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Closing volume and flow volume abnormalities in alpha(1)-antitrypsin phenotype groups in a community population.

Alpha1-antitrypsin phenotype groups, found in a community population studied in Tucson, were compared by using the maximum expiratory flow volume curve and the single-breath nitrogen test, alone and in combination. Subjects 25 to 54 years of age were used for the comparison, among whom there were 728 Pi M, 29 Pi MZ, and 62 Pi MS phenotypes. None of the flow volume parameters or closing volume parameters was able to differentiate among the phenotype groups; subjects in groups heterozygous for alpha1-antitrypsin did not differ from individuals homozygous for Pi M with regard to any or all flow volume or closing volume parameters.

Adult

The impact of urinary schistosomiasis on the health of two community populations living in endemic areas in Tanzania.

Two populations living in separate areas in Tanzania known to be endemic for S. haematobium were investigated for the effects of the infection on community health. Both populations, each of about 450 examinees, had similar infection prevalences of 54-57% with peaks of 66-67% among the 5 to 19 year olds. Over 90% of the infections from either population were symptomatic showing mostly manifestations of vesical lesions. Radiological examinations of a random sample of 100 infected subjects from the population with the lower infection intensity revealed a high prevalence of 28% for bilateral uretero-renal lesions. The prevalence of urological lesions, including the potentially fatal uretero-renal lesions, was higher than hitherto reported from Tanzania. Urinary schistosomiasis was therefore considered to be of more serious public health importance in the country than has been accepted in the past.

Adolescent

Prevalence and risk factors for persistent faecal carriage of extended spectrum beta-lactamase producing Escherichia coli in a paediatric community population.

OBJECTIVE: To investigate clinical and microbiological factors associated with persistent faecal carriage of extended spectrum beta-lactamase (ESBL) producing Escherichia coli in infants. METHODS: Between 2010 and 2022, children aged 3 months to 2 years old were sampled in a community setting in France, at two visits, V1 and V2, 3-24 months apart, to screen for prolonged faecal carriage of ESBL-producing E. coli. Patient clinical information and whole genome sequence of each isolate were used for association studies. RESULTS: A total of 4641 children were sampled. 375 (8%) carried an ESBL-producing Enterobacterales, among which 142 of ESBL-producing E. coli carriers were once again sampled at V2 and included in this study. 21.8% (n = 31/142) and 18.4% (n = 16/99) carried the same ESBL-producing E. coli clone for at least 3 and 6 months, respectively. B2 phylogroup, and among which ST131 clones were associated with an increased risk of persistent carriage. Multivariate analysis identified virulence associated genes involved in adhesion (papC/papGII allele and a tia-like gene) and encoding toxin (senB) as major risk factors for persistence. A genome wide association study highlighted the potential role of the frz metabolic operon, known to be involved in enterocytes adhesion/internalisation. CONCLUSION: Main extraintestinal pathogenic E. coli genomic features (phylogenetic background, adhesion properties) are associated with ESBL-producing E. coli gut colonisation persistence in infants, which could potentially lead to an increased risk of febrile urinary tract infection in these patients.

Child

Prevalence of respiratory abnormalities in a rural and an urban community.

Population samples stratified on sex, age and smoking habits were studied in a rural and an urban community with a low level of air pollution to establish "normal" values of parameters derived from the single-breath N2 curve, the effect of smoking on these parameters, and any differences related to an urban or rural environment. Respiratory symptoms and past illnesses, smoking habits, and residential as well as occupational history were obtained by a respiratory questionnair. Pulmonary function was assessed by the single-breath N2 test and the forced vital capacity maneuver. In "healthy" nonsmokers, residual volume/total lung capacity, closing volume/vital capacity on expiration, and closing capacity/total lung capacity were significantly related to age. The slope of phase III was related to neither height nor age. There was no significant difference in prediction equations between the 2 communities for any of these parameters. Multiple regression analysis indicated that smoking had an effect on residual volume/total lung capacity, closing volume/vital capacity on expiration, closing capacity/total lung capacity, and the slope of phase III in both sexes. Abnormal values were more prevalent among male than female smokers in both communities, the highest prevalence being found in the slope of phase III in both sexes (35 to 40 per cent). The slope of phase III and closing capacity/total lung capacity were consistently related to the current number of cigarettes smoked per day.

Adult

Consideration on the effects of pollution at community and population level.

