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PubMed1990

[Follow-up of newly diagnosed patients with diabetes in the Prague population. I. Incidence of diabetes and disorders of glucose tolerance, methods of detection, complications].

The authors followed up the incidence of new cases of diabetes in nine Prague diabetological clinics, the way of manifestation of diabetes and its detection, age dependence, seasonal character and incidence of complications. The incidence of type 2 diabetes was 269, of type 1 2.3 and impaired glucose tolerance 27 per 100,000 population. In 76% diabetes was detected accidentally, most frequently by the health community doctor or factory medical officer; 65% of the diabetes were older than 60 years. 51% suffered from hypertension and in 0.9% of type 2 diabetics retinopathy was found.

Adult↗
PubMed1988

Lofepramine in the elderly.

Depression prevails in 12-13% of the elderly, of whom a 5th suffer major depressive illness. First admission-rates to psychiatric beds in England increase with aging until the 80s, when they fall off in women but continue to rise in men. Physical illness is a considerable contributor to depression in old age, and consequently depression is more prevalent in elderly general hospital inpatients than in the community. Better screening instruments are needed to detect this depression, and the place of antidepressant therapy needs to be better established. All antidepressants fall short of the ideal, particularly through acting slowly, having side-effects and being dangerous in overdose. Justifiably popular though dothiepin is in the treatment of depression in the elderly, its fatal toxicity index is high. Lofepramine appears to be as effective, to have fewer side-effects and to be safer, but experience of it is relatively meagre in the elderly and satisfactory double-blind comparisons with suitable control drugs in this age group have yet to be reported. If it lives up to its present promise it may be particularly suitable for the physically ill and depressed elderly.

Adjustment Disorders↗
PubMed1985

Giving advice about welfare benefits in general practice.

Many people do not receive the full state welfare benefits to which they are entitled. Roughly two thirds of the population consult their general practitioners at least once a year. General practitioners and community nurses are exceptionally well placed to detect those who are suffering genuine financial hardship but they are not well equipped to give advice about the complex system of state social security benifits. Imparting such advice in suitable cases, particularly where the lack of it is detrimental to health, might be regarded as a proper function of general practitioners and health centres. A method of providing such advice in a health centre with the help of a computer is described.

Family Practice↗
PubMedDate not supplied

[True or false varicose veins in sportsmen? (Result of a survey)].

The incidence of varicose veins remains high, as is proved by official statistics, particularly those of the Army, the average level being given at about 35 per cent, at least in France. A recent statistic produced at the Centre for the Detection of Cardiovascular Disease of the Urban Community of Lille, fairly homogeneous and representative of the North Region, has shown that the incidence is 20 per cent for one or the other saphenous vein in a population of more than 1 500 subjects of mean age 34 years. This study was permitted a distinction between true varicose veins and simple venous swellings, and we can now raise the question of the responsibility of swelling in the high level of varicose veins sometimes reported in competitive athletes, especially in elevated places. The study concerns three population groups, the first unselected (20 per cent varicose veins, 11 per cent swellings), the second consisting of 120 licensed athletes (14 per cent varicose veins, 12 per cent swellings), and the third group consisting of 330 Brigade Firemen (14 per cent and 11 per cent). Swelling was assessed in part by an electronic processor though not with statistically valid precision and the search for valvular incompetence was carried out simply and economically by listening to the Doppler Signal. Very often a very small localised double souffle was heard at the exact site of the venous projection. This raises again the spinous pathogenesis of Piulachs and Vidal-Barraquer, which is discussed and accepted in the unambiguous case.

Adult↗
PubMed1979

Amantadine and influenza A.

Amantadine hydrochloride is currently licensed for the prophylaxis and symptomatic treatment of influenza A infections. Although its efficacy is based on considerable clinical experience, amantadine has had relatively little use for that purpose in the U.S. It is well tolerated and generally nontoxic. It may be particularly useful in the prophylaxis of unvaccinated high-risk individuals and critical personnel. Effective use of amantadine depends on rapid detection of influenza A activity in the community.

Amantadine↗
PubMed1994

Significance and impact of urinary incontinence.

