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Rance J, Lafferty L, Treloar C. Expert stakeholder perspectives on the acceptability of treatment-as-prevention in prison: a qualitative substudy of the 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C). Addiction 2021; 116:2761-2769. [PMID: 33751739 DOI: 10.1111/add.15477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment-as-prevention strategies in custodial settings, yet limited empirical data exists. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' study is the world's first trial of hepatitis C virus (HCV) treatment-as-prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment-as-prevention in prison using interview data from the SToP-C qualitative substudy. DESIGN AND SETTING Qualitative analysis using semi-structured interviews in Australia. PARTICIPANTS Nineteen key HCV experts. MEASUREMENTS Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude; ethicality; opportunity costs; and perceived effectiveness. FINDINGS Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention-as-prevention, including the improvement and expansion of existing harm reduction measures. CONCLUSIONS Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment-as-prevention in Australian prisons found no opposition to the universal rollout of direct-acting anti-virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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Henneberg M, Holloway-Kew K, Lucas T. Human major infections: Tuberculosis, treponematoses, leprosy-A paleopathological perspective of their evolution. PLoS One 2021; 16:e0243687. [PMID: 33630846 PMCID: PMC7906324 DOI: 10.1371/journal.pone.0243687] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/01/2021] [Indexed: 01/17/2023] Open
Abstract
The key to evolution is reproduction. Pathogens can either kill the human host or can invade the host without causing death, thus ensuring their own survival, reproduction and spread. Tuberculosis, treponematoses and leprosy are widespread chronic infectious diseases whereby the host is not immediately killed. These diseases are examples of the co-evolution of host and pathogen. They can be well studied as the paleopathological record is extensive, spanning over 200 human generations. The paleopathology of each disease has been well documented in the form of published synthetic analyses recording each known case and case frequencies in the samples they were derived from. Here the data from these synthetic analyses were re-analysed to show changes in the prevalence of each disease over time. A total of 69,379 skeletons are included in this study. There was ultimately a decline in the prevalence of each disease over time, this decline was statistically significant (Chi-squared, p<0.001). A trend may start with the increase in the disease’s prevalence before the prevalence declines, in tuberculosis the decline is monotonic. Increase in skeletal changes resulting from the respective diseases appears in the initial period of host-disease contact, followed by a decline resulting from co-adaptation that is mutually beneficial for the disease (spread and maintenance of pathogen) and host (less pathological reactions to the infection). Eventually either the host may become immune or tolerant, or the pathogen tends to be commensalic rather than parasitic.
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Affiliation(s)
- Maciej Henneberg
- Biological and Comparative Anatomy Research Unit, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
- Department of Archaeology, Flinders University, Adelaide, Australia
- * E-mail:
| | - Kara Holloway-Kew
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Teghan Lucas
- Department of Archaeology, Flinders University, Adelaide, Australia
- School of Medical Sciences, Anatomy, University of New South Wales, Sydney, New South Wales, Australia
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Van Der Walt M, Keddy KH. The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future. Front Psychiatry 2021; 12:617751. [PMID: 34140898 PMCID: PMC8203803 DOI: 10.3389/fpsyt.2021.617751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
The interplay between tuberculosis and depression has been problematic since the humoralists. Over the centuries similarities in disease management have transpired. With the advent of isoniazid chemotherapy, transformation of tuberculosis patients from morbidly depressive to euphoric was noted. Isoniazid was thereafter widely prescribed for depression: hepatotoxicity ending its use as an antidepressant in 1961. Isoniazid monotherapy led to the emergence of drug resistant tuberculosis, stimulating new drug development. Vastly increased investment into antidepressants ensued thereafter while investment in new drugs for tuberculosis lagged. In the 21st century, both diseases independently contribute significantly to global disease burdens: renewed convergence and the resultant syndemic is detrimental to both patient groups. Ending the global tuberculosis epidemic and decreasing the burden of depression and will require multidisciplinary, patient-centered approaches that consider this combined co-morbidity. The emerging era of big data for health, digital interventions and novel and repurposed compounds promise new ways to treat both diseases and manage the syndemic, but absence of clinical structures to support these innovations may derail the treatment programs for both. New policies are urgently required optimizing use of the current advances in healthcare available in the digital era, to ensure that patient-centered care takes cognizance of both diseases.
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Affiliation(s)
- Martie Van Der Walt
- Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa
| | - Karen H Keddy
- Tuberculosis Platform, South African Medical Research Council, Pretoria, South Africa
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Radović M, Đorđević A, Božanić B. The burden of tuberculosis as a permanent medical and legal challenge for mankind through centuries. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-30478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tuberculosis (TB) is a contagious disease, and throughout human history, it has been permanently opening numerous medical and legal questions, for which the answers are implied by the current social circumstances. In ancient times, insufficient knowledge of the etiopathogenesis of TB resulted in discrimination and isolation of patients. In the Middle Ages, kings used TB as a disease to secure their political power over the citizens, while TB culturally took a romanticized form during the 19th and 20th centuries, together with a great social phobia of contagion, disease, and dying on the other hand. Stereotypes were formed around all TB victims, while society tried to understand the nature of the disease and establish a civilizational relationship with it as a health problem having numerous social implications. Modern public health measures for the control of the TB pandemic were established after the discovery of the Koch bacillus in the 19th century. The invention and mass use of the BCG vaccine, the discovery of streptomycin and isoniazid, and the new era of TB treatment, with the consequent emergence of drug resistance, coepidemic with AIDS, neglect of public health facilities and the current COVID-19 pandemics threaten many legal rights of the infected and the sick and pose new challenges in its global elimination. Numerous attempts by society over the centuries to devise preventive and therapeutic measures for TB, through different levels of social obligations and activities, have had and continue to have a profound impact on the human race, shaping its further response to the victims of this deadly disease.
