bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural Community‐dwelling Elders' Reports of Access to Care: Are There Hispanic versus non‐Hispanic White Disparities?
Authors: Borders Tyrone F.
Published: June 2006

ABSTRACT: Context: Consumer reports can provide useful information about the dimensions of access in need of improvement for particular population subgroups. Purpose: To determine if there are Hispanic versus non‐Hispanic white disparities in rural elders' reports of their health care access. Methods: A telephone survey was conducted among 2,097 rural community‐dwelling elders in West Texas. Dependent variables included reports of the ability to obtain care (see personal doctor/nurse, see specialist, obtain help over phone, and obtain transportation to the clinic) and reports of the ability to obtain care without a long wait (get help over the phone without a long wait, see provider for illness/injury when wanted, see provider for routine care when wanted, and have short office waiting times). Independent variables included predisposing, enabling, and need factors. Univariate and multivariate logistic regression analyses were conducted. Findings: In univariate logistic analyses, Hispanics had worse reports of their ability to always/usually see their personal doctor, see a specialist, obtain transportation to the clinic, see a doctor for illness/injury when wanted, and see a doctor for routine care when wanted. When adding enabling factors to the models, only reports of the ability to see a doctor for illness or injury and for routine care when wanted remained significant. Conclusions: Though the rural medical care system may need to target directly Hispanics to improve their timely access to acute and routine care, the enhancement of health insurance coverage may lead to improved access to personal doctors and specialists among all rural elders.
Health Differences Among Lumbee Indians Using Public and Private Sources of Care
Authors: Bryant Alfred , Goins R. Turner , Bell Ronny , Herrell Richard , Manson Spero M. , Buchwald Dedra
Published: June 2006

ABSTRACT: Context: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. Purpose: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non‐IHS public versus private physicians as sources of usual care. Methods: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self‐examination, and medical conditions. Frequencies, chi‐squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. Findings: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. Conclusions: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted.
Cost Analysis in Telemedicine: Empirical Evidence From Sites in Arizona
Authors: de la Torre Adela , Hernández‐Rodríguez Clemente , García Lorena
Published: June 2006

ABSTRACT: Context: Support of telemedicine for largely rural and ethnically diverse populations is premised on expectations that it increases opportunities for appropriate and timely medical services, and that it improves costeffective service delivery. Purpose: To understand the cost‐effectiveness of telemedicine in 8 small and/or rural sites in Arizona. Methods: A cost analysis framework was used to measure the efficacy of telemedicine in the selected sites from May 1, 2000, to April 30, 2001. Findings: The costs for telemedicine services in half the study sites were more than the costs for conventional face‐to‐face diagnosis when the volume of telemedicine services used at a site was relatively low. This result persisted even when the opportunity cost for the patients in accessing more traditional types of care was included in the cost estimates. Conclusions: These preliminary findings suggest that telemedicine in some instances may not be cost‐effective for providing medical specialists for underserved communities, particularly if these networks are underutilized by the patient population. Further analyses are needed to assess factors influencing utilization patterns of telemedicine services by underserved and ethnic communities before implementing these programs at clinical sites.
Stress Among Migrant and Seasonal Farmworkers in Rural Southeast North Carolina
Authors: Kim‐Godwin Yeoun Soo , Bechtel Gregory A.
Published: June 2006

ABSTRACT: Context: Although funding to enhance the delivery of health care among migrant farmworkers has primarily focused on urgent care issues within this population, the etiology of mental health risks and perceived stress is poorly understood. Purpose: To identify the type and severity of stress perceived by migrant and seasonal farmworkers in rural southeast North Carolina. Methods: During the pre‐agricultural season in 2002, 151 migrant and seasonal farmworkers completed the 39‐item Migrant Farmworker Stress Inventory (MFWSI) in either English or Spanish. Findings: Fifty‐one percent (n = 77) of the respondents perceived themselves at a high level of stress (mean score above 80 of “caseness”) that may subsequently put them at greater risk for experiencing psychological difficulties. The stressors highly ranked (mean.2.5 in a maximum of 4, with “extremely stressful” in a 5‐point Likert scale 0 to 4) were related to their mobile lifestyle, language barriers, insecure job and legal status, financial restraint, and long working hours. Also, drug and alcohol use in the migrant community was found to be one of the significant sources of stressors. Variables influencing high levels of stress include education, social support, religion, marital status, and age. Despite a relatively high level of perceived stress, the majority of respondents (71.5%) viewed their physical health as either “good” or “excellent.”Conclusions: Findings from the study suggest the availability of social support systems may provide significant insight into developing appropriate health services for migrant and seasonal farmworkers and their families.
Rural Mexican‐American Adolescent Sexual Risk Behavior
Authors: Champion Jane Dimmitt , Kelly Pat , Shain Rochelle N. , Piper Jeanna M.
Published: June 2006