All nurses can play an important role in the detection of urinary incontinence (UI) in both community as well as institutional populations. With their advanced practice assessment and patient management skills, NPs are assuming a major role in the diagnosis and treatment of UI in primary and acute care settings, in home care, and in the management of chronic incontinence in long-term care. A strong commitment by the nursing community to emerge as a leading health care provider of incontinence assessment and management will be a major contribution to providing long awaited assistance for the 10 million incontinence sufferers in the United States. This article reviews the significance and impact of UI across all settings.

Adult↗
PubMed1993

[Evaluation of the design and reliability of a questionnaire to identify elderly individuals in need for social and health services].

BACKGROUND: To assess the construction of a short screening questionnaire designed for the detection of elderly people living in the community and in need of social and health care, and to test the reliability of the scores obtained on the scales of Activities of Daily Living (ADL) and mobility through its application. METHODS: A short screening questionnaire of 11 items was designed to score elderly community dwellings on the scales of ADL and mobility of the International Classification of Impairments, Disabilities and Handicaps of the WHO (ICIDH). A random sample of 1,000 people aged 65 and over from the community of a geographical area of Catalonia (Spain) were interviewed in 1989, either by telephone or in-home personal interview, by non-professional trained interviewers on the basis of the mentioned schedule, and scored on the ICIDH ADL and Mobility scales. The design of the screening questionnaire was evaluated on the construction, content and wording through a 16 opinion statements questionnaire upon which 12 professionals, familiarized with questionnaire construction, expressed agreement or disagreement. To test reliability, each interviewer re-scored, one month apart, 20 subjects based on the information they had registered on the questionnaires, and following the same procedure, a gold standard observer re-scored all 1,000 interviews. In addition, a number of interviews were tape recorded, with previous consent of the subjects, and re-scored by 9 different observers. Interobserver and intraobserver reliability was measured with Cohen's weighted kappa coefficient. RESULTS: The average time of questionnaire administration was approximately 10 +/- 5 min. Although the instrument was said to be a good tool for the interviewer to score the subjects on the scales, wording of some items of the questionnaire need to be reviewed. Both intraobserver and interobserver reliability were high: kappa coefficients of 0.79-0.97 and > 0.75 respectively. CONCLUSIONS: The use of a simple and reliable ADL and mobility questionnaire is a practical way to obtain information on the functional status of elderly people living at home, and to select elderly people for a further comprehensive assessment of their social and health care needs for planning the appropriate services in the community.

Activities of Daily Living↗
PubMed1993

Ultrasonographic prediction of esophageal varices in Schistosomiasis mansoni.

Bleeding from esophageal varices is a common and serious problem in Schistosomiasis mansoni. A simple and accurate method of detection would facilitate measurement of individual and community morbidity and allow institution of preventive measures. An ultrasonographic scoring system grading periportal fibrosis, portal vein diameter, spleen size, and portasystemic anastomoses was evaluated as a predictor of esophageal varices and a past history of upper gastrointestinal hemorrhage in 43 patients with hepatosplenic schistosomiasis. Ultrasonographic variceal score correlated (r = 0.86, p < 0.001) with the endoscopic variceal grade. Patients with a sonographic score of 5 or greater were highly likely (21 of 23) to have varices of grade II or greater (sensitivity, 91.3%; specificity, 94.7%). Only those with sonographic scores of 5 or greater (15 of 23) had bled from esophageal varices. The ultrasonographic score provided a simple, inexpensive, accurate, and noninvasive means of screening individuals with hepatosplenic schistosomiasis for esophageal varices, and correlated strongly with prior gastrointestinal hemorrhage. It is not known whether a similar score would be useful in hepatic cirrhosis.

Adolescent↗
PubMed1996

[Tuberculosis found among foreigners and treated at the National Hiroshima Hospital or Hiroshima Anti-Tuberculosis Association].