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Abstract
INTRODUCTION Certain real life applications of scientific and social science ideas that knowingly reject accumulated empirical biomedical evidence have been termed 'pseudoscience,' or empirical rejectionism. An uncritical acceptance of empiricism, or even of evidence-based medicine, however, can also be problematic. OBJECTIVES With reference to a specific type of medical denialism associated with moral failure, justified by dissident AIDS and anti-vaccine scientific publications, this paper seeks to make the argument that this type of denialism meets certain longstanding definitions for classification as pseudoscience. METHODS This paper uses a conceptual framework to make certain arguments and to juxtapose arguments for evidence-based approaches to medicine against literature that highlights certain limitations of an unquestioning approach to empiricism. RESULTS Discussions of certain real life examples are used to derive the important insight that, under certain conditions, moral failure can result in the violation both Type I and Type II scientific error types, with catastrophic consequences. CONCLUSION It is argued that the validity of all theory should not be assumed before sufficient empirical evidence has accumulated to support its validity across contexts. However, caution is required, to avoid the consequences of an unquestioning approach to empiricism.
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Affiliation(s)
- Chris Callaghan
- University of the Witwatersrand, School of Economic and Business Sciences
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Badu E, Mpofu C, Farvid P. Towards TB Elimination in Aotearoa/New Zealand: Key Informant Insights on the Determinants of TB among African Migrants. Trop Med Infect Dis 2018; 3:E44. [PMID: 30274440 PMCID: PMC6073404 DOI: 10.3390/tropicalmed3020044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022] Open
Abstract
Migrants living in low incidence countries, including New Zealand (NZ), are disproportionately affected by tuberculosis (TB). This foreign-born group poses important challenges to achieving the national TB elimination targets. Thus, the aim of this study was to contribute to the understandingof factors that influence the incidence of TB among African migrants living in NZ. We employed a semi-structured interview approach to explore the perceptions of NZ-based African community leaders, health professionals and a non-governmental TB support organisation about the wider determinants of TB. The findings, though not completely generalizable, suggest that many NZ-based Africans endure a difficult process of integration, perceive themselves as least susceptible to TB and have low awareness about available health services. Furthermore, the cost of general practitioner (GP) services, mistrust of health professionals, TB stigma and the NZ immigration policy were indicated as important barriers to TB services. Strategies to address TB among migrants must therefore be more holistic and not be centred on a fragmented approach that overemphasises the biomedical approaches, as the incidence of TB is more likely the outcome of a complex interplay of several underlying factors.
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Affiliation(s)
- Emmanuel Badu
- Department of Public Health, Auckland University of Technology (AUT), 90 Akoranga Drive, Northcote 0627, New Zealand.
| | - Charles Mpofu
- Department of Interprofessional Health Studies, Auckland University of Technology (AUT), 90 Akoranga Drive, Northcote 0627, New Zealand.
| | - Panteá Farvid
- Department of Psychology, Auckland University of Technology (AUT), 90 Akoranga Drive, Northcote 0627, New Zealand.
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Jackson C, Mostowy JH, Stagg HR, Abubakar I, Andrews N, Yates TA. Working conditions and tuberculosis mortality in England and Wales, 1890-1912: a retrospective analysis of routinely collected data. BMC Infect Dis 2016; 16:215. [PMID: 27207086 PMCID: PMC4875674 DOI: 10.1186/s12879-016-1509-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modelling studies suggest that workplaces may be important sites of Mycobacterium tuberculosis transmission in high burden countries today. Contemporary data on tuberculosis by occupation from these settings are scarce. However, historical data on tuberculosis risk in different occupations are available and may provide insight into workplace transmission. We aimed to ascertain whether, in a high burden setting, individuals working in crowded indoor environments (exposed) had greater tuberculosis mortality than individuals employed elsewhere (unexposed). METHODS The Registrar General's Decennial Supplements from 1890-2, 1900-2 and 1910-2 contain data on mortality from tuberculosis by occupation for men in England and Wales. In these data, the association between occupational exposure to crowded indoor environments and tuberculosis mortality was assessed using an overdispersed Poisson regression model adjusting for socioeconomic position, age and decade. RESULTS There were 23,962 deaths from tuberculosis during 14.8 million person-years of follow-up among men working in exposed occupations and 28,483 during 19.9 million person-years of follow-up among men working in unexposed occupations. We were unable to categorise a large number of occupations as exposed or unexposed. The adjusted rate ratio for death from tuberculosis was 1.34 (95 % confidence interval 1.26-1.43) comparing men working in exposed occupations to those in unexposed occupations. CONCLUSIONS Tuberculosis mortality in England and Wales at the turn of the 20th century was associated with occupational exposure to crowded indoor environments. The association between working conditions and TB in contemporary high burden settings requires further study.
