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A Story

Publications and source records attributed to A Story.

10 recordsLinked to original sources
PubMed2006

No increase in human cases of Mycobacterium bovis disease despite resurgence of infections in cattle in the United Kingdom.

A resurgence of Mycobacterium bovis infections in cattle in the United Kingdom since the 1980s has raised concern about risks to human health. Enhanced surveillance data for England, Wales and Northern Ireland between 1993 and 2003 of culture-positive human M. bovis cases identified 315 M. bovis infections; the mean annual number of cases was 28 (range 12-41). The most frequently reported exposures were consumption of unpasteurized dairy products 41/83 (49%) and exposure to cattle 45/123 (37%). Of all cases, 249 (83%) were born before 1960. Of 50 cases born after 1960, only 14 were born in the United Kingdom. Over the same time period the annual number of new herd infections increased from 332 to 1749 as derived from the UK State Veterinary Service database. In conclusion, despite a more than fivefold increase in cattle herd infections during the 1990s, there was no increase in reported human cases.

Adult↗
PubMed2006

Epidemiology and response to the growing problem of tuberculosis in London.

As in other countries with low tuberculosis incidence, tuberculosis in England and Wales tends to be concentrated in some subgroups of the population, and is mainly a problem in large cities. In 2003, almost half of all tuberculosis cases reported in England and Wales were from London, where the incidence was almost five times higher than in the rest of England and Wales. While the highest proportion of cases occur in foreign born patients, evidence from a large outbreak of drug resistant tuberculosis points to ongoing active transmission among marginalised groups including homeless people, hard drug users, and prisoners. Increasing rates of disease and levels of drug resistance, combined with a concentration of disease in hard-to-reach risk groups now present a major challenge to tuberculosis control in the city. To respond to the changing epidemiology observed in recent years, treatment and control services are being reconfigured, surveillance has been improved with the implementation of the London TB register, and the utility of mobile digital x ray screening for at risk populations such as homeless people and prisoners is being evaluated. However, tuberculosis in London is not yet under control and more needs to be done. Services must adapt to the needs of those groups now most affected. This will require continued improvements to surveillance and monitoring, combined with improved access to care, better case detection, rapid diagnosis and active social support for people undergoing treatment.

Journal Article↗
PubMed2004

Explaining risk factors for drug-resistant tuberculosis in England and Wales: contribution of primary and secondary drug resistance.

Drug-resistant tuberculosis can be transmitted (primary) or develop during the course of treatment (secondary). We investigated risk factors for each type of resistance. We compared all patients in England and Wales with isoniazid- and multidrug-resistant tuberculosis in two time-periods (1993-1994 and 1998-2000) with patients with fully sensitive tuberculosis, examining separately patients without and with previous tuberculosis (a proxy for primary and secondary drug-resistant tuberculosis). Patients with previous tuberculosis smear positivity and arrival in the United Kingdom <5 years were strongly associated with multidrug resistance and isoniazid resistance. In patients with no previous tuberculosis HIV infection, residence in London and foreign birth were risk factors for multidrug resistance, and non-white ethnicity, residence in London and HIV infection for isoniazid resistance. Risk factors for each type of resistance differ. Elevated risks associated with London residence, HIV positivity, and ethnicity were mainly seen in those without previous tuberculosis (presumed transmission).

Adolescent↗
PubMed2001

Tuberculosis in disadvantaged groups.

Tuberculosis remains predominantly a disease of the disadvantaged and marginalized. The incidence of the disease is increasing in many industrially developed countries, particularly among the poor, ethnic minorities, prisoners and other institutionalized persons, and the socially isolated and hard to reach groups. Strengthening of the tuberculosis services is required to care for these groups. Millions of people in the developing nations are disadvantaged by poverty and inequity, and recent health sector reforms have not always been entirely in their interest. A further serious problem is the HIV/AIDS pandemic, which not only facilitates the spread of tuberculosis but, by its associated stigma, leads to delayed treatment seeking and poor adherence to therapy. In recent times, emphasis has moved away from didactic principles of tuberculosis "control" to community-and patient-centered health services, based on analysis of local factors affecting case finding and adherence to therapy.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Necropsies in African children: consent dilemmas for parents and guardians.

BACKGROUND: Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS: To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS: A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS: Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a "waste of time," as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS: It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services.

Adolescent↗