In this study, we investigated 31 foreign patients who had been diagnosed as having pulmonary tuberculosis at the National Hiroshima Hospital or Hiroshima Anti-Tuberculosis Association between 1982 to 1995. Their age ranged from 17 to 63 years, and all of them had been in Japan for less than five years. Twelve of the patients came from South America, 18 from Asia, and one from Egypt. Seven Peruvians had been infected in a tuberculosis outbreak. The reasons of their immigration were job-seeking (14 out of 31), education (8 out of 31), and marriage to Japanese men (6 out of 31). None of them were illegal immigrants. In four women who had married Japanese men, various symptoms such as cough, sputum, and slight fever came on during pregnancy, however, none of them had been diagnosed as having tuberculosis, and consequently they had received no medication during pregnancy. In 6 out of the 8 patients who were college students, their sputa were negative for tubercle bacilli, and they could be treated by chemotherapy as outpatients. In provincial cities, every effort should be made to detect tuberculosis among members of the foreign community who are living under different environments and conditions.

Adolescent↗
PubMed1996

Use of self-report postal questionnaires for district-based adult oral health needs assessment.

Self-report postal questionnaires have been advocated as an efficient means of collecting local data on adult oral health needs. The aim of this study was to compare the response from deprived and affluent communities and examine a method for the detection and compensation of non-response bias. An oral health status questionnaire was administered by post to random samples of older residents from affluent and deprived electoral wards. The survey was conducted in three distinct stages to increase the response rate and to quantify the effects of non-response. A response of 59.6 per cent was achieved from the deprived ward and 77.7 per cent from the affluent ward, this difference was statistically significant. The response rate compared favourably with contemporary national and international studies of oral health using postal survey methods. The pattern of response over the three stages was used to detect the presence and direction of non-response bias. This analysis showed evidence of non-response bias for only one variable of interest, for which an estimated prevalence value was calculated.

Activities of Daily Living↗
PubMed1995

[Community-based hepatocellular carcinoma screening in seven townships in Taiwan].

The early detection and prompt treatment of hepatocellular carcinoma (HCC) may prolong life and improve the quality of life of affected patients. In order to compare sensitivity and specificity of various screening biomarkers, identify subjects with a high risk of developing HCC, and estimate prevalence and incidence of HCC among subjects, a community-based HCC screening program was implemented in Sanchi, Chutung, Potzu, and Kaohsu, Taiwan Island as well as Makung, Huhsi and Paihsa in Penghu Islets. First stage screening of HCC was based on serological markers including hepatitis B surface antigen (HBsAg), antibody against hepatitis C virus (anti-HCV), alpha-fetoprotein (AFP > or = 20 ng/mL), alanine transaminase (> or = 40 IU/L), and aspartate transaminase (> or = 45 IU/L); as well as history of liver cirrhosis or HCC among first-degree relatives. Subjects who were positive for at least one of above six first-stage criteria were referred for second-stage screening by abdominal ultrasonography. Confirmatory diagnosis of HCC was made in suspicious cases according to aspiration cytology surgical pathology, digital substracted angiogram and/or computed tomography. A total of 12,026 men in seven study townships and 1,800 women in two townships in Penghu were recruited for first-stage screening (response rate: men, 25.5%; women, 46.8%). The positive rates for first-stage screening were 30.9% men and 34.6% women. The response rates for second-stage screening were 91% men and 90.5% women. Age-standardized prevalence of HCC per 1,000 subjects was 5.2 for men and 0.8 for women in Penghu Islets and 1.2 for men on Taiwan island. Among five serological biomarkers, HBsAg carrier status had the highest sensitivity (88.2%) and AFP had the second highest sensitivity (43.1%). The specificity of these markers was highest for AFP (99.0%) and lowest for HBsAg carrier status (80.3%). There were 16 new HCC cases identified after an intensive follow-up of 137 cases affected with liver cirrhos is giving an annual HCC incidence rate of 5.3%, while the rate for non-cirrhotic subjects who were positive on first-stage screening was only 0.15%. The combination of HBsAg and AFP for the first-stage screening and abdominal ultrasonography for the second-state screening seems valid for the early detection of HCC, but its cost-effectiveness remains to be elucidated by a longer follow-up study.

Adult↗
PubMed2003

Case study of the distribution of mucosa-associated Bifidobacterium species, Lactobacillus species, and other lactic acid bacteria in the human colon.