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Affiliation(s)
- Charlotte Jackson
- />Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB UK
| | - Joanna H. Mostowy
- />Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB UK
| | - Helen R. Stagg
- />Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB UK
| | - Ibrahim Abubakar
- />Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB UK
- />MRC Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH UK
- />Tuberculosis Section, Public Health England, 61 Colindale Ave, London, NW9 5EQ UK
| | - Nick Andrews
- />Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Ave, London, NW9 5EQ UK
| | - Tom A. Yates
- />Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, 4th Floor Mortimer Market, off Capper Street, London, WC1E 6JB UK
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Reid A, Garrett E, Dibben C, Williamson L. 'A confession of ignorance': deaths from old age and deciphering cause-of-death statistics in Scotland, 1855-1949. THE HISTORY OF THE FAMILY : AN INTERNATIONAL QUARTERLY 2015; 20:320-344. [PMID: 26900320 PMCID: PMC4738191 DOI: 10.1080/1081602x.2014.1001768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/18/2014] [Indexed: 06/05/2023]
Abstract
A large amount of the research undertaken in an attempt to discover the reasons underlying the late nineteenth- and early twentieth-century mortality decline in Britain has relied on the statistics published by the Registrars General. The processes by which individual causes of death are recorded and then processed in order to create the statistics are not, however, well understood. In this article, the authors build on previous work to piece together a time series of causes of death for Scotland, which removes many of the discontinuities encountered in the published statistics that result from the Registrar General deciding to update the nosology, or classification system, which was being used to compile his figures. Having regrouped individual causes of death to 'smooth' the time series, the authors use the new groups to examine the changing causes of death in Scotland for selected age groups, before turning to undertake a detailed examination of mortality amongst those aged 55 or more. The authors find that when deaths from 'old age' in the latter age group are separated from other 'ill-defined' causes, it becomes obvious that there was a 'rebranding' of cause of death. The authors then use individual-level data from two Scottish communities to further dissect the roles played by 'informants' and 'doctors' in this rebranding, in order to see how these roles may have altered over time and what the consequences might be for one's view of how mortality changed in Scotland between 1855 and 1949. Finally, the authors argue that their findings have important implications for some of historical demography's most prominent theories: the McKeown thesis and the theory of epidemiological transition.
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Affiliation(s)
- Alice Reid
- Cambridge Group for the History of Population and Social Structure, Department of Geography, University of Cambridge, Cambridge, UK
| | - Eilidh Garrett
- Department of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Chris Dibben
- Research Institute of Geography and the Lived Environment, School of GeoSciences, University of Edinburgh, UK
| | - Lee Williamson
- Research Institute of Geography and the Lived Environment, School of GeoSciences, University of Edinburgh, UK
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Lönnroth K, Migliori GB, Abubakar I, D'Ambrosio L, de Vries G, Diel R, Douglas P, Falzon D, Gaudreau MA, Goletti D, González Ochoa ER, LoBue P, Matteelli A, Njoo H, Solovic I, Story A, Tayeb T, van der Werf MJ, Weil D, Zellweger JP, Abdel Aziz M, Al Lawati MR, Aliberti S, Arrazola de Oñate W, Barreira D, Bhatia V, Blasi F, Bloom A, Bruchfeld J, Castelli F, Centis R, Chemtob D, Cirillo DM, Colorado A, Dadu A, Dahle UR, De Paoli L, Dias HM, Duarte R, Fattorini L, Gaga M, Getahun H, Glaziou P, Goguadze L, del Granado M, Haas W, Järvinen A, Kwon GY, Mosca D, Nahid P, Nishikiori N, Noguer I, O'Donnell J, Pace-Asciak A, Pompa MG, Popescu GG, Robalo Cordeiro C, Rønning K, Ruhwald M, Sculier JP, Simunović A, Smith-Palmer A, Sotgiu G, Sulis G, Torres-Duque CA, Umeki K, Uplekar M, van Weezenbeek C, Vasankari T, Vitillo RJ, Voniatis C, Wanlin M, Raviglione MC. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45:928-52. [PMID: 25792630 PMCID: PMC4391660 DOI: 10.1183/09031936.00214014] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/02/2015] [Indexed: 12/31/2022]
Abstract
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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Affiliation(s)
- Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Both authors contributed equally
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
- Both authors contributed equally
| | - Ibrahim Abubakar
- TB Section, University College London and Public Health England, London, UK
| | - Lia D'Ambrosio
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | - Roland Diel
- University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany
| | - Paul Douglas
- Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Marc-Andre Gaudreau
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Delia Goletti
- National Institute for Infectious Diseases, Rome, Italy
| | - Edilberto R. González Ochoa
- Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
| | - Philip LoBue
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Howard Njoo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Ivan Solovic
- TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia
| | | | - Tamara Tayeb
- National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Diana Weil
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Stefano Aliberti
- Università degli Studi di Milano – Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | | | | | - Vineet Bhatia
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Amy Bloom
- US Agency for International Development, Washington, DC, USA
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | | | - Rosella Centis
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Andrei Dadu
- TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ulf R. Dahle
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hannah M. Dias
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Mina Gaga
- National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece
| | | | - Philippe Glaziou
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Lasha Goguadze
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Walter Haas
- Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Asko Järvinen
- Finnish Lung Health Association, Helsinki, Finland
- Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland
| | - Geun-Yong Kwon
- Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Payam Nahid
- University of California, San Francisco, CA, USA
- American Thoracic Society (ATS), New York, NY, USA
| | - Nobuyuki Nishikiori
- Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | - Joan O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Giorgia Sulis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Carlos A. Torres-Duque
- Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia
| | | | - Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Maryse Wanlin
- Fonds des Affections Respiratoires (FARES), Brussels, Belgium
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Current Aims and Challenges Associated With Cervical Cancer Prevention. Clin Obstet Gynecol 2014; 57:241-55. [DOI: 10.1097/grf.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Lessons from history of socioeconomic improvements: a new approach to treating multi-drug-resistant tuberculosis. J Biosoc Sci 2013; 46:600-20. [PMID: 24103436 DOI: 10.1017/s0021932013000527] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.