ABSTRACT: Context: There is a need for community‐based, culturally sensitive, cognitive‐behavioral interventions to reduce sexual risk behavior among minority adolescents. Studies of adolescent risk and protective behaviors have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural minority adolescent women. Purpose: To examine the protective and risk behaviors of these rural Mexican‐American adolescent women and their relationship to physical or sexual abuse. Methods: Mexican‐American adolescent women aged 14–19 years were recruited through a rural health clinic and administered a self‐report assessment for protective and risk behavior and sexual, physical, and psychological abuse. Findings: Rural minority adolescent women endured high levels of psychological distress and many risk behaviors yet experienced few protective behaviors. Barriers to health care included access and confidentiality. Physically or sexually abused adolescents endured relatively greater risk and fewer protective behaviors than nonabused. Conclusions: Rural Mexican‐American adolescent women may benefit from confidential identification and assessment of abuse history and risk and protective behaviors so that appropriate psychological treatment can accompany accessible medical treatment. The prevalence of risk behaviors and abuse among these women presents a need for development of behavioral interventions for risk reduction and promotion of health protective behaviors.
“A 28‐Day Program Ain't Helping the Crack Smoker”—Perceptions of Effective Drug Abuse Prevention Interventions by North Central Florida African Americans Who Use Cocaine
Authors: Brown Emma J. , Hill Mary Angelique , Giroux Stacey A.
Published: June 2006

ABSTRACT: Context: Cocaine is a major problem in the rural South, but knowledge is limited regarding the impact on African American populations. Purpose: This study of 18–39‐year‐old black drug users assessed perceptions of contributing factors to drug use and possible interventions. Methods: The study design was qualitative‐descriptive, utilizing 4 focus groups with 5 rural women and 14 small‐city residents. Findings: Some respondents perceived that drug use initiation and continuation were due to themes of (1) loss, (2) peer pressure, (3) personal problems and dealing with pain, (4) desire for fun or to “feel good,” and (5) drugs and drug‐related messages within their environments. Common themes of effective strategies to stop drug use were (1) the necessity of wanting to quit, (2) the importance of help or support from family and friends, and (3) the need for resources, such as a job, car, and housing. Some respondents agreed on 3 human resources: (1) family, (2) ex‐users, and (3) churches. Strategies to increase attendance at drug prevention programs included (1) making the program fun/enjoyable, (2) having mixed gender programs, (3) providing food/money, and (4) having the programs in their community. Recurrent themes were the lack of drug prevention intervention programs available to respondents and the failure of traditional programs of the majority culture to adequately meet their needs. Conclusion: Effective drug prevention programs for southern African Americans who use cocaine must be community based, personalized, and culturally relevant.
Correlates of Physician Visits Among Children and Adolescents in West Texas: Effects Of Hyperglycemia Symptoms
Authors: Arif Ahmed A. , Venati Girikumar , Borders Tyrone F. , Rohrer James E.
Published: June 2006

ABSTRACT: Context: Health care services use by children varies tremendously. Because of the increasing prevalence of diabetes in children and adolscents, one of the major concerns is access to physician care among children with diabetes and diabetes symptoms. Purpose: This population‐based cross‐sectional study examines correlates of physician visit among children and adolescents living in west Texas. Methods: A telephone survey was administered in 2002 to a random sample of households in 106 counties of West Texas. The sample included 5,462 respondents with children aged between 3 and 18 years. Proportional odds ordered logistic regression analysis was used to determine correlates of physician visits in the previous 12 months. Findings: Hispanic children were less likely than non‐Hispanic whites to have a recent physician visit; there were no significant rural‐urban differences. Children with insurance (adjusted odds ratio=2.21, 95% CI =1.89–2.59) were more likely to visit physicians. Almost 16% of children in this study did not have any health insurance coverage. Children reporting 3 or more hyperglycemia symptoms and those with a family history of diabetes had 1.81 times and 1.20 times the odds of visiting the physician. Conclusions: Presence of health insurance and increasing symptoms of diabetes were found to influence the utilization of physician services. Since most of the cases of diabetes that have recently been diagnosed among Texas youth are type 2 diabetes, it is important that adolescents and their parents are educated about the risk factors and how to recognize them.
What Would Be the Effect of Referral to High‐Volume Hospitals in a Largely Rural State?
Authors: Ward Marcia M. , Jaana Mirou , Wakefield Douglas S. , Ohsfeldt Robert L. , Schneider John E. , Miller Thomas , Lei Yang
Published: June 2006