The distribution of mucosa-associated bacteria, bifidobacteria and lactobacilli and closely related lactic acid bacteria, in biopsy samples from the ascending, transverse, and descending parts of the colon from four individuals was investigated by denaturing gradient gel electrophoresis (DGGE). Bifidobacterial genus-specific, Lactobacillus group-specific, and universal bacterial primers were used in a nested PCR approach to amplify a fragment of the 16S rRNA gene. DGGE profiles of the bifidobacterial community were relatively simple, with one or two amplicons detected at most sampling sites in the colon. DGGE profiles obtained with Lactobacillus group-specific primers were complex and varied with host and sampling site in the colon. The overall bacterial community varied with host but not sampling site.

Adult↗
PubMed2000

Changes in the community structure of ammonia-oxidizing bacteria during secondary succession of calcareous grasslands.

The community structure of beta-subclass Proteobacteria ammonia-oxidizing bacteria was determined in semi-natural chalk grassland soils at different stages of secondary succession. Both culture-mediated (most probable number; MPN) and direct nucleic acid-based approaches targeting genes encoding 16S rRNA and the AmoA subunit of ammonia monooxygenase were used. Similar shifts were detected in the composition of the ammonia oxidizer communities by both culture-dependent and independent approaches. A predominance of Nitrosospira sequence cluster 3 in early successional fields was replaced by Nitrosospira sequence cluster 4 in late successional fields. The rate of this shift differed between the two areas examined. This shift occurred in a background of relative stability in the dominant bacterial populations in the soil, as determined by domain-level polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE). Molecular analysis of enrichment cultures obtained using different ammonia concentrations revealed biases towards Nitrosospira sequence cluster 3 or Nitrosospira sequence cluster 4 under high- or low-ammonia conditions respectively. High-ammonia MPNs suggested a decease in ammonia oxidizer numbers with succession, but low-ammonia MPNs and competitive PCR targeting amoA failed to support such a trend. Ammonia turnover rate, not specific changes in plant diversity and species composition, is implicated as the major determinant of ammonia oxidizer community structure in successional chalk grassland soils.

Ammonia↗
PubMed1999

Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less.

PURPOSE: We evaluated the detection rate of prostate cancer in men with suspicious digital rectal examination findings and serum prostate specific antigen (PSA) 4 ng./ml. or less. We also evaluated the stage and grade of cancers detected. MATERIALS AND METHODS: We screened 22,513 community volunteers by PSA testing and digital rectal examination at 6-month intervals. Biopsy was recommended when either test was suspicious for cancer. In the subset of 2,703 white and black men in whom PSA was 4 ng./ml. or less and digital rectal examination was suspicious for prostate cancer we compared compliance with biopsy recommendations, cancer detection rates, and stage and grade of cancers detected. We then correlated these results with patient age, race and serum PSA concentration. We performed multivariate logistic regression analysis to predict cancer based on clinical characteristics, and evaluated the positive predictive value of digital rectal examination for detecting cancer as stratified by race and PSA. RESULTS: Of the men 70% underwent biopsy with no difference in compliance according to age, race or PSA level. The 13% cancer detection rate correlated with age, race and PSA (p <0.003). The positive predictive value of a suspicious digital rectal examination was 5, 14 and 30% in men with PSA 0 to 1.0, 1.1 to 2.5 and 2.6 to 4.0 ng./ml., respectively. All cancers were clinically localized. Of the 72% of cases that were surgically staged 82% were organ confined and 78% were moderately differentiated. CONCLUSIONS: The positive predictive value of suspicious digital rectal examination was appreciable in men with low serum PSA. The majority of cancer cases detected by digital rectal examination had features of clinically important and potentially curable disease.

Aged↗
PubMed2005

The use of (14)C tracer technique to assess the functional response of zooplankton community grazing to toxic impact.