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Amo-Adjei J, Awusabo-Asare K. Reflections on tuberculosis diagnosis and treatment outcomes in Ghana. Arch Public Health 2013; 71:22. [PMID: 23971675 PMCID: PMC3765431 DOI: 10.1186/2049-3258-71-22] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Available evidence in Ghana shows the implementation of tuberculosis (TB) control activities efforts since the beginning of the 1900s. In spite of that, TB continues to be one of the common diseases in the country. In 1994, local and international policy windows opened for renewed strategies for the control of TB. This paper explores some of the approaches which have been in place since 1994 and their implications for treatment outcomes. METHODS The study combines quantitative and qualitative data. The quantitative data consist of treatment outcome from 1997-2010 and the qualitative data are derived from in-depth interviews with some staff of the TB control programme. Poisson regression and inductive coding were applied to the quantitative and qualitative data respectively. RESULTS Reported cure rates increased from 43.6% to 87.7% between 1997 and 2010. The data from the in-depth interviews (IDIs) suggested that improvements in diagnosis, community TB care, stigma reduction among community and health workers towards TB patients, the public-private partnership, and the enablers' package contributed to the improved better treatment outcomes, particularly from 2008. CONCLUSIONS Lessons learnt include the achievement of objectives with varying strategies and stakeholder interventions. Further studies would be needed to quantify the contributions of the various interventions to help determine those that are cost effective as well as efficient and effective for TB control.
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Affiliation(s)
- Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Kofi Awusabo-Asare
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Hobday RA, Dancer SJ. Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives. J Hosp Infect 2013; 84:271-82. [PMID: 23790506 PMCID: PMC7132476 DOI: 10.1016/j.jhin.2013.04.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/22/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infections caught in buildings are a major global cause of sickness and mortality. Understanding how infections spread is pivotal to public health yet current knowledge of indoor transmission remains poor. AIM To review the roles of natural ventilation and sunlight for controlling infection within healthcare environments. METHODS Comprehensive literature search was performed, using electronic and library databases to retrieve English language papers combining infection; risk; pathogen; and mention of ventilation; fresh air; and sunlight. Foreign language articles with English translation were included, with no limit imposed on publication date. FINDINGS In the past, hospitals were designed with south-facing glazing, cross-ventilation and high ceilings because fresh air and sunlight were thought to reduce infection risk. Historical and recent studies suggest that natural ventilation offers protection from transmission of airborne pathogens. Particle size, dispersal characteristics and transmission risk require more work to justify infection control practices concerning airborne pathogens. Sunlight boosts resistance to infection, with older studies suggesting potential roles for surface decontamination. CONCLUSIONS Current knowledge of indoor transmission of pathogens is inadequate, partly due to lack of agreed definitions for particle types and mechanisms of spread. There is recent evidence to support historical data on the effects of natural ventilation but virtually none for sunlight. Modern practice of designing healthcare buildings for comfort favours pathogen persistence. As the number of effective antimicrobial agents declines, further work is required to clarify absolute risks from airborne pathogens along with any potential benefits from additional fresh air and sunlight.
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Affiliation(s)
- R A Hobday
- Department of Microbiology, Hairmyres Hospital, East Kilbride, Lanarkshire G75 8RG, UK
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Karim K. Tuberculosis care: Olympics 1948 vs 2012. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:736-741. [PMID: 22874724 DOI: 10.12968/bjon.2012.21.12.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Tuberculosis (TB) is a multi-faceted illness associated with a long and fascinating history. Although much has changed in the diagnosis, treatment and prevention of TB over the past six decades, many of the challenges remain remarkably similar. In developing solutions to these challenges, key stakeholders and politicians would do well to learn from some of the more effective strategies from the pre-chemotherapy era. Despite working with insufficient resources, nurses have historically contributed significantly to the work of the multidisciplinary teams in delivering care to patients and families, as well as in implementing national TB control and prevention programmes. The current resurgence of TB in the UK makes it imperative to achieve consistently and appropriately-funded TB services across the country. Whether NHS commissioners and politicians will engage with nurses and others in the reconfigured NHS to achieve this, however, remains to be seen.