ABSTRACT: Context: Volume of certain surgical procedures has been linked to patient outcomes. The Leapfrog Group and others have recommended evidence‐based referral using specific volume thresholds for nonemergent cases. The literature is limited on the effect of such referral on hospitals, especially in rural areas. Purpose: To examine the impact of evidence‐based referral by volume standard for 5 hospital procedures (abdominal aortic artery repair, coronary angioplasty, coronary artery bypass graft, esophageal cancer surgery, and pancreatic resection) in a largely rural state. Methods: Healthcare Cost and Utilization Project Iowa State Inpatient Dataset was analyzed to identify hospitals meeting the volume standard versus those not meeting the standard. Findings: Relatively few hospitals perform these procedures in Iowa. Hospitals performing the procedures at a volume above the threshold standard set by the Leapfrog Group tend to be larger, receive more transfers from other hospitals for these procedures, and perform fewer of these procedures on an emergency basis. In Iowa, hospitals that met the volume standard did not differ from hospitals that did not meet the volume standard in risk‐adjusted mortality rates. The impact of evidence‐based referral would be substantial in terms of travel time for some procedures (ie, coronary artery bypass graft, pancreatic resection, and esophageal cancer surgery) and produce considerable lost revenue for some hospitals. Conclusions: Evidence‐based referral would be associated with substantial burden for some patients and hospitals in Iowa. This negative impact does not appear to be offset by improvement in in‐hospital mortality rates. These initial findings suggest that there are a number of issues that need to be considered, especially in a rural state, before evidence‐based referral is embraced as a means to enhance patient outcomes.
The Federal Employees Health Benefits Program: Model for Competition in Rural America?
Authors: Mueller Keith J. , McBride Timothy D. , Andrews Courtney , Fraser Roslyn , Xu Liyan
Published: June 2006

ABSTRACT: Context: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created the Medicare Advantage (MA) program, which promotes the entry of private Preferred Provider Organization (PPO) plans into regions that have not previously had Medicare managed care plans. The assumption that a competitive environment will develop is based on experiences in the Federal Employees Health Benefits Program (FEHBP). Purpose: The authors test the hypothesis that the FEHBP has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas. Methods: Data from the US Office of Personnel Management are used to quantify the number of FEHBP‐certified plans in each US county and the number of enrollees in each plan. Data from the Area Resource File are used to measure independent variables in multivariate analysis to account for the number of FEHBP‐certified health plans competing in each US county. Findings: While 98% of all counties have at least 3 plans with enrollment, in many sparsely populated rural areas, only 1 of the plans is an open‐enrollment plan (excludes plans for letter carriers). There is a strong relationship between the number of FEHBP plans and areas with high population counts and high population density. In many counties with low population counts (under 3,000), most PPOs are not contracting with the nearest primary care provider. Conclusions: The FEHBP is not a perfect predictor of MA plan activity because the MA program does not use the FEHBP approach of certifying regional plans that must offer local access. However, the FEHBP experience indicates that plans are attracted to areas with high population counts and high population density.
Assisted Living in Rural America: Results From a National Survey
Authors: Hawes Catherine , Phillips Charles D. , Holan Scott , Sherman Michael , Hutchison Linnae L.
Published: June 2006

ABSTRACT: Context: Expanding the availability of long‐term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that has been growing in popularity is assisted‐living facilities (ALFs). Purpose and Methods: This paper describes rural ALFs and compares them with metropolitan ALFs. Data were collected using a multistage sample design that yielded a nationally representative sample of ALFs. Telephone interviews were completed with administrators of 1,251 ALFs in 1998. Findings: Nationwide, assisted living was largely administered by private payment, and there was an undersupply in rural areas. Compared with metropolitan ALFs, rural ALFs were smaller and less likely to offer the types of services and accommodations associated with the philosophy of assisted living. They were more likely to offer accommodations with little privacy, and while similar in the services they offered, rural ALFs were less likely to have nurses on staff, particularly licensed practical nurses. Moreover, they were less likely to offer a combination of high services and high privacy. Finally, rural ALFs charged lower prices than urban ALFs; however, the average price was still unaffordable for most elderly rural residents. Conclusions: These findings suggest that assisted living, as currently structured, will make only a marginal contribution to meeting the needs of frail elders in rural areas.
Delivery Complications Associated With Prenatal Care Access for Medicaid‐Insured Mothers in Rural and Urban Hospitals
Authors: Laditka Sarah B. , Laditka James N. , Bennett Kevin J. , Probst Janice C.
Published: June 2006

ABSTRACT: Context: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. Purpose: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Methods: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, X2, t tests, and multivariate logistic regression. Findings: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non‐Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non‐Hispanic whites. Conclusions: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.
Herbal Remedies Used by Selected Migrant Farmworkers in El Paso, Texas
Authors: Poss Jane , Pierce Rebecca , Prieto Veronica
Published: June 2006

ABSTRACT: Context: Little is known about the use of complementary and alternative medicine among the approximately 1.6 million migrant farmworkers in the United States. Purpose: To evaluate the use of medicinal plants and natural remedies among a convenience sample of 100 migrant farmworkers living temporarily in a migrant worker center in El Paso, Texas. Methods: A structured interview instrument was designed to elicit information about reasons for medicinal herb use, form in which herbs were ingested, serious side effects experienced, location of purchase, effectiveness of treatment, and use of allopathic medications. Findings: The majority of workers used herbal remedies or other natural products because they believed them to be more effective than pharmaceuticals and because of tradition. Most learned about herbal remedies from a relative, primarily from their mother, and the majority who used herbal remedies believed them to be very helpful in treating specific illnesses. No adverse reactions to any herbal remedy were reported. The majority of participants did not inform their physician about their use of herbal remedies. According to the literature, potential adverse interactions between herbal remedies used and allopathic medications included gastrointestinal irritation, renal toxicity, and hypoglycemia. Conclusions: Health care providers must be knowledgeable about the use of herbal remedies among migrant farmworkers. By showing an understanding of and sensitivity to the use of these remedies, health care providers will be able to conduct more comprehensive health assessments of migrant workers and their families and provide them with more culturally competent care.
Effect of endurance training on muscle microvascular filtration capacity and vascular bed morphometry in the elderly
Authors: Charles M. , Charifi N. , Verney J. , Pichot V. , Feasson L. , Costes F. , Denis C.
Published: June 2006