The effects of pollution at population level are considered in relation to demographic characteristics and overall to the birthrate. The direct and indirect effects of pollution on community structure is discussed. The influence of pollution may vary according to the food-chain structure; (as a consequence, the hazard 'ceteris paribus' will be greater in freshwater communities than in marine ones). Relations between 'diversity' and 'stability' are discussed. In addition, the advantages and difficulties in using 'diversity' and 'biotic' indices for monitoring polluted water are taken into account.

Animals

Delivering Mental Health Services to an ambulatory, low-income population. Lincoln Community Health Center, Durham, North Carolina.

The social work and mental health unit of a comprehensive neighborhood health center delivers mental health services in coordination with general health services to ambulatory patients in a predominantly low-income black community. The unit works with other general health, mental health, and social service resources to provide a broad continuum of coordinated care. Services are provided to individuals, families, and groups, along with consultation, education, training, and referral. Before the unit was established in July 1971, the patients it serves were seen only for crisis intervention and in emergency rooms and did not have the benefit of a thorough evaluation or follow-up. Staff of the unit now identify potential medical and emotional problems before they reach the crisis stage, and they maintain contact with the patients to ensure that the prescribed regimen is carried out.

Aftercare

Survey of psychiatric morbidity in a semi-urban population in Sri Lanka.

This paper reports a survey of psychiatric morbidity in a semi-urban community (population 7,653) in Sri Lanka. The entire population was first screened by social workers using a standardized interview. Probable cases were then examined by psychiatrists. Each psychiatric disorder identified was rated on four different parameters of severity, and only those rating moderate or severe were labelled as cases. The socio-demographic characteristics of the cases and the population at risk, and the frequency and nature of psychiatric disorders are presented in Tables. The 6-month period prevalence for all psychiatric disorders was 45.5 per 1,000, with psychoses amounting to 6.9 (males 5.5; females 8.4) per 1,000, and neuroses to 25.2 (males 9.9; females 40.6) per 1,000. The large majority of disorders were chronic and had not received psychiatric treatment. The relevance of these surveys in the provision of psychiatric services in developing countries is discussed.

Adolescent

Silent carriage of tigecycline- and carbapenem-resistant Klebsiella quasipneumoniae co-harbouring tetX(4) and blaNDM-1 in healthy individuals in China.

OBJECTIVES: To investigate the occurrence and genomic characteristics of tigecycline- and carbapenem-resistant Klebsiella quasipneumoniae isolated from healthy individuals in China. METHODS: During a nationwide screening programme, faecal samples from healthy community individuals were cultured for carbapenem-resistant Enterobacterales. Antimicrobial susceptibility testing, whole-genome sequencing and conjugation assays were performed for two K. quasipneumoniae isolates co-harbouring tet(X4) and blaNDM-1. RESULTS: Two K. quasipneumoniae strains carrying tet(X4) and blaNDM-1 were recovered from healthy individuals without recent hospitalisation or antibiotic exposure. Both isolates showed resistance to tigecycline (>8 μg/mL) and carbapenems (≥4 μg/mL). Genomic analysis demonstrated close clonal relatedness between the isolates (ST6460-1LV, KL151). The blaNDM-1 gene was located on an IncX3 plasmid associated with mobile genetic elements, whereas tet(X4) was carried by an IncX1 plasmid. Conjugation assays confirmed successful transfer of both resistance genes, which frequently co-transferred into recipient strains. CONCLUSIONS: To our knowledge, this is the first report of K. quasipneumoniae co-harbouring tet(X4) and blaNDM-1 in healthy individuals in China. The findings indicate that healthy community populations may serve as a hidden reservoir for last-resort antimicrobial resistance genes and underscore the importance of community-based surveillance within a One Health framework.

Klebsiella quasipneumoniae

Extension of health service coverage in Costa Rica.

Costa Rica's National Health Plan for 1971-1980 has given top priority to extension of health coverage--focusing especially on marginal rural and periurban areas. By June 1977 implementation of this plan had provided coverage for over 80 per cent of Costa Rica's scattered rural population. Community participation was being encouraged, together with an integrated approach to the problems of these marginal regions.

Community Health Services

Patterns of childhood mortality and growth status in a rural Zapotec community.

