and thus of the long-term prognosis. Both of these components have been incorporated into major public health programmes aimed at melanoma control in Australia over the last 25 years. Primary prevention programmes have been aimed at reducing the desire for a tan and subsequent overexposure to sunlight. Secondary prevention (early detection) programmes have encouraged people in the community to seek early attention if they notice a new or changing pigmented lesion. Although the age-adjusted incidence and mortality rates for Australia continue to rise, cohort analysis of both incidence and mortality rates reveals that the overall rise is not reflected in all age groups. In the younger cohorts--groups that it has been possible to influence by our public health campaigns in recent decades--both incidence and mortality rates are dropping.

Australia↗
PubMed1990

Maternal serum Down syndrome screening: unconjugated estriol is not useful.

Study of 41 known Down syndrome cases and 441 matched controls did not confirm earlier reports that low unconjugated estriol levels can be used to detect fetal Down syndrome. Hence the obstetric community should exercise caution in using unconjugated estriol levels as a marker in prenatal Down syndrome screening.

Down Syndrome↗
PubMed1991

Carriage and community treatment of methicillin-resistant Staphylococcus aureus: what happens to colonized patients after discharge?

During a maternity hospital outbreak of colonization/infection due to methicillin-resistant Staphylococcus aureus (MRSA), mothers and babies from 35 families were known to have been discharged colonized with MRSA. Thirty-two of these families were followed up by screening in the community. After 4 weeks, carriage was still detectable in 22 families. The ten families in which carriage was no longer detectable had MRSA isolated at discharge from enrichment culture only. All of the 11 families who had MRSA isolated on direct culture at discharge continued to carry MRSA. Mothers and babies from the 22 families still carrying MRSA at 4 weeks were offered topical treatment. Carriage persisted in ten of these families despite treatment. The most common site of persistent carriage was the perineum in mothers and the throat in infants.

Carrier State↗
PubMed2006

Breast imaging reporting and data system (BI-RADS) or French "classification ACR" What tool for what use? A point of view.

The American College of Radiology Task Force on Breast Cancer published in 2003 the fourth edition of BI-RADS for Mammography. It is a lexicon of mammography terms including illustrations of each feature described, followed by a reporting format with assessment categories according to the degree of concern. The aim is to reduce inconsistencies in mammography reports and recommendations for assessment, to facilitate outcome monitoring and to allow each radiologist to audit his own mammography practice. In France, the Société Française de Radiologie acquired the rights to translate BI-RADS, word for word and without adaptation or influence. The last edition was published in 2004. Simultaneously, French Haute Autorité de Santé and National Committee for Breast Cancer Screening proposed to all community practice mammography facilities a classification of detected abnormalities stating more clearly than BI-RADS do which feature has to be included in such and such assessment category and how to manage it. This "classification ACR" is adapted from BI-RADS but strongly influenced by the context of the French nationwide screening programme, and by European recommendations to limitate undesirable risks of screening such as false positive and overdiagnosis. The differences between the two systems are discussed.

Breast Diseases↗
PubMed2005

Actinomycetes isolated from lichens: evaluation of their diversity and detection of biosynthetic gene sequences.

Actinomycetes, one of the major communities of the microbial population present in soil, can also be found inhabiting a wide diversity of ecological sources. We have explored the use of lichens as an alternative source for the isolation of novel actinomycetes. Lichens are symbiotic mixtures of fungi, green algae and/or cyanobacteria and whereas these symbiotic components have been extensively described, the microbial community inhabiting this niche has not been well characterized. We studied the diversity of the actinomycete population isolated from lichens collected in tropical areas from the Hawaii and Reunion islands and in cold areas from Alaska. The diversity of the microbial population was evaluated using fatty acid analysis and molecular fingerprinting. A PCR approach to screen the isolates for genes associated with secondary metabolite production was applied to evaluate the biosynthetic potential of these strains; profiles obtained for each isolate were compared to the antimicrobial activity exhibited by these isolates in laboratory conditions. Our results demonstrate that lichens represent an extremely rich reservoir for the isolation of a wide diversity of actinomycetes many of them representing still today a rich untapped source of secondary metabolites.

Actinobacteria↗
PubMed2006

Improved surgeon performance in clinical trials: an analysis of quality assurance audits from the American College of Surgeons Oncology Group.

