To screen or not to screen: using spiral computerized tomography in the early detection of lung cancer.
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Community Health Services↗
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WHO guidelines on detecting pneumonia in children.
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Child, Preschool↗
Considerations for evaluating community high blood pressure control programmes.
A major reason for building evaluation procedures into community high blood pressure control programmes is the potential to influence programme planning and operation positively. Evaluation can assist smooth, successful implementation of programme plans on a continuous basis. Evaluation can provide for staff development and training and help administrators be accountable to themselves, their staffs, and their clients. Three basis types of evaluation are relevant to hypertension control programmes: process, outcome, and impact. Process evaluation measures programme efforts by assessing, modifying, and reassessing daily operations. This type of evaluation examines the use of resources, patterns of staff interaction, processes used in planning, decision making, or organization of staff to carry out these efforts. Outcome evaluation measures programme effects and extent to which programme achieve results in the target population. This activity helps determine how well programme objectives are achieved and whether activities should be continued, expanded, or redirected. Impact evaluation provides information on the long-term effects of the hypertension control programme on the community at large, such as morbidity and mortality changes. Because of the need for large sample sizes to detect these changes, impact evaluation is not usually conducted by a single community programme. As community programmes grow in number, the competition for resources becomes greater. Legislators will demand more information about programme costs and effectiveness, which will be needed to justify expenditures and compete for additional resources.
Community Health Services↗
Improving the detection of psychological disorders.
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Community Psychiatry↗
Evaluation of a population-based screening for type 2 diabetes: a community-based screening project in Puli, Taiwan.
BACKGROUND: A Markov method incorporating the relationships between prevalence, incidence, and mortality with respect to type 2 diabetes was used to assess a population-based screening for this disease. METHODS: Data from a population-based screening project for residents of Puli, Taiwan, over 30 years of age (n= 1,219) were used to estimate the annual incidence of asymptomatic type 2 diabetes, the prevalence to incidence (P/I) ratio, and the hazard rate of death due to type 2 diabetes. These parameters were employed to develop a Markov process to evaluate the effects of early detection of type 2 diabetes on the risk of death from this disease in a simulated population (n= 10,000) receiving biennial, 5-year interval, or no screening. RESULTS: The estimated annual incidence, average duration from asymptomatic to symptomatic type 2 diabetes (P/I ratio), and hazard rate for death from this disease were 0.86% (95% CI 0.50-1.48), 10 years (95% CI 7.69-14.01), and 1.1% per year, respectively. This yields an optimal screening interval of 5 years. Simulation of a 5-year interval screening regimen versus no screen ing yielded a relative risk reduction of 31% (95% CI 12-46%). A similar value was found for a biennial screening regime. CONCLUSIONS: The results suggest that early detection of type 2 diabetes via a community-based screening project in developing countries with high prevalence is worthwhile.
Adult↗
Antisociality, underarousal and the validity of the Concealed Information Polygraph Test.
The Concealed Information Polygraph Test has been advocated as the preferred method for the physiological detection of deception. In this study, we further examined the validity of the Concealed Information Test in antisocial individuals. Physiological responding to concealed information was assessed in 48 male prisoners, and compared with responding in 31 male community volunteers. Based upon the association between antisociality and autonomic hyporesponsivity, lower detection rates were expected in the prisoners. Participants were questioned on five personally significant items (e.g., day of birth), instructed to deny recognition of this information, and promised a financial reward when able to hide recognition. Prisoners showed reduced autonomic reactivity in comparison to the community volunteers. This hyporesponsivity had little impact on the sensitivity of the Concealed Information Test. Detection efficiency in the prisoners was significantly above chance (d=2.67; a=0.82; 79%), and did not differ significantly from that obtained in the community volunteers (d=3.04; a=0.85; 87%). The present data support the validity of the Concealed Information Test in criminal populations.
Adult↗
Trends and social factors in blood pressure control in Scottish MONICA surveys 1986-1995: the rule of halves revisited.
Time trends and social factors in detection, treatment and control of hypertension in the community were examined in four independent Scottish MONICA cross-sectional surveys in 1986, 1989, 1992 and 1995. Residents aged 25-64 years were recruited randomly from general practice lists in north Glasgow, Scotland with stratification by sex and 10-year age groups. A total of 1262 participated in the first survey, 1397 in the second, 1516 in the third and 1836 in the fourth. Differences and trends in proportions of hypertension undetected, detected but untreated, treated but uncontrolled and controlled across the four surveys were tested by chi(2), and the associations of the poor control of hypertension with social factors were estimated by multivariate logistic regression model to derive odds ratios. Using the cut point of >/=160/95 mmHg, proportion of hypertension undetected across the four surveys was 56.3, 44.6, 32.0 and 38.2%, and of treated controlled hypertension was 15.2, 26.4, 32.0 and 32.8% (both trends P<0.001). Multivariate analysis showed that poor control of hypertension was not related to social deprivation, but significantly related to being male, young, of low body mass index and heavy alcohol drinking. Undetected hypertension was significantly related to full-time employment, and untreated hypertension to high social class and possibly education level. These findings suggest that in this part of Scotland the management of hypertension has improved, so the 'rule of halves' no longer applies. Control of blood pressure is not positively associated with social deprivation, but people at a high risk of poor control of hypertension should be targeted.
