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At least 1,369 records · Page 76Linked to original sources
PubMed2003

Trends and patterns of tuberculosis: interpretations and prospects of tuberculosis control in Vojvodina, Yugoslavia, 1987-2000.

AIM: To assess the trends and pattern of tuberculosis in Vojvodina, Yugoslavia. METHODS: Using a retrospective design, data on 393 diagnosed TB cases were investigated for the years 1987, 1993 and 2000. RESULTS: TB case notification has been increasing in Vojvodina. The number of reported TB cases was 146 in 1987, 101 in 1993 and 146 in 2000; cases were predominantly in the age group 20-39 years (44.5%) in 1987, compared to the 40-59 year age group in 1993 and 2000 (38.6% and 45.9%, respectively). The majority of patients belonged to lower socio-economic groups. Manifestations of TB such as cough, weight loss and exhaustion were common. With the increasing trend of alcoholism from 1987 to 2000, delays in reporting were noticed. TB-related mortality was 1.4% in 1987 and 4.1% in 2000. Resistance to TB drugs among previously treated cases was 2.7% in 1987, 0.9% in 1993 and 2.7% in 2000. With respect to the increasing resistance, the levels of detection and surveillance were poor. The implementation of the DOTS strategy remained fairly low. CONCLUSION: TB is a chronic problem in Vojvodina. Prompt community-oriented actions need to be taken to improve case detection and cure rates through DOTS.

Directly Observed Therapy↗
PubMed2001

Ischaemic strokes: management in first six hours.

Cerebrovascular disease (CVD) or stroke is one of the foremost causes of high morbidity and mortality for many nations of the world, posing a major socio-economic challenge in the occupational and neuro-rehabilitational programmes of the 'stroke-survivors'. For example, in USA alone it has been estimated that a sum of 3261 million dollars is spent as direct cost for treatment, in addition to 4104 million dollars as indirect costs, consequent on economic losses of 'stroke victims'. Thus, the new concept in stroke pathophysiology and strategies for stroke prevention have assumed global importance. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15% of urban population is hypertensive (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many other reasons such as patient's compliance in taking medicine and poor followup in clinical practice that may lead to failure in reducing stroke mortality. In subjects, who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin is well established in prevention of stroke. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight. Associated conditions like diabetes mellitus etc. should also be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base stations for these surveys, because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

Anticoagulants↗
PubMed1996

[Importance of Chlamydia pneumoniae as a new respiratory pathogen].

The incidence of Chlamydia pneumoniae as a cause of respiratory tract infection was evaluated in a one-year prospective study in 142 patients with community-acquired pneumonia. An indirect immunofluorescence method which detects antibodies in acute and convalescent serum samples was used. Serological evidence of current infection was a four-fold rise in IgG antibody titer or a positive IgM fraction. C. pneumoniae was the causative pathogen in nine patients. This result is similar to those obtained in other studies and suggests that C. pneumoniae is a common etiological agent of community-acquired pneumonia in the studied area.

Adolescent↗
PubMed1997

Plasmids isolated from marine sediment microbial communities contain replication and incompatibility regions unrelated to those of known plasmid groups.