The use of functional endpoints in risk assessment of pollutants for marine pelagic communities is scarce, especially for the function of zooplankton communities. This work presents a rapid, inexpensive and ecologically relevant technique to assess the effect of toxic compounds on the grazing rates of zooplankton communities. The combination of a (14)C-tracer labelling technique with a fast (< 3 h) and representative sub-sampling and handling makes it possible to measure changes in food uptake of freshly collected natural zooplankton communities in a short-term assay. The methodology is described and its validity is determined by a full account of the fate of isotope tracers (up to 15% taken up by zooplankton). Egg production of Acartia tonsa cultures exposed to DCOI yielded EC(50) values of 118+/-33 nM DCOI after three days, where EC(50) values from grazing of natural zooplankton communities was 136+/-29 nM DCOI, indicating that grazing was the more sensitive variable. Finally the method was tested in a mesocosm experiment designed to evaluate the toxicity of the antifouling compound zinc pyrithion (ZPT) with an EC(50) value of 17 nM ZPT (SD=3.3 nM, n=3). The method was found to be reproducible both at the community (CV=8-39%) and individual level (CV=23-53%), and could detect small changes in response to a toxicant in a natural pelagic system. The use of natural communities in combination with the fast and cost-effective procedure makes this technique a powerful tool in risk assessment, where lack of ecological relevance or reproducible results often results in unwanted high uncertainties.

Animals↗
PubMedDate not supplied

The role of health care practitioners in the detection and control of hypertension.

It is well established that pharmacologic treatment of sustained diastolic blood pressure elevation can reduce the risk of subsequent cardiovascular morbidity and mortality. One problem confronting health care workers is to ensure that the maximum number of people who would benefit from antihypertensive treatment actually are brought under treatment and good control. Because hypertension is asymptomatic, it has been suggested that routine blood pressure measurement by a wide variety of health care practitioners would help to increase coverage. A community blood pressure survey was done to estimate detection and control rates. Information also was collected on recency of attendance to seven categories of health care practitioners. Nearly 90% of the population had seen a physician within the previous two years. Although nearly all subjects had visited a dentist, only 75% had visited within the last two years. For the other categories, population coverage was much lower. There was no evidence that undetected or untreated hypertensive persons were more likely to be seen by nonphysicians. These results do not identify a role for nonphysicians in hypertension detection or monitoring. Rather, routine blood pressure measurement on all patients by physicians should be adequate to ensure high detection and treatment rates.

Adult↗
PubMed2004

Succession of a microbial community during stable operation of a semi-continuous garbage-decomposing system.

The microbial community in a garbage-decomposing system was analyzed using denaturing gradient gel electrophoresis (DGGE) on the basis of 16S rDNA. The system treated 1 kg of garbage everyday for two months at ambient temperature with almost constant decomposition efficiency, although a transient pH increase occurred. Succession of the banding pattern of the DGGE profile suggested that the bacterial community was not directly affected by the continuous addition of non-sterilized garbage into the open system, but changed with the fluctuation of pH. These resistance and resilience characteristics of the community structure may be effective to keep the decomposition efficiency stable. The analyses of the DNA sequences from the DGGE bands suggested the existence of uncultured or novel bacteria as well as Lactobacillus sp., Corynebacterium spp., Enterococcus spp., and Staphylococcus sp. A specific PCR detection was performed to evaluate the existence of Escherichia coli within the community. E. coli 16S rDNAs were not detected from the decomposing system.

Journal Article↗
PubMed1983

The community health volunteer scheme in India: an evaluation.

In this paper, we have placed the discussion of community health volunteer (CHV) scheme within the larger context of the evolution of primary health care organization in India. Drawing on a national evaluation study and a micro village level study, we have outlined the key issues in the design and implementation of the CHV scheme. These issues relate to the range and quality of services, the characteristics of clients served, nature of health problems attended, community participation, extent of help rendered by CHV to PHC staff, and problems of logistics and supply of manuals, kits and medicines. Our analysis shows that the CHV scheme has succeeded in bringing primary curative care to the doorsteps of the people. To a smaller extent, it has also helped in improving related services such as family planning, immunization and detection and treatment of malaria. Both the village community and the field staff of the regular health care organization find the CHV as a useful link between the community and the primary health center. Also CHVs are not confining to only a privileged few but they are catering to a cross-section of different caste and class groups in the village community.

Allied Health Personnel↗