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Affiliation(s)
- Kelvin Karim
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Tabrah FL. Koch's postulates, carnivorous cows, and tuberculosis today. HAWAII MEDICAL JOURNAL 2011; 70:144-8. [PMID: 21886302 PMCID: PMC3158372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With Koch's announcement in 1882 of his work with the tubercle bacillus, his famous postulates launched the rational world of infectious disease and an abrupt social change--strict patient isolation. The postulates, so successful at their inception, soon began to show some problems, particularly with cholera, which clearly violated some of Koch's requirements. Subsequent studies of other diseases and the discovery of entirely new ones have so altered and expanded the original postulates that they now are little but a precious touch of history. The present additions and replacements of the original concepts are skillful changes that several authors have devised to introduce new order into understanding complex viral and prion diseases. In 1988, this knowledge, with the totally rational response of the British population and its cattle industry, was critical in promptly blocking the threatened epidemic of human prion disease. In contrast, the recent upsurge of tuberculosis (TB) in the worldwide AIDS epidemic in developing countries, and the sudden increase in metabolic syndrome in wealthy ones, suggests the need for focused sociobiologic research seeking ways to affect the damaging lifestyle behavior of many less educated populations in both settings. The world awaits an equivalent of Koch's Postulates in sociobiology to explain and possibly avert large self-destructive behaviors.
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Affiliation(s)
- Frank L Tabrah
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
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Kalawat U, Sharma KK, Reddy PNR, Kumar AG. Study of bronchoalveolar lavage in clinically and radiologically suspected cases of pulmonary tuberculosis. Lung India 2010; 27:122-4. [PMID: 20931028 PMCID: PMC2946711 DOI: 10.4103/0970-2113.68307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT About 30 to 50 % of pulmonary tuberculosis patients have sputum report negative for acid fast bacilli or present with no expectoration. A lot of research is going on to find methods to establish early and accurate diagnosis of pulmonary tuberculosis (PTB) as institutions of early treatment can have significant effects on morbidity and mortality of patients and also the development of MDR-TB. Samples other than sputum play an important role in the diagnosis of disease in such patients. AIMS To assess the significance of bronchoalveolar lavage samples and fiberoptic bronchoscopy (FOB) in the early diagnosis of occult sputum smear negative pulmonary tuberculosis. SETTINGS AND DESIGN Study was conducted in a tertiary care hospital. FOB was performed in patients with three consecutive sputum smear negative acid fast bacilli to obtain bronchoalveolar lavage (BAL) samples. Written informed consent was obtained from these patients. MATERIALS AND METHODS BAL samples were subjected to Z-N staining and culture on L-J slopes for acid fast bacilli. Sputum samples from the same patients were also cultured. RESULTS BAL samples were positive in 82.2% of sputum smear negative samples. Culture positivity of BAL samples was 90.9% as compared to sputum culture positivity which was 26.4%. Overall diagnosis could be established in 86.6% of patients with the help of fiber optic bronchoscopy. CONCLUSIONS BAL samples are very useful in early sputum smear negative pulmonary tuberculosis and FOB can play an important role in diagnosis of lower respiratory tract infections with minimal complications in hands of an expert.
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Affiliation(s)
- Usha Kalawat
- Department of Microbiology, Srivenkateswara Institute of Medical Sciences, Tirupati- 517 507, Andhra Pradesh, India
| | - Krishna K. Sharma
- Department of Microbiology, Srivenkateswara Institute of Medical Sciences, Tirupati- 517 507, Andhra Pradesh, India
| | - Prakash N. R. Reddy
- Department of Microbiology, Srivenkateswara Institute of Medical Sciences, Tirupati- 517 507, Andhra Pradesh, India
| | - A. Gururaj Kumar
- Department of Microbiology, Srivenkateswara Institute of Medical Sciences, Tirupati- 517 507, Andhra Pradesh, India
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Rust G, Satcher D, Fryer GE, Levine RS, Blumenthal DS. Triangulating on success: innovation, public health, medical care, and cause-specific US mortality rates over a half century (1950-2000). Am J Public Health 2010; 100 Suppl 1:S95-104. [PMID: 20147695 PMCID: PMC2837442 DOI: 10.2105/ajph.2009.164350] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2009] [Indexed: 01/17/2023]
Abstract
To identify successes in improving America's health, we identified disease categories that appeared on vital statistics lists of leading causes of death in the US adult population in either 1950 or 2000, and that experienced at least a 50% reduction in age-adjusted death rates from their peak level to their lowest point between 1950 and 2000. Of the 9 cause-of-death categories that achieved this 50% reduction, literature review suggests that 7 clearly required diffusion of new innovations through both public health and medical care channels. Our nation's health success stories are consistent with a triangulation model of innovation plus public health plus medical care, even when the 3 sectors have worked more in parallel than in partnership.
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Affiliation(s)
- George Rust
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310, USA.