Two hundred ninety-seven bacteria carrying plasmids that range in size from 5 to 250 kb were identified from more than 1,000 aerobic heterotrophic bacteria isolated from coastal California marine sediments. While some isolates contained numerous (three to five) small (5- to 10-kb) plasmids, the majority of the natural isolates typically contained one large (40- to 100-kb) plasmid. By the method of plasmid isolation used in this study, the frequency of plasmid incidence ranged from 24 to 28% depending on the samples examined. Diversity of the plasmids occurring in the marine sediment bacterial populations was examined at the molecular level by hybridization with 14 different DNA probes specific for the incompatibility and replication (inc/rep) regions of a number of well-characterized plasmid incompatibility groups (repB/O, FIA, FII, FIB, HI1, HI2, I1, L/M, X, N, P, Q, W, and U). Interestingly, we found no DNA homology between the plasmids isolated from the culturable bacterial population of marine sediments and the replicon probes specific for numerous incompatibility groups developed by Couturier et al. (M. F. Couturier, F. Bex, P. L. Bergquist, and W. K. Maas, Microbiol. Rev. 52:375-395, 1988). Our findings suggest that plasmids in marine sediment microbial communities contain novel, as-yet-uncharacterized, incompatibility and replication regions and that the present replicon typing system, based primarily on plasmids derived from clinical isolates, may not be representative of the plasmid diversity occurring in some marine environments. Since the vast majority of marine bacteria are not culturable under laboratory conditions, we also screened microbial community DNA for the presence of broad- and narrow-host-range plasmid replication sequences. Although the replication origin of the conjugally promiscuous broad-host-range plasmid RK2 (incP) was not detectable in any of the plasmid-containing culturable marine isolates, DNA extracted from the microbial community and amplified by PCR yielded a positive signal for RK2 oriV replication sequences. The strength of the signal suggests the presence of a low level of the incP replicon within the marine microbial community. In contrast, replication sequences specific for the narrow-host-range plasmid F were not detectable in DNA extracted from marine sediment microbial communities. With the possible exception of mercuric chloride, phenotypic analysis of the 297 plasmid-bearing isolates did not demonstrate a correlation between plasmid content and antibiotic or heavy metal resistance traits.

Basidiomycota↗
PubMed1997

Strokes in the elderly: prevalence, risk factors & the strategies for prevention.

Current demographic trends suggest that the Indian population will survive through the peak years of occurrence of stroke (age 55-65 yr) and stroke-survivors in the elderly with varying degree of residual disability, will be a major medical problem. The available data from community surveys from different regions of India for 'hemiplegia' presumed to be of vascular origin indicate a crude prevalence rate in the range of 200 per 100,000 persons. Thus, the anticipated costs of rehabilitation of stroke-victims will pose enormous socio-economic burden on our meagre health-care resources, similar to what is now faced by industrialised nations in the West. Therefore, prevention of strokes at any age should be our main strategy in national health planning. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15 per cent of the urban population is 'hypertensive' (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many reasons such as patient's compliance in taking medicines and poor follow up in clinical practice that may lead to failure in reducing stroke mortality. In subjects who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin in prevention of stroke is well established. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight, and associated conditions like diabetes mellitus etc., should be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base-stations for these surveys because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

Aged↗
PubMed2001

Breast cancer screening in a rural Wisconsin community.

BACKGROUND: Screening tests have been shown to play an important role in earlier disease stage detection of breast cancer. AIM: The aim of this study was to assess the acceptance of screening mammography in a rural community in Wisconsin. METHODS: A cohort of 60 patients with breast cancer was analyzed retrospectively for disease stage, screening mammography, and patient compliance. RESULTS: Of 60 patients with breast cancer, only 25 (42%) underwent screening mammography. Compliance was suboptimal among patients; especially poor in the elderly population. CONCLUSION: Promotional steps to increase acceptance of screening tests need to be emphasized especially in patients > or = 60 years in age to enhance early detection of breast cancer and prolong disease-free interval.

Adult↗
PubMedDate not supplied

A culturally competent approach to cancer news and education in an inner city community: focus group findings.

Ethnic minorities who live in socioeconomically disenfranchised communities suffer disproportionately from many health problems including cancer. In an effort to reduce these disparities, many health-care practitioners and scholars have promoted "culturally competent" health education efforts. One component of culturally competent education is a grounded knowledge base. To obtain knowledge about the cancer-related ideas of members of one African American community, researchers conducted focus groups with public housing residents and used the findings to develop a five-part television news series about breast, prostate, and cervix cancers. We found that participants gathered information from the folk, popular, and professional health sectors and constructed their cancer-related ideas from this information. Furthermore, experiences of racism, sexism, and classism colored their beliefs and behaviors regarding the prevention, detection, and treatment of common cancers. For this community "cancer" represents a giant screen upon which individual fears and societal ethnic, political, and economic tensions are projected.