BACKGROUND: The American College of Surgeons Oncology Group (ACOSOG) represents an organized effort by surgeons to participate in clinical trials research. To assess the quality of trial conduct by surgeons on a national level and the feasibility of improvement through education, this study examined the findings of the Quality Assurance Audit Program of the ACOSOG over time. STUDY DESIGN: Outcomes of 249 routine audits conducted from 2001 to 2004 were reviewed for major and minor deficiencies and overall performance (acceptable versus unacceptable) in compliance with regulatory requirements (REG) and patient case review (PCR). RESULTS: From 2001 to 2004, active trials have increased. Major deficiencies in REG fell from 31% to 20% for IRB documentation (p = 0.002) and from 31% to 9% for informed consent (p < 0.001). The major deficiency rates in PCR decreased from 21% to 6% (patient consent), 16% to 7% (eligibility), 13% to 7% (treatment), 34% to 6% (outcomes), 6% to 1% (toxicity), and 16% to 3% (data). During 2001 to 2004, the overall acceptable performance rates were 82%, 72%, 84%, and 92%, respectively, in REG (p = 0.093), and significantly improved in PCR (47%, 55%, 77%, 94%, respectively; p < 0.001). No difference was detected in acceptable rates between academic versus community sites, for either REG (86% versus 76%, respectively; odds ratio: 1.91; 95% CI: 0.87 to 4.19) or PCR (63% versus 68%, respectively; odds ratio: 0.81; 95% CI: 0.42 to 1.53). CONCLUSIONS: Despite initial deficiencies, surgical trials are now conducted with high standards nationwide. In response to educational programs, surgeon performance in clinical trials has measurably improved. Quality assurance audits have served both surveillance and educational roles.

Clinical Competence↗
PubMed2006

Defining and detecting undesirable disturbance in the context of marine eutrophication.

An understanding of undesirable disturbance to the balance of organisms is needed to diagnose marine eutrophication as defined by EU Directives and OSPAR. This review summarizes the findings of the UK Defra-funded Undesirable Disturbance Study Team, which concluded that 'an undesirable disturbance is a perturbation of a marine ecosystem that appreciably degrades the health or threatens the sustainable human use of that ecosystem'. A methodology is proposed for detecting disturbance of temperate salt-water communities dominated by phytoplanktonic or phytobenthic primary producers. It relies on monitoring indicators of ecosystem structure and vigour, which are components of health. Undesirable disturbance can be diagnosed by accumulating evidence of ecohydrodynamic type-specific changes in: (i) bulk indicators; (ii) frequency statistics; (iii) flux measurements; (iv) structural indicators; and (v) indicator species. These are exemplified by (i) chlorophyll, transparency, dissolved oxygen, and opportunistic seaweed cover; (ii) HABs frequency; (iii) primary production; (iv) benthic and planktonic 'trophic indices'; (v) seagrasses and Nephrops norvegicus. Ecological Quality Objectives are proposed for some of these. Linking the diagnosis to eutrophication requires correlation of changes with nutrient enrichment. The methodology, which requires the development of a plankton community index and emphasizes the importance of primary production as an indicator of vigour, can be harmonized with the EU Water Framework Directive and OSPAR's Strategy to Combat Eutrophication.

Chlorophyll↗
PubMed2002

Intermittent administration of iron and sulfadoxine-pyrimethamine to control anaemia in Kenyan children: a randomised controlled trial.

BACKGROUND: Iron supplementation is recommended for children at high risk of anaemia, but its benefits may not outweigh the associated risk of malaria in areas of seasonal transmission. We investigated the effect on haemoglobin concentrations of intermittent administration of iron supplements and sulfadoxine-pyrimethamine in symptom-free children under intense health surveillance. METHODS: In a trial of two by two factorial design, 328 anaemic Kenyan children were randomly assigned either iron or placebo and sulfadoxine-pyrimethamine or placebo (82 to each group). Primary outcomes were haemological indicators of iron status and inflammation at the end of the follow-up, and occurrence of malaria attacks. Morbidity surveillance consisted of medical examinations every 4 weeks, continuous passive case detection, and visits twice a week to community health-workers. Analyses were by intention to treat. FINDINGS: After 12 weeks, the groups assigned iron plus sulfadoxine-pyrimethamine, iron alone, or sulfadoxine-pyrimethamine alone had higher haemoglobin concentrations than the group assigned placebo (treatment effect adjusted for prognostic factors at baseline: 11.1 g/L [95% CI 7.5 to 14.7]; 10.7 g/L [7.1 to 14.3]; and 3.1 g/L [-0.5 to 6.7]). Administration of iron plus sulfadoxine-pyrimethamine also lowered the proportion with anaemia from 100% at baseline to 36% at 12 weeks, and of iron deficiency from 66% at baseline to 8% at 12 weeks. Survival analysis showed no evidence of substantially increased risk of malaria after iron supplementation. INTERPRETATION: Iron supplementation gives substantial health benefits, which may outweigh possible inherent risks caused by malaria. A larger study than ours is needed to assess benefits and risks of intermittent administration of sulfadoxine-pyrimethamine in reducing the incidence of malaria attacks in areas of seasonal malaria transmission.

Anemia↗
PubMed1996

Sources in science: who can we trust?

Journalists' sources of medical and scientific news seem limitless--journals, press releases, press conferences, newsletters, scientific meetings, and "tipoffs". But whether any one piece of information satisfies two important criteria-journalistic interest and scientific credibility-is another matter. Peer-reviewed journals, in particular, are perceived to be trustworthy sources. Yet, there are increasing concerns in scientific publishing about commercial pressures from pharmaceutical companies, honorary authorship, scientific error, and outright fraud, which journalists cannot be expected to detect. That is down to the scientific community, which must recognise the importance of maintaining impartial sources of public information.

Advertising↗
PubMed1986

Laboratory diagnosis of herpes simplex virus infections. Principles guiding the development of rapid diagnostic tests.