Aim:  Exercise training is a strong stimulus for vascular remodelling and could restore age‐induced vascular alterations. The purpose of the study was to test the hypothesis that an increase in vascular bed filtration capacity would corroborate microvascular adaptation with training.

Methods:  We quantified (1) microvascularization from vastus lateralis muscle biopsy to measure the capillary to fibre interface (LC/PF) and (2) the microvascular filtration capacity (Kf) in lower limbs through a venous congestion plethysmography procedure. Twelve healthy older subjects (74 ± 4 years) were submitted to a 14‐week training programme during which lower‐limbs were trained for endurance exercise.

Results:  The training programme induced a significant increase in the aerobic exercise capacity of lower limbs (+11%Vo2peak; P < 0.05; +28% Citrate Synthase Activity; P < 0.01). Kf was largely increased (4.3 ± 0.9 10−3 mL min−1 mmHg−1 100 mL−1 post‐training vs. 2.4 ± 0.8 pre‐training, mean ± SD; P < 0.05) and microvascularization developed as shown by the rise in LC/PF (0.29 ± 0.06 post‐ vs. 0.23 ± 0.06 pre‐training; P < 0.05). Furthermore, Kf and LC/PF were correlated (r = 0.65, P < 0.05).

Conclusion:  These results demonstrated the microvascular adaptation to endurance training in the elderly. The increase in Kf with endurance training was probably related to a greater surface of exchange with an increased microvessel/fibre interface area. We conclude that measurement of the microvascular filtration rate reflects the change in the muscle exchange area and is influenced by exercise training.
Antidiphtheria Antibody Responses in Patients and Carriers ofCorynebacterium diphtheriaein the Arkhangelsk Region of Russia
Authors: Danilova Elena , Jenum Pål A. , Skogen Vegard , Pilnikov Valentin F. , Sjursen Haakon
Published: June 2006

Diphtheria is under control in industrialized countries. However, single cases and outbreaks still occur and the disease is not completely understood. Forty-three individuals suspected of having diphtheria who were referred to the Infectious Disease Hospital of Arkhangelsk from December 1994 to March 1995 were included in this study. Fifteen patients were diagnosed as having diphtheria and received equine hyperimmune antidiphtheria toxin antiserum, and 28 were diagnosed as carriers, 12 with nondiphtherial tonsillitis or pharyngitis and 16 without symptoms. Serum samples were obtained on admission and during the course of the disease or during follow-up of carrier status. Samples were analyzed for antibodies against diphtheria toxin with both an in vitro neutralization test (NT) and a human-specific enzyme immunoassay. All of the cases but one were confirmed by a positive culture. Twelve patients had pharyngeal diphtheria, and three had combined laryngeal and pharyngeal disease. Half of the patients had life-threatening disease, and one died. On admission, the median antibody titers measured with the NT were 0.085 IU/ml for the patients, 5.12 IU/ml for the symptomatic carriers, and 10.24 IU/ml for the healthy carriers. All of the diphtheria patients but one and nine of the carriers (six symptomatic and three healthy) had increased antibody levels during the first 7 to 10 days after admission. No obvious correlation was revealed between the antibody level or its kinetics and the course of the disease. Antibody levels on admission of >1 IU/ml were associated with a low risk of diphtheria.
Analysis of Serum Antibodies in Patients Suspected of Having Inflammatory Bowel Disease
Authors: Jaskowski Troy D. , Litwin Christine M. , Hill Harry R.
Published: June 2006