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19
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Torgerson PR, Torgerson DJ. Public health and bovine tuberculosis: what's all the fuss about? Trends Microbiol 2010; 18:67-72. [DOI: 10.1016/j.tim.2009.11.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 10/21/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
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A prologue to the respirology tuberculosis review series 2010: Impact of tuberculosis on patients: Learning from the past? Respirology 2010; 15:1-3. [DOI: 10.1111/j.1440-1843.2009.01642.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Soc Sci Med 2009; 68:2240-6. [DOI: 10.1016/j.socscimed.2009.03.041] [Citation(s) in RCA: 558] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Indexed: 11/17/2022]
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22
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Goldberg DS. In Support of a Broad Model of Public Health: Disparities, Social Epidemiology and Public Health Causation. Public Health Ethics 2009. [DOI: 10.1093/phe/phn035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pucciarelli DL, Grivetti LE. The Medicinal Use of Chocolate in Early North America. Mol Nutr Food Res 2008; 52:1215-27. [DOI: 10.1002/mnfr.200700264] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Krieger N. Proximal, distal, and the politics of causation: what's level got to do with it? Am J Public Health 2008; 98:221-30. [PMID: 18172144 PMCID: PMC2376874 DOI: 10.2105/ajph.2007.111278] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2007] [Indexed: 11/04/2022]
Abstract
Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength. To make this case, I draw on an ecosocial perspective to show how public health got caught in the middle of the problematic proximal-distal divide--surprisingly embraced by both biomedical and social determinist frameworks--and propose replacing the terms proximal and distal with explicit language about levels, pathways, and power.
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Affiliation(s)
- Nancy Krieger
- Professor, Department of Society, Human Development, and Health, Harvard School of Public Health, Kresge 717, 677 Huntington Ave, Boston, MA 02115, USA.
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27
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Bukhman G, Kidder A. Cardiovascular disease and global health equity: lessons from tuberculosis control then and now. Am J Public Health 2007; 98:44-54. [PMID: 18048779 DOI: 10.2105/ajph.2007.110841] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Early 20th-century cardiovascular voluntary organizations in the United States drew strength from the well-established antituberculosis movement. By mid-century, heart disease among the young and tuberculosis had declined in this country. The international fight against tuberculosis has gathered force since the 1990s. Meanwhile, support for international cardiovascular interventions has lagged behind. We trace the divergent path of the international cardiovascular movement and suggest ways in which it could once again learn from the trials and achievements of tuberculosis control.
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Affiliation(s)
- Gene Bukhman
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Mass, USA.
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Cambanis A, Ramsay A, Yassin MA, Cuevas LE. Duration and associated factors of patient delay during tuberculosis screening in rural Cameroon. Trop Med Int Health 2007; 12:1309-14. [PMID: 17949400 DOI: 10.1111/j.1365-3156.2007.01925.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES (i) To determine patient delay - the time from the onset of symptoms to presentation at a health facility - and its causes in patients undergoing sputum smear examination in Cameroon; and (ii) to compare the results with those of a previous study in Ethiopia. METHODS A cross-sectional study of 243 consecutive patients using a structured questionnaire. RESULTS Median (interquartile range) patient delay in Cameroon was 2.0 (1-4) weeks, shorter than the 4.3 (2-13) week delay in Ethiopia. Significantly fewer patients delayed more than 1, 2 and 3 months in Cameroon than in Ethiopia (P < 0.001). Delays in Cameroon were significantly associated with being the main income earner, the belief that TB is stigmatizing, and the use of traditional medicine - the latter being the only factor significant in both studies. CONCLUSION Engaging traditional healers in TB control programs and reducing stigma through education could help to reduce patient delays, accelerate diagnosis, improve clinical outcomes and reduce disease transmission. These results, when placed in context of national human development indices, suggest that economic development, investment in health care and literacy may all be involved in improving access to TB services in sub-Saharan Africa.
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Wilson PK. Confronting "hereditary" disease: eugenic attempts to eliminate tuberculosis in progressive era America. THE JOURNAL OF MEDICAL HUMANITIES 2006; 27:19-37. [PMID: 16583268 DOI: 10.1007/s10912-005-9001-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Tuberculosis was clearly one of the most predominant diseases of the early twentieth century. At this time, Americans involved in the eugenics movement grew increasingly interested in methods to prevent this disease's potential hereditary spread. To do so, as this essay examines, eugenicists' attempted to shift the accepted view that tuberculosis arose from infection and contagion to a view of its heritable nature. The methods that they employed to better understand the propagation and control of tuberculosis are also discussed. Finally, the essay explores the interpretative analyses of data that the Eugenics Record Office used in an attempt to convince contemporaries of the hereditary transmission of tuberculosis.
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Affiliation(s)
- Philip K Wilson
- Department of Humanities, H-134, Penn State College of Medicine, The Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033-2390, USA.
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31
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Smith-Nonini S. When "the program is good, but the disease is better": lessons from Peru on drug-resistant tuberculosis. Med Anthropol 2005; 24:265-96. [PMID: 16081336 DOI: 10.1080/01459740500189548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This is a qualitative study of the politics of public health surrounding a resurgent tuberculosis epidemic in Lima, Peru during the 1990s. The paper traces the role of debt and neoliberal economics in creating conditions for the epidemic, and the reforms that turned Peru's TB program into a model for treating drug-susceptible disease by 1996. Despite this success, public health officials were blind-sided by the appearance of drug-resistant TB in the late 1990s when their "good" program turned out to be not good enough. The study follows the conflict, and eventual collaboration, that ensued between the Ministry of Health and a local NGO affiliated with Boston-based Partners in Health, which undertook a radical program of community-based directly-observed therapy (DOTS-Plus) to treat drug-resistant patients who otherwise would have died. Lessons from this case are relevant to many international settings where "hot-spots" of drug-resistant TB currently exist and go untreated, posing a threat to the success of national TB control programs.