While the incidence of many bacterial sexually transmitted diseases appears to be decreasing, the complications and frequency of viral sexually transmitted diseases in developed countries has increased over 10-fold in the last decade. Since 1975 genital herpes simplex virus infections have increased at a rate of 12% in the United Kingdom. Significant advances in our understanding of the epidemiology, natural history, and therapy of symptomatic genital herpes has occurred in the last 5 yr. In order to properly utilize this information, however, more widespread availability of laboratory diagnostic testing for herpes simplex virus is needed. The availability of tissue culture isolation facilities for herpes simplex virus has expanded to many community hospitals. More importantly, rapid assays to detect herpes simplex virus using monoclonal and polyclonal antibodies in enzyme-linked immunosorbent assay and immunofluorescent assays and/or detection of herpes simplex virus deoxyribonucleic acid by hybridization methods have also been developed. Recent studies indicate that these assays approach the sensitivity of viral isolation when samples from mucocutaneous lesions are taken. These rapid assays have also allowed clinicians to more rapidly diagnose serious herpes simplex virus infection such as neonatal herpes and to institute antiviral therapy earlier in the course of disease. Although the specificity of these assays in high prevalence populations appears excellent, few studies have evaluated these assays in populations where the prevalence of herpes simplex virus is low. Rapid assays for herpes simplex virus also appear to have decreased sensitivity (less than 60%) in detecting asymptomatic excretion of herpes simplex virus from the lower genital tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗
PubMed1998

Screening for sexually transmitted infections.

The high prevalence of STI in many developed countries; their costly physical, psychological, and relationship sequelae; and their association with the acquisition and transmission of HIV necessitate the introduction of screening programs, especially those that encourage opportunistic screening in diverse health care and community settings. This requirement is accompanied by the need for better awareness and education of health care professionals, especially those working in primary care or in sexual health disciplines, and knowledge of local prevalence and other epidemiologic factors to allow cost-effective targeting of high-risk groups. Such programs should be accompanied by the development of effective clinical alliances between those undertaking screening, the diagnostic microbiology laboratories, and clinicians with local responsibility for case management and public health control. The development of new molecular methods of diagnosis for the common bacterial STI permits screening in the community to be extended. This will help detect those asymptomatic persons who would not otherwise access health services but who may act as important vectors in STI spread and who continue to maintain local reservoirs.

Adolescent↗
PubMed2001

Gene expression monitoring in soils by mRNA analysis and gene lux fusions.

Two methods recently developed to monitor the gene expression of microbial communities in soil are the extraction and detection of messenger RNA from soil microorganisms and the construction and use of lux-based bioreporter strains. The goal of these approaches is to assess microbial activity in natural and impacted soil environments.

Artificial Gene Fusion↗
PubMed1995

Feasibility of involving literate tribal youths in tuberculosis case-finding in a tribal area in Tamil Nadu.

SETTING: Tribal area in South India with a population of 96,000, where the tuberculosis case-finding activity was very poor. OBJECTIVES: To investigate the feasibility of (1) involving literate (who can read and write) tribal youth volunteers for detecting cases of pulmonary tuberculosis (PT) in their respective hamlets; and (2) antituberculosis drug delivery to sputum-positive patients at their homes by village health nurses (VHNs). DESIGN: One volunteer from each of 61 hamlets was selected and trained in the detection of subjects with chest symptoms, sputum collection and transportation to the Primary Health Centre for smear examination. All smear-positive patients were treated with 2RHZ/6TH and the drugs were supplied by VHNs fortnightly at their homes. RESULTS: During a period of 1 year (1992-93), the total population screened was 9383 persons; of these 5755 were aged 15 years and above. A total of 338 symptomatic subjects were identified; 12 sputum-positive cases were detected and started on treatment. Antituberculosis drugs were supplied by VHNs to patients for the first 9 months of the study and by literate youths for the next 3 months. Spot drug checks revealed that 11 of the 12 patients were regular in drug consumption. CONCLUSION: It is feasible to train literate tribal youth volunteers within a short time to detect subjects with chest symptoms in the community and thereby cases of pulmonary tuberculosis. They can serve as an excellent model for community participation in difficult areas.

Antitubercular Agents↗
PubMed1989

Determinants of drinking water quality in rural Nicaragua.

One hundred and fifty-three water samples from rural Nicaragua were examined for the presence of faecal coliforms during both wet and dry periods. A linear model was fitted by analysis of covariance with the logarithm of the faecal coliform count as the dependent variable. As expected, traditional water sources were grossly contaminated at all times whereas piped water sources were much cleaner. Hand-dug protected wells had significantly higher levels of faecal contamination than unprotected riverside wells and springs during the dry season. The possible reasons for this unexpected finding are discussed. A close association between rainfall and faecal contamination was demonstrated but the effect of rainfall depended on the type of water source. An association between water quality and the size of the community served by the source was also detected. The finding that stored water was usually more contaminated than fresh water samples is consistent with the results from other studies. Since it is unusual for water quality to be inversely correlated with accessibility, this study site would be suitable for investigating the relative importance of water-borne versus water-washed transmission mechanisms in childhood diarrhoea.

Child↗