Inflammatory bowel disease (IBD) is the general term used for a heterogeneous group of intestinal disorders, including Crohn's disease (CD) and ulcerative colitis (UC). Serological markers such as anti-
Saccharomyces cerevisiae
antibodies (ASCA) and atypical perinuclear antineutrophilic cytoplasmic antibody (atypical pANCA) have proven useful in the diagnosis and differentiation of CD and UC. Immunoglobulin A (IgA) antibody directed against the outer membrane protein C (OmpC) of
Escherichia coli
is said by one group to have clinical utility in diagnosing IBD, specifically in ASCA-negative CD patients. Our objective in this study was to compare the results obtained from two separate laboratories offering similar IBD tests using sera from suspected IBD patients. One hundred ninety-seven sera received for IBD testing were included in the study. The agreement between the two laboratories was 93.4% for ASCA IgA, 90.9% for ASCA IgG, and 87.8% for atypical pANCA IgG. There were 25 sera with ASCA-negative/OmpC-positive results reported by one laboratory. Thirteen of these 25 (52.0%) ASCA-negative/OmpC-positive sera were also atypical pANCA positive (9 as determined by both laboratories, 3 by one, and 1 by the other). Atypical pANCA antibody is found primarily in IBD patients with UC and colon-limited CD (Crohn's colitis). We conclude that the ASCA and atypical pANCA assays showed good agreement between the two laboratories, but the data for ASCA-negative/OmpC-positive sera suggest that many (52.0%) of these patients were more likely to have had UC or Crohn's colitis based on the presence of an atypical pANCA.
Fatal Myocardial Necrosis Caused by
Staphylococcus lugdunensis
and Cytomegalovirus in a Patient with Scleroderma
Authors: Pirilä Laura , Söderström Karl-Ove , Hietarinta Marja , Jalava Jari , Kytö Ville , Toivanen Auli
Published: June 2006

A 42-year-old woman developed a rapidly progressing fatal heart failure. At the autopsy extensive necrosis of the myocardium was seen, with an almost complete absence of inflammatory cells and the presence of bacterial structures identified as
Staphylococcus lugdunensis
by PCR. In addition, the cytomegalovirus genome was found to be located inside the cardiomyocytes.
Identification of Extended-Spectrum, AmpC, and Carbapenem- Hydrolyzing β-Lactamases in
Escherichia coli
and
Klebsiella pneumoniae
by Disk Tests
Authors: Jacoby George A. , Walsh Kelley E. , Walker Victoria J.
Published: June 2006

Antibiotic disks with and without clavulanic acid, 3-aminophenylboronic acid, or EDTA were tested with a set of 55
Klebsiella pneumoniae
and
Escherichia coli
strains producing well-characterized extended-spectrum, AmpC, or carbapenem-hydrolyzing β-lactamases. A relatively simple scheme was devised for distinguishing β-lactamase types in clinical isolates with or without intact outer membrane porins.
Isolation of
Bartonella henselae
DNA from the Peripheral Blood of a Patient with Cat Scratch Disease up to 4 Months after the Cat Scratch Injury
Authors: Arvand Mardjan , Schäd Susanne G.
Published: June 2006

We report the case of a girl with cervical lymphadenitis and a persistent primary lesion of cat scratch disease (CSD).
Bartonella henselae
DNA was isolated from plasma samples collected 3 and 4 months after the cat scratch, indicating that recurrent and long-term shedding of
Bartonella
DNA into peripheral blood may occur in typical CSD.
Evaluation of the Epidemiological Relevance of Variable-Number Tandem-Repeat Genotyping ofMycobacterium bovisand Comparison of the Method with IS6110Restriction Fragment Length Polymorphism Analysis and Spoligotyping
Authors: Allix Caroline , Walravens Karl , Saegerman Claude , Godfroid Jacques , Supply Philip , Fauville-Dufaux Maryse
Published: June 2006

Sources ofMycobacterium boviscontamination remain unclear for many cases of animal and human disease. A major limitation is the lack of sufficiently informative or epidemiologically well evaluated molecular methods for typing. Here, we report an evaluation of a high-throughput method based on 29 mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) loci to genotype 127M. bovisisolates from cattle from 77 different Belgian farms, representative of a nationwide collection obtained from 1995 to 2003. MIRU-VNTR stability was demonstrated by analyzing a series of 74 isolates in total, obtained from different animals from a single farm or from different farms with an identified epidemiological link. The genotyping results and the genotypic diversity (h) were compared with those obtained by IS6110restriction fragment length polymorphism (RFLP) analysis and spoligotyping. Among 68 isolates with no known epidemiological link, MIRU-VNTR typing discriminated better than either RFLP analysis or spoligotyping, with isolates taken individually (32 versus 16 and 17 genotypes;h= 0.91 versus 0.73 and 0.85, respectively) or in combination (32 versus 28 genotypes;h= 0.91 versus 0.92). Maximal resolution was already achieved with a subset of 9 loci. The observed congruence of the genetic relationships based on IS6110RFLP analysis, spoligotyping, and MIRU-VNTR markers is consistent with a clonal population structure ofM. bovis.These results support MIRU-VNTR typing as a convenient and discriminatory technique for analysis of the population structure ofM. bovisin much greater detail and for addressing some still unresolved issues in the epidemiology of the pathogen.
Novel Recombinant Norovirus Causing Outbreaks of Gastroenteritis in Santiago, Chile
Authors: Vidal Roberto , Roessler Patricia , Solari Verónica , Vollaire Jimena , Jiang Xi , Matson David O. , Mamani Nora , Prado Valeria , O'Ryan Miguel L.
Published: June 2006