Adult↗
PubMed2004

Improving child maltreatment detection systems: a large-scale case study involving health, social services, and school professionals.

OBJECTIVES: The purpose of this 5-year study was to improve detection in two consecutive phases: (a) To close the gap between the number of identified cases and the actual number of cases of child abuse by increasing detection; and (b) To increase the possibility of a broader spectrum of detection. METHOD: The Balearic Islands (one of the Autonomous Communities of Spain, with 161,287 children under 18 years old) was selected as the study area. Phase 1: front-line professionals (181) from all the health and social services agencies were trained in detection. Phase 2, school professionals (251) from all schools in the territory were also trained. The independent factor was the intervention provided to the professionals with training and support. A pre-post design was used over the area, divided in territories, in which the program was gradually implemented to provide within-territory and between-territories controls. RESULTS: Phase 1: Comparison before-after implementation of the program showed that detection was tripled in the Balearic Islands (from .58 to 1.77 per 1,000 children). An unplanned generalization effect was found, and post hoc analysis considering only the islands showed the expected increase. Phase 2: A subsequent increased detection rate was found in Child Protection Services cases 2.18 per 1,000. Of those new cases, 24.5% came from schools, after controlling for duplication. CONCLUSIONS: This detection system showed positive changes after training and supporting frontline health and social services professionals. However, these professionals only have occasional contacts with the child population. Therefore, to broaden the spectrum of detection and to reach more maltreated children, who are less likely to be visible to CPS, it is necessary to train and support school professionals because of the frequency of their contacts with children on an almost daily basis.

Adolescent↗
PubMedDate not supplied

Familial aggregation of Trypanosoma brucei gambiense trypanosomiasis in a very high incidence community in Zaire.

Familial aggregation of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) was investigated in 3 adjacent villages of central Zaire where 318/1431 inhabitants had previously suffered from HAT. Neither spatial nor familial aggregation was detected when analysing the distribution of cases in the whole community using Poisson, negative binomial and pairwise odds ratio models. However, clustering of cases was observed when specific familial relationships were examined. The risk of HAT for a child was significantly increased if the mother had also had HAT, but it was not influenced by a past history of HAT in the father. Sisters and brothers of cases of HAT had a higher risk of HAT than siblings of individuals who had never had HAT, but no such association was documented for half-sisters and half-brothers. Among married couples, a past history of HAT in one spouse had no impact on the other spouse's risk of HAT. Indirect arguments suggested that familial clustering was a consequence of shared exposure, either sequential or simultaneous, rather than of genetic susceptibility. The existence of familial clustering should be kept in mind when implementing passive or active case-finding activities.

Adolescent↗
PubMed2001

Control of anthelmintic resistant endoparasites in a commercial sheep flock through parasite community replacement.

An effort was undertaken to replace a community of sheep endoparasites that had been classified as resistant to levamisole and albendazole with a community of more susceptible parasites using a dilution approach that could be integrated into the management of a commercial flock. For this study, pastures on this sheep farm were divided into two areas: north and south. Strategically timed anthelmintic treatments combined with pasture management reduced to nondetectable levels the endemic community of anthelmintic resistant parasites in this flock and on these pastures by early summer. A group of 102 ewes, lambs, and rams were experimentally infected with third stage larvae from the more susceptible community of parasites. These sheep then seeded the south pastures with the new parasite community, while sheep on the north pastures maintained the endemic resistant community. Despite its insensitivity as a technique for detecting anthelmintic resistance, fecal egg count reduction tests at the end of the grazing season indicated that the more susceptible parasites were present on the south pastures while resistant parasites were present on the north. The following grazing season, similar protocols were used to introduce the more susceptible parasites onto the north pastures. At the end of the grazing season, fecal egg count reduction tests indicated that the new community of parasites had become established on both groups of pastures of the farm.

Albendazole↗
PubMed2005

Soil microbial community responses to additions of organic carbon substrates and heavy metals (Pb and Cr).