Adult↗
Rheumatoid factor isotypes in patients with rheumatoid arthritis and in subjects with "false-positive" reactions.
The appearance of RFs, as detected by standard serological techniques, often precedes the onset of clinical RA by years. This pre-rheumatoid immunological reactivity is not associated with C-reactive protein response or occurrence of antibodies against native type II collagen. The profile of RF isotypes appeared to be similar between pre-rheumatoid and rheumatoid sera. RA sera contained somewhat more frequently IgG and IgA class RFs than "false-positive" sera from a community-based population sample. 7S IgM could be detected at about the same frequency in rheumatoid sera, in RF-positive pre-rheumatoid sera and in sera with "false-positive" RF reactions. The significance of the findings in terms of the pathogenesis of RA will be discussed.
Adult↗
The design of a practical and reliable fall detector for community and institutional telecare.
Falls are one of the greatest obstacles to independent living for frail and elderly people. Their early detection is an important step in providing people with the reassurance and confidence necessary to maintain an active lifestyle. We have investigated a worn fall detector linked to a community alarm system. A worn device is the only one which is satisfactory, provided that it generates few false alarms. The fall detector we have developed is the size of a small radio pager. It uses a two-stage detection process which senses shock and the orientation of the wearer. A fall is detected within 20 s and triggers a radio signal to a community alarm system. Tests were devised using a jointed mannequin to simulate five modes of falling to understand the effects of impact at different parts of the body. This allowed us to select the appropriate trigger threshold and wearing positions for the sensor. Prototypes were evaluated with 20 people to observe false alarms. The final design allowed reliable detection in 180 different falling scenarios.
Accidental Falls↗
Prevalence of epilepsy. A door-to-door survey in the Sicilian community of Riposto.
In a door-to-door survey of common neurological disorders in Sicily (SNES Project), we administered a screening symptoms questionnaire and a brief neurological examination to detect epileptic patients. All of the subjects effectively resident in the community of Riposto on 1 November 1987 (prevalence day) were investigated (n = 9956). The subjects with a positive questionnaire or a previous diagnosis of epilepsy were extensively examined by a neurologist and then definitively classified for epilepsy by a panel of senior neurologists. The crude prevalence of active and non-active epilepsy was 3.21/1000; the prevalence of active epilepsy alone was 2.71/1000. Of the 27 active cases, sixteen were affected by generalized tonic-clonic seizures, four by absences and four by complex partial attacks. All except two were being treated with antiepileptic drugs, most with phenobarbital. Our prevalence rate is lower than that reported by most authors, but similar to the rates in other Sicilian communities.
Adolescent↗
Routine screening for fetal anomalies: expectations.
Ultrasound has become a routine part of prenatal care. Despite this, the sensitivity and specificity of the procedure is unclear to many patients and healthcare providers. In a small study from Canada, 54.9% of women reported that they had received no information about ultrasound before their examination. In addition, 37.2% of women indicated that they were unaware of any fetal problems that ultrasound could not detect. Most centers that perform ultrasound do not have their own statistics regarding sensitivity and specificity; it is necessary to rely on large collaborative studies. Unfortunately, wide variations exist in these studies with detection rates for fetal anomalies between 13.3% and 82.4%. The Eurofetus study is the largest prospective study performed to date and because of the time and expense involved in this type of study, a similar study is not likely to be repeated. The overall fetal detection rate for anomalous fetuses was 64.1%. It is important to note that in this study, ultrasounds were performed in tertiary centers with significant experience in detecting fetal malformations. The RADIUS study also demonstrated a significantly improved detection rate of anomalies before 24 weeks in tertiary versus community centers (35% versus 13%). Two concepts seem to emerge from reviewing these data. First, patients must be made aware of the limitations of ultrasound in detecting fetal anomalies. This information is critical to allow them to make informed decisions whether to undergo ultrasound examination and to prepare them for potential outcomes.Second, to achieve the detection rates reported in the Eurofetus study, ultrasound examination must be performed in centers that have extensive experience in the detection of fetal anomalies.
Congenital Abnormalities↗
[Pneumocystis jiroveci infection in immunocompetent patients with pulmonary disorders, in Portugal].