Capsid and polymerase (RdRp) genes of 13 norovirus outbreak strains from Chile were compared. The genes sequences were discordant for five strains, and recombination was confirmed for two of them by amplification of a 1,360-bp gene segment containing a fragment of both genes. These strains belonged to a novel genogroup by RdRp sequence and to genogroup GII/3 by capsid sequence. Determining the clinical and epidemiological impact of human calicivirus recombination will require future studies.
Nongastric
Helicobacter
Species Detected in the Intestinal Tract of Children
Authors: Zhang Li , Day Andrew , McKenzie Gavin , Mitchell Hazel
Published: June 2006

The presence of members of the family
Helicobacteraceae
in the colon of children was investigated using PCR, denaturing gradient gel electrophoresis, and fluorescent in situ hybridization. The rate of detection of species belonging to the
Helicobacteraceae
family in children with inflammatory bowel disease (92%) and irritable bowel syndrome (100%) was found to be significantly higher than that in healthy children (25%) (
P
< 0.05).
Use of the GenoType Mycobacterium CM and AS Assays To Analyze 76 Nontuberculous Mycobacterial Isolates from Greece
Authors: Gitti Zoe , Neonakis Ioannis , Fanti Garyfallia , Kontos Fanourios , Maraki Sofia , Tselentis Yiannis
Published: June 2006

Seventy-six nontuberculous mycobacterial isolates obtained from patients living in Greece were analyzed with the GenoType Mycobacterium CM (for common mycobacteria) and AS (for additional species) assays. GenoType correctly identified all but one of the mycobacterial species. For this species, additional probes should be designed and added to the strip.
First Report of Septicemia Caused by an Obligately Anaerobic
Staphylococcus aureus
Infection in a Human
Authors: Peake Sandra L. , Peter John Victor , Chan Louisa , Wise Rolf P. , Butcher Andrew R. , Grove David I.
Published: June 2006

In this case report, we describe the first instance of septicemia caused by an obligately anaerobic
Staphylococcus aureus
in a human. A 45-year-old man presented with septicemia, septic arthritis, and multiple pulmonary abscesses, which were caused by an obligately anaerobic
S. aureus
. The clinical and microbiological features that led to the diagnosis are discussed. Genotyping cannot at present reliably separate
S. aureus
subsp.
aureus
from
S. aureus
subsp.
anaerobius
, but phenotypic characteristics suggest that the present isolate is a previously undescribed strain of anaerobic
Staphylococcus aureus
.
An In-House RD1-Based Enzyme-Linked Immunospot-Gamma Interferon Assay Instead of the Tuberculin Skin Test for Diagnosis of LatentMycobacterium tuberculosisInfection
Authors: Codecasa Luigi , Mantegani Paola , Galli Laura , Lazzarin Adriano , Scarpellini Paolo , Fortis Claudio
Published: June 2006

Identification of individuals infected withMycobacterium tuberculosisis essential for the control of tuberculosis (TB). The specificity of the currently used tuberculin skin test (TST) is poor because of the broad antigenic cross-reactivity of purified protein derivative (PPD) with BCG vaccine strains and environmental mycobacteria. Both ESAT-6 and CFP-10, two secretory proteins that are highly specific forM. tuberculosiscomplex, elicit strong T-cell responses in subjects with TB. Using an enzyme-linked immunospot (ELISPOT)-IFN-γ assay and a restricted pool of peptides derived from ESAT-6 and CFP-10, we have previously demonstrated a high degree of specificity and sensitivity of the test for the diagnosis of TB. Here, 119 contacts of individuals with contagious TB who underwent TST and the ELISPOT-IFN-γ assay were consecutively recruited. We compared the efficacy of the two tests in detecting latent TB infection and defined a more appropriate TST cutoff point. There was little agreement between the tests (k = 0.33,P< 0.0001): 53% of the contacts with a positive TST were ELISPOT negative, and 7% with a negative TST were ELISPOT positive. Furthermore, respectively 76 and 59% of the ELISPOT-negative contacts responded in vitro to BCG and PPD, suggesting that most of them were BCG vaccinated or infected with nontuberculous mycobacteria. The number of spot-forming cells significantly correlated with TST induration (P< 0.0001). Our in-house ELISPOT assay based on a restricted pool of highly selected peptides is more accurate than TST for identifying individuals with latent TB infection and could improve chemoprophylaxis for the control of TB.
Development of a Sensitive and Specific Assay Combining Multiplex PCR and DNA Microarray Primer Extension To Detect High-Risk Mucosal Human Papillomavirus Types
Authors: Gheit Tarik , Landi Stefano , Gemignani Federica , Snijders Peter J. F. , Vaccarella Salvatore , Franceschi Silvia , Canzian Federico , Tommasino Massimo
Published: June 2006