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Affiliation(s)
- Sandy Smith-Nonini
- Department of Sociology and Anthropology, Elon University, Durham, NC 27705, USA.
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32
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Barreto ML. O conhecimento científico e tecnológico como evidência para políticas e atividades regulatórias em saúde. CIENCIA & SAUDE COLETIVA 2004. [DOI: 10.1590/s1413-81232004000200010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nas últimas décadas, têm-se observado mudanças na organização do modelo ocidental de Estado, com clara tendência de redução das suas atividades econômicas e sociais diretas. Ao mesmo tempo, percebe-se a ampliação de alguns dos seus papéis na elaboração de políticas e como regulador de uma série de parâmetros da vida social. Nesse contexto, consolida-se a noção de que são cada vez mais necessários conhecimentos científicos que fundamentem os processos de tomada de decisões. A idéia de política baseada em evidência foi apropriada pelo Estado moderno, e na saúde vem recebendo especial atenção. Avalia-se que, assim procedendo, se ampliam as chances de se tomar decisões mais efetivas, trazendo maiores benefícios à saúde da população, com menos custos econômicos ou sociais. Essa nova abordagem torna o Estado um crescente consumidor dos resultados da atividade científica. O objetivo deste ensaio é discutir alguns aspectos da relação entre o processo de produção do conhecimento científico e os processos gerais de tomada de decisões na área da saúde, com maior ênfase naqueles relacionados às atividades regulatórias. Após rever a literatura recente sobre o tema, comenta-se a importância dessa discussão no contexto do SUS no Brasil.
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Doran T, Whitehead M. Do social policies and political context matter for health in the United Kingdom? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2004; 33:495-522. [PMID: 14582870 DOI: 10.2190/578t-juwb-18v6-a59e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This U.K. case study combines lessons from historical assessments with new empirical analyses of trends over the last decade to inform an appraisal of the impact of social actions on health. The empirical analyses examine life expectancy in the 354 local government councils in England by first identifying those that have better or worse health than expected fromtheir socioeconomic profile, and then selecting paired sets of "overachievers" and "underachievers" for more in-depth analysis. The findings taken as a whole provide evidence that social policies and political context do indeed matter for health. The historical material from the first industrial revolution, in particular, provides some of the most compelling evidence for this proposition. The empirical analyses over the last decade found a very powerful inverse association: the more deprived the local council, the lower the life expectancy of the population within that locality. However, even for the same level of deprivation and socioeconomic characteristics, some councils were doing much better than others in terms of health: for example, more than three years difference in life expectancy for carefully matched "urban fringe" councils. The article then examines the councils' political makeup and hence their likely policy perspective.
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Affiliation(s)
- Tim Doran
- Department of Public Health, Liverpool, United Kingdom.
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34
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Coker RJ. Public health impact of detention of individuals with tuberculosis: systematic literature review. Public Health 2003; 117:281-7. [PMID: 12966751 DOI: 10.1016/s0033-3506(03)00035-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As the world witnesses ever-increasing rates of tuberculosis, particularly of drug-resistant strains affecting some of society's most marginalized individuals, policy makers and legislators may again visit the statute books in order to strengthen their armamentarium of tools to protect public health. This paper assesses the evidence in support of the sanction to detain those with tuberculosis who are perceived as posing a public health threat, and shows that little research has been conducted to inform policy, probably because traditional epidemiological methods used to assess the impact of interventions are not feasible.
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Affiliation(s)
- R J Coker
- ECOHOST, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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35
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Hurtado AM, Hill KR, Rosenblatt W, Bender J, Scharmen T. Longitudinal study of tuberculosis outcomes among immunologically naive Aché natives of Paraguay. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2003; 121:134-50. [PMID: 12740957 DOI: 10.1002/ajpa.10228] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study documents the course of a tuberculosis epidemic in an immunologically naive group of South American Indians within fewer than 20 years after first sustained contact with outsiders. Groups of Northern Aché (ah-CHAY) of eastern Paraguay were contacted and settled on reservations between 1971-1979. Not surprisingly, the Aché are very susceptible to tuberculosis, and the epidemiological characteristics of the disease are quite different from those of populations that have had tuberculosis for centuries. Within 6 years of the first detected case of tuberculosis among the Aché, the prevalence rate of active tuberculosis cases reached 18.2%, and of infected cases among adults, 64.6%, some of the highest rates ever reported for any human group. Remarkably, males and females are equally likely to have been diagnosed with active tuberculosis, Aché children between birth and 5 years of age are least vulnerable to tuberculosis, high nutritional and socioeconomic status do not decrease the risk of disease or infection, and children immunized with BCG are less responsive to tuberculin challenge than are other children. Moreover, similar to the Yanomamö, but unlike populations of European or African descent, a high percentage of Aché with active disease test negative on tuberculin challenge tests (purified protein derivative; PPD). These differences may be due to a high prevalence of diminished cell-mediated immunity, and T-helper 2 dominance. We also hypothesize that these immunological characteristics, low genetic diversity, hostile intergroup interactions, and behavioral noncompliance to treatment protocols together contribute to the high rates of active disease observed. Existing tuberculosis control programs are poorly equipped to handle the impact of these causal complexities on the course of recent tuberculosis epidemics that have quickly spread throughout native communities of Latin America during the last decade.