The use of molecular tools with a great capacity to detect and differentiate strains of Pneumocystis has resulted: in the identification of low numbers of P. jiroveci organisms in clinically silent, colonized, immunocompromised patients and in immunocompetent persons. Considering this information, the aim of this study was to determine the prevalence of P. jiroveci carriers (subclinical infections) in Portuguese patients with pulmonary disorders and in healthy individuals. A total of 45 pulmonary specimens were collected from 45 immunocompetent adults with pulmonary disorders, and 37 oral washings from 37 healthy adults, between March 2001 and February 2004. All samples were analysed by indirect immunofluorescence with monoclonal antibodies and by amplification of the LSU mtrRNA by nested PCR. The results obtained in this study indicate that: 1) P. jiroveci is frequently detected (24.4%) in patients with pulmonary disorders in Portugal; 2) this population might play a role in circulation and transmission of P. jiroveci organisms in the community; 3) patients receiving corticosteroids are more likely to have detectable P. jiroveci in lungs (18%) than patients who are not receiving this immunosuppressor (12%); 4) P. jiroveci is infrequently detected in healthy adults. This may be due to very low numbers of latent organisms present in the lungs of healthy adults, difficulty in detecting few organisms, or due to the type of samples used. Screening of these individuals and notification of the results to their physician might be important: for further follow-up and whether or not prophylaxis or treatment should be prescribed; and for the clarification of the epidemiology of P. jiroveci asymptomatic infections.
Adult↗
Room size is the major determinant for tuberculin conversion in health care workers exposed to a multidrug-resistant tuberculosis patient.
OBJECTIVE: Transmission of Mycobacterium tuberculosis (MTB) to health care workers (HCWs) still represents a public health concern. A total of 71 obstetric workers underwent contact tracing after recent workplace exposure to a highly infectious multidrug-resistant tuberculosis patient [i.e., index case (IC)]. Aim of the study was to identify the main exposure predictors for the risk of conversion through evaluation of tuberculin screening results. METHODS: HCWs were investigated by a questionnaire (community, occupational, IC exposure risk factors) and tuberculin skin test screening. RESULTS: Conversion was detected in 5 (8%) of the 63 exposed workers and was not associated with either community or previous work-related risk factors. According to risk assessment, tuberculin conversion was related to neither amount time of exposure, workshifts, nor number of contacts. Conversely, an exposure to the IC in different hospital rooms was found significantly different among converters compared to non-converters (chi (2), P = 0.004). In particular, conversion was associated with exposure in two (obstetric emergency room, ambulatory discharge) out of the nine contact environments. Tuberculin conversion rates were associated with the room cubations of the exposure environments (chi (2) for trend, P < 0.01) and with worker age. In a logistic regression model adjusted for age, the lower room cubation was found the strongest predictor for tuberculin conversion (OR = 2.46, P = 0.02). CONCLUSION: The study shows that the factors affecting airborne mycobacterial dose (patient infectiousness, low sized confined rooms) were the major determinants for MTB transmission after a brief exposure to a highly infectious TB case.
Adult↗
Performance of two immunosorbent assay kits for the detection of serum immunoglobulin G to Helicobacter pylori in untreated greek patients.
BACKGROUND: The performance of serological methods used to detect Helicobacter pylori varies with the ethnicity and prevalence of the infection in the community. We have prospectively evaluated the performance of two commercially available serum enzyme immunoassays (EIA) detecting H. pylori immunoglobulin G (IgG) antibodies in the sera of untreated Greek patients. METHODS: One-hundred-and-thirty consecutive untreated dyspeptic patients underwent endoscopy with biopsies from the gastric body (n = 2) and antrum (n = 2). Serum samples were also obtained from each patient. Serum H. pylori IgG antibody titres were determined with two EIA kits (Pyloriset EIA-G and Milenia H. pylori IgG). Sensitivities, specificities and optimal cut-off values of serum EIAs were determined for the population under investigation by using receiver operating characteristic (ROC) curve analysis and histology as gold standard. RESULTS: Ninety-seven patients were defined H. pylori-positive and 33 negative by histology. ROC curve analysis for the Pyloriset kit yielded 86% (95% CI, 78%-92%) sensitivity and 85% (68%-95%) specificity at an optimal cut-off value of >358 units/ml. The respective values for the Milenia kit were 86% (78%-92%) and 82% (65%-93%) at an optimal cut-off value of >51 units/ml. The suggested cut-off values of the manufacturers for Pyloriset and Milenia kits are >300 and >44 EIA units, respectively, which yield 2% and 4% higher sensitivity, but 9% lower specificity for both EIA kits. CONCLUSIONS: Both serum EIA kits performed well in our study. Our data show that EIA cut-off values should be optimized for the population under investigation.
Adolescent↗
Comparison of microbial community compositions of two subglacial environments reveals a possible role for microbes in chemical weathering processes.