Microcosm experiments were conducted with soils contaminated with heavy metals (Pb and Cr) and aromatic hydrocarbons to determine the effects of each upon microbial community structure and function. Organic substrates were added as a driving force for change in the microbial community. Glucose represented an energy source used by a broad variety of bacteria, whereas fewer soil species were expected to use xylene. The metal amendments were chosen to inhibit the acute rate of organic mineralization by either 50% or 90%, and lower mineralization rates persisted over the entire 31-day incubation period. Significant biomass increases were abolished when metals were added in addition to organic carbon. The addition of organic carbon alone had the most significant impact on community composition and led to the proliferation of a few dominant phylotypes, as detected by PCR-denaturing gradient gel electrophoresis of bacterial 16S rRNA genes. However, the community-wide effects of heavy metal addition differed between the two carbon sources. For glucose, either Pb or Cr produced large changes and replacement with new phylotypes. In contrast, many phylotypes selected by xylene treatment were retained when either metal was added. Members of the Actinomycetales were very prevalent in microcosms with xylene and Cr(VI); gene copy numbers of biphenyl dioxygenase and phenol hydroxylase (but not other oxygenases) were elevated in these microcosms, as determined by real-time PCR. Much lower metal concentrations were needed to inhibit the catabolism of xylene than of glucose. Cr(VI) appeared to be reduced during the 31-day incubations, but in the case of glucose there was substantial microbial activity when much of the Cr(VI) remained. In the case of xylene, this was less clear.

Actinomycetales↗
PubMed1994

Stimulating cancer screening among Latinas and African-American women. A community case study.

Recent studies have attributed underutilization of early cancer detection programs among the disadvantaged to knowledge deficits and myths, lack of belief in cancer susceptibility (denial), and such attitudinal barriers as fear and embarrassment. Video modalities have been demonstrated to be effective in increasing knowledge and promoting health-protective behavior in low-income people of color. Waiting rooms of public health clinic facilities in large urban areas provide a captive audience of predominantly African Americans and Latinos with a preference for obtaining health information from audiovisual media. The development of a culturally sensitive, cost-effective documentary format is described. An experience of rapid acceleration in demand for Pap smears in an underserved Latino community of East Los Angeles following the showing of one of these videos is chronicled as a spontaneous and informal evaluation of this approach to health education/promotion video production.

Adolescent↗
PubMed2006

Cardiovascular risk factor control among diabetic patients attending community-based diabetic care clinics in Italy.

AIM OF THIS STUDY: To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in diabetic patients attending a network of urban community-based diabetic care clinics in Italy. METHODS: The study population included 1078 consecutive patients with type 2 diabetes mellitus (47% women, mean age 67.6+/-9.8 years) visited at eight diabetic care clinics between 1 and 30 of November 2004. Values of glycosilated hemoglobin, blood pressure, and cholesterol subfractions, as well as clinical and medication data, were prospectively collected in all cases in a computerized database. RESULTS: Despite a high prevalence of hypertension (66.6%), only 29.6% of patients met the treatment goal of a systolic blood pressure <130 mmHg, while a diastolic blood pressure <80 mmHg was reached by 38.6% of the study cohort. Optimal LDL cholesterol values (<100mg/dl) were present in just 25.5% of cases. Values of glycosilated hemoglobin <7% were present in 57.8% of patients. CONCLUSIONS: We conclude that adherence to current guidelines for cardiovascular prevention and cardiovascular risk factor control represent an exception in diabetic patients attending community-based diabetic care clinics. Major efforts are required to improve the quality of health care currently delivered to diabetic patients.

Aged↗
PubMedDate not supplied

Cancer screening in the community. Taking the show on the road.