The importance of assays for the detection and typing of human papillomaviruses (HPVs) in clinical and epidemiological studies has been well demonstrated. Several accurate methods for HPV detection and typing have been developed. However, comparative studies showed that several assays have different sensitivities for the detection of specific HPV types, particularly in the case of multiple infections. Here, we describe a novel one-shot method for the detection and typing of 19 mucosal high-risk (HR) HPV types (types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73, and 82). This assay combines two different techniques: multiplex PCR with HPV type-specific primers for amplification of viral DNA and array primer extension (APEX) for typing. This novel method has been validated with artificial mixtures of HPV DNAs and clinical samples that were already analyzed for the presence of mucosal HPV types by a different consensus PCR method, i.e., GP5+/GP6+. Our data showed a very good agreement between the results from the multiplex PCR/APEX assay and those from the GP5+/GP6+ PCR (overall rates of HPV positivity, 63.0 and 60.9%, respectively). Whereas the GP5+/GP6+ PCR was slightly more sensitive for the detection of HPV type 16 (HPV-16), multiplex PCR-APEX found a higher number of infections with HPV-33, HPV-53, and multiple HPV types. These favorable features and the high-throughput potential make our present novel assay ideal for large-scale clinical and epidemiological studies aimed at determining the spectrum of mucosal HR HPV types in cervical specimens.
Heterogeneity of Methicillin-SusceptibleStaphylococcus aureusStrains at a German University Hospital Implicates the Circulating-Strain Pool as a Potential Source of Emerging Methicillin-ResistantS. aureusClones
Authors: Layer F. , Ghebremedhin B. , König W. , König B.
Published: June 2006

Recently, we demonstrated rapid dissemination of different methicillin-resistantStaphylococcus aureus(MRSA) clones at the Institute for Microbiology at the University of Magdeburg (B. Ghebremedhin, W. König, and B. König, Eur. J. Clin. Microbiol. Infect. Dis.24:388-398, 2005). The majority of them harbored the readily transmissiblemeccassette type IV. Thus, theoretically, methicillin-susceptibleStaphylococcus aureus(MSSA) might capture themecAgene from circulating MRSA, or MRSA strains might catch mobile toxin genes from MSSA. Therefore, we characterized MSSA strains circulating at the University Hospital in Magdeburg. Among a total of 84 MSSA strains under study, about 40% possessed thetst(toxic shock syndrome toxin) gene and up to four additional enterotoxin genes.tst-positive MSSA strains belonged to all knownagrgroups (I to IV) and to 14 differentspatypes (t008, t012, t015, t019, t024, t056, t065, t127, t133, t162, t271, t287, t399, and t400), and they were classified by multilocus sequence typing (MLST) as ST1, ST8, ST30, ST39, ST45, ST101, ST121, ST395, and ST426. In contrast, simultaneously circulating MRSA strains (n= 24) harbored in general two or three genes of the enterotoxin gene cluster, and thetst-positive MRSA isolates belonged to the well-known epidemic types ST22, ST45, and ST228 and were classified asspatypes t001, t028, and t032. From our results, one may conclude that the pool of circulating MSSA strains is an important parameter with regard to the epidemiology of hospital- and community-acquired MRSA clones and their potential virulence.
Phylogenetic Analysis of Previously Nontypeable Hepatitis C Virus Isolates from Argentina
Authors: Gismondi María Inés , Becker Pablo Daniel , Valva Pamela , Guzmán Carlos Alberto , Preciado María Victoria
Published: June 2006

Phylogenetic analysis of hepatitis C virus isolates from Argentina that were previously nontypeable by restriction fragment length polymorphism (RFLP) analysis revealed that they belong to genotype 1a. A substitution at position 107 (G→A), which is the landmark of these strains, was shown to be distributed among isolates worldwide. The RFLP patterns obtained for these isolates should be added to the ones reported for genotype 1 isolates.
Correlation between Microdilution, E-test, and Disk Diffusion Methods for Antifungal Susceptibility Testing of Posaconazole against
Candida
spp
Authors: Sims Charles R. , Paetznick Victor L. , Rodriguez Jose R. , Chen Enuo , Ostrosky-Zeichner Luis
Published: June 2006

Agar-based antifungal susceptibility testing is an attractive alternative to the microdilution method. We examined the correlation between the microdilution, E-test, and disk diffusion methods for posaconazole against
Candida
spp. A total of 270 bloodstream isolates of
Candida
spp. with a broad range of posaconazole MICs were tested using the CLSI M27-A2 method for microdilution, as well as the M-44A method and E-test methods for agar-based testing on Mueller-Hinton agar supplemented with 2% glucose and 0.5 μg of methylene blue. MICs and inhibitory zone diameters at the prominent growth reduction endpoint were recorded at 24 and 48 h. The
Candida
isolates included
Candida albicans
(
n
= 124),
C. parapsilosis
(
n
= 44),
C. tropicalis
(
n
= 41),
C. glabrata
(
n
= 36),
C. krusei
(
n
= 20),
C. lusitaniae
(
n
= 3), and
C. dubliniensis
(
n
= 2). The overall concordance (i.e., the percentage of isolates within two dilutions) between the E-test and microdilution was 64.8% at 24 h and 82.6% at 48 h. When we considered an arbitrary breakpoint of ≤1 μg/ml, the agreement between the E-test and microdilution methods was 87.8% at 24 h and 93.0% at 48 h. The correlation of MICs with disk diffusion zone diameters was better for the E-test than the microdilution method. Zone correlation for diameters produced by the disks of two manufacturers was high, with a Pearson test value of 0.941 at 24 h. The E-test and microdilution MICs show good concordance and interpretative agreement. The disk diffusion zone diameters are highly reproducible and correlate well with both the E-test and the microdilution method, making agar-based methods a viable alternative to microdilution for posaconazole susceptibility testing.
The Continuing Story of Class IIa Bacteriocins
Authors: Drider Djamel , Fimland Gunnar , Héchard Yann , McMullen Lynn M. , Prévost Hervé
Published: June 2006