Viable microbes have been detected beneath several geographically distant glaciers underlain by different lithologies, but comparisons of their microbial communities have not previously been made. This study compared the microbial community compositions of samples from two glaciers overlying differing bedrock. Bulk meltwater chemistry indicates that sulfide oxidation and carbonate dissolution account for 90% of the solute flux from Bench Glacier, Alaska, whereas gypsum/anhydrite and carbonate dissolution accounts for the majority of the flux from John Evans Glacier, Ellesmere Island, Nunavut, Canada. The microbial communities were examined using two techniques: clone libraries and dot blot hybridization of 16S rRNA genes. Two hundred twenty-seven clones containing amplified 16S rRNA genes were prepared from subglacial samples, and the gene sequences were analyzed phylogenetically. Although some phylogenetic groups, including the Betaproteobacteria, were abundant in clone libraries from both glaciers, other well-represented groups were found at only one glacier. Group-specific oligonucleotide probes were developed for two phylogenetic clusters that were of particular interest because of their abundance or inferred biochemical capabilities. These probes were used in quantitative dot blot hybridization assays with a range of samples from the two glaciers. In addition to shared phyla at both glaciers, each glacier also harbored a subglacial microbial population that correlated with the observed aqueous geochemistry. These results are consistent with the hypothesis that microbial activity is an important contributor to the solute flux from glaciers.
Bacteria↗
The role of lay workers in community health education: experiences of the North Karelia project.
The role of natural community leaders in serving as lay health workers in a comprehensive community health programme has been explored. In rural Finland, nearly 300 persons were trained to detect cardiovascular risk factors (smoking, high-cholesterol diet, high blood pressure) in their communities, and to advise community members of the desirability of lowering these risk factors. Initial data from studies of the lay health workers and their intervention work support the concept that carefully select community health workers who are to varying degrees representative of their local populations, can well act as intermediaries in preventive health care strategies.
Attitude to Health↗
Microbial diversity and resistance to copper in metal-contaminated lake sediment.
Contamination of habitats with heavy metals has become a worldwide problem. We describe herein the analysis of lake sediment contaminated with high concentrations of copper as a consequence of mine milling disposal over a 100-year period. Copper concentrations in the sediment were found to vary with depth and ranged from 200 to 5500 ppm. Analysis of the microbial community with T-RFLP identified a minimum of 20 operational taxonomic units (OTU). T-RFLP analysis along a depth profile detected as many as nine shared OTUs across 15 centimeters, suggesting a conservation of community structure over this range. Only two genera, Arthrobacter and Ralstonia, were detected among 50 aerobic copper-resistant isolates cultivated on R2A, one of which (Ralstonia sp.) was characterized by the sequestration of copper, identified by electron diffraction scanning, in growing colonies. Scanning electron microscopy showed changes to the outer envelope of the cells when grown in the presence of copper. The copper-resistant Ralstonia isolates were also resistant to Ni, Cd, and Zn, showing two patterns of phenotypic resistant to these three metals in which either resistance to Zn or Ni was expressed in an isolate but never both.
Arthrobacter↗
Effects of pH and oxygen and ammonium concentrations on the community structure of nitrifying bacteria from wastewater
Shifts in nitrifying community structure and function in response to different ammonium concentrations (50, 500, 1,000, and 3,000 mg of N liter-1), pH values (pH 6.0, 7.0, and 8.2), and oxygen concentrations (1, 7, and 21%) were studied in experimental reactors inoculated with nitrifying bacteria from a wastewater treatment plant. The abilities of the communities selected for these conditions to regain their original structures after conditions were returned to the original conditions were also determined. Changes in nitrifying community structure were determined by performing an amplified ribosomal DNA (rDNA) restriction analysis of PCR products obtained with ammonia oxidizer-specific rDNA primers, by phylogenetic probing, by small-subunit (SSU) rDNA sequencing, and by performing a cellular fatty acid analysis. Digestion of ammonia-oxidizer SSU rDNA with five restriction enzymes showed that a high ammonium level resulted in a great community structure change that was reversible once the ammonium concentration was returned to its original level. The smaller changes in community structure brought about by the two pH extremes, however, were irreversible. Sequence analysis revealed that the highest ammonium environment stimulated growth of a nitrifier strain that exhibited 92.6% similarity in a partial SSU rRNA sequence to its nearest relative, Nitrosomonas eutropha C-91, although the PCR product did not hybridize with a general phylogenetic probe for ammonia oxidizers belonging to the beta subgroup of the class Proteobacteria. A principal-component analysis of fatty acid methyl ester data detected changes from the starter culture in all communities under the new selective conditions, but after the standard conditions were restored, all communities produced the original fatty acid profiles.
Journal Article↗