PURPOSE: The authors describe the efforts involved in improving cancer screening of an underserved population using a mobile clinic to bring these services to the community. The background, methods, results, and implications are discussed, as are the logistics of packing, scheduling, and providing follow-up. OVERVIEW: Members of the University of Pittsburgh Cancer Institute Cancer Prevention and Early Detection Program developed a cancer screening program to serve the underserved communities in the Pittsburgh area. The African American Cancer Screening Program has presented the staff with significant challenges. The most significant of those challenges has been taking the most comprehensive screening program to the areas convenient to clients. Although coordinating staff, materials, and transportation was a challenge, the logistical problems involved were resolved, allowing for the opportunity to "take the show on the road". CLINICAL IMPLICATIONS: Because the mortality rate from some cancers is higher in black Americans, early cancer screening and detection is crucial in this population. The establishment of a mobile cancer screening clinic allows underserved communities access to these services. The physical screening, educational counseling, scheduling of mammographies and flexible sigmoidoscopies, and meticulous follow-up provided through the mobile clinic may lead to a greater awareness and reduced morbidity and mortality from cancer in these communities.

Black or African American↗
PubMed2003

Measuring life-space mobility in community-dwelling older adults.

OBJECTIVES: To evaluate the validity and reliability of a standardized approach for assessing life-space mobility (the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA)) and its ability to detect changes in life-space over time in community-dwelling older adults. DESIGN: Prospective, observational cohort study. SETTING: Five counties (three rural and two urban) in central Alabama. PARTICIPANTS: Community-dwelling Medicare beneficiaries (N=306; 46% male, 43% African American) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews. MEASUREMENTS: The LSA assessed the range, independence, and frequency of movement over the 4 weeks preceding assessments. Correlations between the baseline LSA and measures of physical and mental health (physical performance, activities of daily living, instrumental activities of daily living, a global measure of health (the short form-12 question survey), the Geriatric Depression Scale, and comorbidities) established validity. Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change. RESULTS: For all LSA scoring methods, baseline and 2-week follow-up LSA correlations were greater than 0.86 (95% confidence interval=0.82-0.97). Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility. The LSA showed both increases and decreases at 6 months. DISCUSSION: Life-space correlated with observed physical performance and self-reported function. It was stable over a 2-week period yet showed changes at 6 months.

Activities of Daily Living↗
PubMed2003

Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments.

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion. Following a period of participant observation, a purposive sample of 30 nurses, 10 each from a teaching hospital, a long-term facility, and a home care agency, participated in semistructured interviews. Dimensional analysis provided the methodological framework for data collection and interpretation. The results reinforce prior findings that the ability of nurses to recognize acute confusion and to distinguish it from dementia can be attributed to their personal philosophies about aging. Care environment was identified as a factor that influenced clinical reasoning in limited ways under certain conditions and within certain contexts.

Acute Disease↗
PubMed2001

Positron emission tomography using(18)F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp: optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. Results from the European Community Concerted Action Multicenter study on use of(18)F-fluoro-deoxyglucose Positron Emission Tomography for the Detection of Myocardial Viability.

AIMS: To assess the accuracy of positron emission tomography to predict recovery of global cardiac function after revascularization in patients with coronary artery disease. METHODS AND RESULTS: One hundred and seventy-eight patients (157 male, 58+/-10 years) with coronary artery disease and left ventricular dysfunction (mean ejection fraction 39+/-14%) were enrolled in six European centres. They underwent a common protocol for the assessment of viability using(18)F-fluoro-2-deoxyglucose (FDG) positron emission tomography during a standardized euglycaemic hyperinsulinaemic glucose clamp before revascularization by either surgery (n=140) or angioplasty (n=38). Seven patients were excluded because of incomplete revascularization of a dysfunctional region. Based on the recovery of global ejection fraction 2-6 months after revascularization, patients were classified into two groups: 82 patients who had a >5% improvement in ejection fraction postoperatively, and 89 patients without postoperative ejection fraction improvement. Optimal cut-off points for postoperative improvement of global cardiac function were computed, using receiver operating curve analysis. The highest sensitivity (79%) and specificity (55%) for predicting postoperative ejection fraction improvement by positron emission tomography was found when three or more dysfunctional segments had a relative FDG uptake >45% of normal remote myocardium (overall accuracy 67%). CONCLUSIONS: In a large cohort of coronary patients with impaired ejection fraction, FDG positron emission tomography demonstrated high sensitivity and moderate specificity to predict improvement of cardiac function after coronary revascularization.

Adult↗