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Affiliation(s)
- A Magdalena Hurtado
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico 87131-1086, USA.
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Lonky NM. Reducing death from cervical cancer examining the prevention paradigms. Obstet Gynecol Clin North Am 2002; 29:599-611, v. [PMID: 12509087 DOI: 10.1016/s0889-8545(02)00020-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prevention of morbidity and mortality from cervical cancer will hinge upon our understanding of the epidemiology, the molecular basis, and natural history of the disease and its associated precursors. This article serves as an introduction and presents our current challenge to prevent or find all women at risk, and alter the course of disease to effect a regression or a cure.
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Affiliation(s)
- Neal M Lonky
- Department of Obstetrics and Gynecology, Kaiser Permanente, Anaheim, California 92801, USA
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Gandy M, Zumla A. The resurgence of disease: social and historical perspectives on the 'new' tuberculosis. Soc Sci Med 2002; 55:385-96; discussion 397-401. [PMID: 12144147 DOI: 10.1016/s0277-9536(01)00176-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The resurgence of tuberculosis is one of the most serious global public health challenges of the twenty-first century. This paper argues that the decline of tuberculosis since the nineteenth century is far better understood than its resurgence over the last twenty years. It is suggested that insights gained from the historical study of disease may provide a better analytical framework for understanding the contemporary dynamics of disease epidemiology than the current emphasis on the bio-medical and behavioural characteristics of individual patients. It is concluded that tuberculosis research requires a combination of advances in bio-medical knowledge with a broader understanding of the evolving relationship between disease and modern societies.
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Affiliation(s)
- Matthew Gandy
- Department of Geography, University College London, UK.
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Colgrove J. The McKeown thesis: a historical controversy and its enduring influence. Am J Public Health 2002; 92:725-9. [PMID: 11988435 PMCID: PMC1447153 DOI: 10.2105/ajph.92.5.725] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2002] [Indexed: 11/04/2022]
Abstract
The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations?
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Affiliation(s)
- James Colgrove
- Program in the History and Ethics of Public Health and Medicine, Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Kanaya AM, Glidden DV, Chambers HF. Identifying pulmonary tuberculosis in patients with negative sputum smear results. Chest 2001; 120:349-55. [PMID: 11502628 DOI: 10.1378/chest.120.2.349] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinicians need to decide whether to begin empiric therapy for patients who are suspected of having tuberculosis (TB) but have negative sputum smear results. Culture results may take weeks, and delaying treatment may allow further transmission of disease. STUDY OBJECTIVE To identify the clinical, demographic, and radiographic characteristics that identify smear-negative patients who have TB, and to create a TB prediction rule. DESIGN Retrospective chart review. SETTING University-affiliated public hospital in San Francisco, CA, between 1993 and 1998. PATIENTS Forty-seven patients with TB and 141 control patients who were hospitalized with a suspicion of pulmonary TB; all had negative sputum smear results. MEASUREMENTS AND RESULTS Demographic, clinical, and radiographic variables were determined by chart review. In multivariate analysis, a positive tuberculin skin test result (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.0 to 11.9) was independently associated with an increased risk of a positive TB culture finding. A radiographic pattern not typical of pulmonary tuberculosis (OR, 0.3; 95% CI, 0.1 to 0.7) and expectoration with cough (OR, 0.3; 95% CI, 0.1 to 0.6) were predictive of a decreased risk. An interaction between HIV seropositivity and mediastinal lymphadenopathy on the chest radiograph was also associated with a positive TB culture result (OR, 7.2; 95% CI, 1.4 to 36.0). The TB prediction score (TPS) was created with widely ranging likelihood ratios that could affect the posterior probability of TB by 30-fold. CONCLUSION The TPS put into context with the overall prevalence of TB in a given area may help clinicians decide if a patient with negative sputum smear results should start empiric antituberculous therapy or wait for culture results. These results need prospective validation.
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Affiliation(s)
- A M Kanaya
- Divisions of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol 2001; 30:668-77. [PMID: 11511581 DOI: 10.1093/ije/30.4.668] [Citation(s) in RCA: 925] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Krieger
- Department of Health and Social Behavior, Harvard School of Public Health, 667 Huntington Avenue, Boston, MA 02115, USA.
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Cohen JE, Milio N, Rozier RG, Ferrence R, Ashley MJ, Goldstein AO. Political ideology and tobacco control. Tob Control 2000; 9:263-7. [PMID: 10982561 PMCID: PMC1748370 DOI: 10.1136/tc.9.3.263] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J E Cohen
- Ontario Tobacco Research Unit, Centre for Health Promotion, and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
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Affiliation(s)
- T R Frieden
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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