Many bacteria produce antimicrobial peptides, which are also referred to as peptide bacteriocins. The class IIa bacteriocins, often designated pediocin-like bacteriocins, constitute the most dominant group of antimicrobial peptides produced by lactic acid bacteria. The bacteriocins that belong to this class are structurally related and kill target cells by membrane permeabilization. Despite their structural similarity, class IIa bacteriocins display different target cell specificities. In the search for new antibiotic substances, the class IIa bacteriocins have been identified as promising new candidates and have thus received much attention. They kill some pathogenic bacteria (e.g.,
Listeria
) with high efficiency, and they constitute a good model system for structure-function analyses of antimicrobial peptides in general. This review focuses on class IIa bacteriocins, especially on their structure, function, mode of action, biosynthesis, bacteriocin immunity, and current food applications. The genetics and biosynthesis of class IIa bacteriocins are well understood. The bacteriocins are ribosomally synthesized with an N-terminal leader sequence, which is cleaved off upon secretion. After externalization, the class IIa bacteriocins attach to potential target cells and, through electrostatic and hydrophobic interactions, subsequently permeabilize the cell membrane of sensitive cells. Recent observations suggest that a chiral interaction and possibly the presence of a mannose permease protein on the target cell surface are required for a bacteria to be sensitive to class IIa bacteriocins. There is also substantial evidence that the C-terminal half penetrates into the target cell membrane, and it plays an important role in determining the target cell specificity of these bacteriocins. Immunity proteins protect the bacteriocin producer from the bacteriocin it secretes. The three-dimensional structures of two class IIa immunity proteins have been determined, and it has been shown that the C-terminal halves of these cytosolic four-helix bundle proteins specify which class IIa bacteriocin they protect against.
Carbohydrate Binding Modules: Biochemical Properties and Novel Applications
Authors: Shoseyov Oded , Shani Ziv , Levy Ilan
Published: June 2006

Polysaccharide-degrading microorganisms express a repertoire of hydrolytic enzymes that act in synergy on plant cell wall and other natural polysaccharides to elicit the degradation of often-recalcitrant substrates. These enzymes, particularly those that hydrolyze cellulose and hemicellulose, have a complex molecular architecture comprising discrete modules which are normally joined by relatively unstructured linker sequences. This structure is typically comprised of a catalytic module and one or more carbohydrate binding modules (CBMs) that bind to the polysaccharide. CBMs, by bringing the biocatalyst into intimate and prolonged association with its substrate, allow and promote catalysis. Based on their properties, CBMs are grouped into 43 families that display substantial variation in substrate specificity, along with other properties that make them a gold mine for biotechnologists who seek natural molecular “Velcro” for diverse and unusual applications. In this article, we review recent progress in the field of CBMs and provide an up-to-date summary of the latest developments in CBM applications.
Mortality from non-malignant diseases in a cohort of female pulp and paper workers in Norway
Authors: Langseth H , Kjærheim K
Published: June 2006

Objectives:The objective of the present study was to investigate the risk of death from non-malignant diseases in female pulp and paper workers in Norway.

Methods:A total of 3143 women first employed between 1920–93 were included in the study cohort. Information about each cohort member was obtained from personnel record files in the mills in order to identify employment periods and job categories. Data on cause and date of death were added by linkage to the Cause of Death Register using unique personal identification numbers. The follow up period was 1951–2000. Standardised mortality ratios (SMRs) with 95% confidence intervals (95% CIs) were calculated using the national female mortality rates as reference. Poisson regression analysis was used to examine internal relations between the duration of employment in paper departments and the risk of death from selected causes. Relative risks (RRs) and 95% CIs were calculated.

Results:The study showed a significantly increased risk for total non-malignant mortality (SMR = 1.14, 95% CI 1.05 to 1.24), mainly due to increased mortality from ischaemic heart disease (SMR = 1.22, 95% CI 1.03 to 1.43) and cerebrovascular diseases (SMR = 1.16, 95% CI 0.94 to 1.42). Analysis by department showed the highest risk of death in paper department workers with short term employment. Internal analyses showed a 5% and 9% increase in risk of dying from ischaemic heart disease and respiratory diseases, respectively, among paper department workers exposed to paper dust. The risk decreased with increasing duration of employment.

Conclusion:The increased risk of ischaemic heart diseases and respiratory diseases seen among employees of paper departments may be related to exposure to paper dust.