Infant and childhood mortality (birth to 14 years), and growth status of 143 schoolchildren (5 to 14 years) are considered for a rural, Zapotec-speaking community (population, 1703) in the Valley of Oaxaca, Mexico. Mortality statistics are based on civil records from 1945 to 1970. Growth status is based on weight and height for age, and weight for weight for height. In the Zapotec community, about 59% of all deaths occur in children under 15 years of age; thus, a considerable percentage of individuals die before reaching reproductive age. Children under 5 years of age, however, account for approximately 54% of all deaths, and mortality in children 1 to 4 years of age is especially high (27% of all deaths). The latter figure suggests chronic malnutrition, frequent disease and generally poor circumstances in the community. This suggestion is supported in the heights and weights of schoolchildren, survivors of the rigorous selection processes of the pre-school years. The majority of children are below the 5th centile for stature in well-nourished American children. Weight for height, however, approximates that of the USA reference data.

Adolescent

A comparison of three survey methods to obtain data for community mental health program planning.

A perennial problem for mental health planners is assessing community needs and existing services. The three most common methods used to obtain this data are the telephone survey, the mail-out questionnaire, and the face-to-face interview. However, there are advantages and disadvantages associated with each approach in terms of sampling, response rates, and economic costs. The present study utilized all three methods to survey the same community population in order to determine the comparability of obtained data and relative efficacy of the methods. A standard 21-item questionnaire was developed to obtain demographic and epidemiological data. This included nine Likert-type items to obtain opionions on a typical question such as "To what extent would you have confidence in recommending the Mental Health Center to members of your immediate family?" In the first method, survey teams made door-to-door interviews to complete 449 questionnaires on a random sample. In the second method, 1,000 questionnaires were mailed to a random sample with returns requested. In the third method, 224 people were randomly selected from the telephone directory and asked to respond to the questionnaire over the phone. Precautions were taken in all methods to ensure confidentiality of responses. All respondents were classified according to a two-factor index based on occupation and education. The data were analyed to determine whether comparable data were obtained through divergent methods. Results are discussed and implications are given for community mental health planners.

Community Mental Health Services

Relation of protease inhibitor phenotypes to obstructive lung diseases in a community.

To examine the relative risk for the development of obstructive lung disease in persons heterozygous for alpha1-antitrypsin deficiency, we determined protease inhibitor phenotypes in 2944 subjects in a general community population. Phenotype M was found in 89.5 per cent, MS in 7.1 per cent, and MZ in 3.0 per cent of the population. There were two persons of phenotype Z and six of phenotype SZ. The study also included respiratory questionnaires and spirometry. There were no statistically significant differences in the prevalence of respiratory symptoms and diagnoses or of ventilatory impairment among the three major phenotype groups (M, MS and MZ), nor were there differences in the rates of deterioration of function with age or smoking. Consequently, we do not consider population screening for heterozygous alpha1-antitrypsin deficiency to be worthwhile.

Adolescent

Epidemic kepone poisoning in chemical workers.

From March 1974 through July 1975, 76 (56%) of 133 persons who had worked at a pesticide plant that produced Kepone, a chlorinated hydrocarbon insecticide, contracted a previously unrecognized clinical illness characterized by nervousness, tremor, weight loss, opsoclonus, pleuritic and joint pain, and oligospermia. Illness incidence rates for production workers (64%) were significantly higher than for nonproduction personnel (16%). The mean blood Kepone level for workers with illness was 2.53 ppm and for those without disease 0.60 ppm (p less than 0.001). Blood Kepone levels in current workers (mean, 3.12 ppm) were higher than those in former employees (1.22 ppm). Blood Kepone levels for workers in nearby businesses and for residents of a community within 1.6 km of the plant ranged from undetectable to 32.5 ppb. Illness attributable to Kepone was found in two wives of Kepone workers; there was no apparent association between frequency of symptoms and proximity to the plant in the survey of the community population.

Chemical Industry

The Vermont epidemic of Legionnaires' disease.

Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.

Adolescent

A survey of a long-stay psychiatric population: implications for community services.

Two hundred and twenty long-stay psychiatric patients were surveyed by means of semi-standardized interviews and by obtaining information from nursing staff and case records. Each patient's needs for accommodation and employment were assessed as if immediate discharge from hospital were being contemplated. The results of the exercise emphasize the need for long-stay to permanent accommodation. The validity of this method of assessing community care requirements is discussed.

Activities of Daily Living