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King JB, Jones KG, Goldberg E, Rollins M, MacNamee K, Moffit C, Naidu SR, Ferguson MA, Garcia-Leavitt E, Amaro J, Breitenbach KR, Watson JM, Gurgel RK, Anderson JS, Foster NL. Increased Functional Connectivity After Listening to Favored Music in Adults With Alzheimer Dementia. J Prev Alzheimers Dis 2020; 6:56-62. [PMID: 30569087 DOI: 10.14283/jpad.2018.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Personalized music programs have been proposed as an adjunct therapy for patients with Alzheimer disease related dementia, and multicenter trials have now demonstrated improvements in agitation, anxiety, and behavioral symptoms. Underlying neurophysiological mechanisms for these effects remain unclear. METHODS We examined 17 individuals with a clinical diagnosis of Alzheimer disease related dementia using functional MRI following a training period in a personalized music listening program. RESULTS We find that participants listening to preferred music show specific activation of the supplementary motor area, a region that has been associated with memory for familiar music that is typically spared in early Alzheimer disease. We also find widespread increases in functional connectivity in corticocortical and corticocerebellar networks following presentation of preferred musical stimuli, suggesting a transient effect on brain function. CONCLUSIONS Findings support a mechanism whereby attentional network activation in the brain's salience network may lead to improvements in brain network synchronization.
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Affiliation(s)
- J B King
- Jeffrey S. Anderson, 1A71 School of Medicine, 50 N Medical Drive, Salt Lake City, UT 84132,
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Hammack TS, Amaguaña RM, Andrews WH, Al-Hasani SM, Asmundson R, Battista K, Beatty SJ, Berges-Soubies VA, Bozicevich T, Brooks D, Case J, Coles C, Copeland F, Davis-Debella PE, Entis P, Feldsine P, Fourcade L, Garcia GR, Goins DG, Jackson T, Koch S, Lafogiannis JA, Lee J, Lerner I, McIntyre D, McKee B, McNally S, Muchnik V, Mui L, Pfundheller R, Raghubeer EV, Rains D, Ruscica G, Schmieg J, Sellers R, Smoot M, Sobol R, Thunberg R, Torres S, Trinidad LF, Tuncan E, Watson JM. Rappaport-Vassiliadis Medium for Recovery of Salmonellaspp. from Low Microbial Load Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.1.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Twenty-three laboratories participated in a collaborative study to compare the relative effectiveness of Rappaport-Vassiliadis (RV) medium incubated at 42°C, selenite cystine (SC) broth (35°C), and tetrathionate (TT) broth (35 and 43°C) for recovery of Salmonella from the following foods with a low microbial load: dried egg yolk, dry active yeast, ground black pepper, guar gum, and instant nonfat dry milk. For dry active yeast, lauryl tryptose (LT) broth, incubated at 35°C, was used instead of SC broth. All of the foods were artificially inoculated with single Salmonella serovars, that had been lyophilized before inoculation, at high and low target levels of 0.4 and 0.04 colony forming units/g food, respectively. For analysis of 870 test portions, representing all of the foods except yeast, 249 Salmonella-positive test portions were detected by RV medium, 265 by TT broth (43°C), 268 by TT broth (35°C), and 269 by SC broth (35°C). For analysis of 225 test portions of yeast, 79 Salmonella-positive test portions were detected by RV medium, 79 by TT broth (43°C), 84 by TT broth (35°C), and 68 by LT broth (35°C). RV medium was comparable to, or even more effective than, the other selective enrichments for recovery of Salmonella from all of the foods except guar gum. It is recommended that RV (42°C) and TT (35°C) be used with foods that have a low microbial load, except for guar gum for which SC (35°C) and TT (35°C) are recommended.
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Affiliation(s)
- Thomas S Hammack
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
| | - R Miguel Amaguaña
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
| | - Wallace H Andrews
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
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Aisyah DN, Shallcross L, Hayward A, Aldridge RW, Hemming S, Yates S, Ferenando G, Possas L, Garber E, Watson JM, Geretti AM, McHugh TD, Lipman M, Story A. Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London. J Viral Hepat 2018; 25:1260-1269. [PMID: 29851232 DOI: 10.1111/jvh.12936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.
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Affiliation(s)
- D N Aisyah
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Faculty of Public Health Universitas Indonesia, Depok, Indonesia
| | - L Shallcross
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK
| | - A Hayward
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Institute of Epidemiology and Health Care, University College London, London, UK
| | - R W Aldridge
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - S Hemming
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - S Yates
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - G Ferenando
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - L Possas
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - E Garber
- UCL Infectious Disease Informatics, Farr Institute of Health Informatics, London, UK.,Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - J M Watson
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - A M Geretti
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - T D McHugh
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - M Lipman
- Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK
| | - A Story
- University College London Hospitals, London, UK
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Watson JM, Azim MA. Comparative Efficiency of Various Methods of Infecting Mice withSchistosoma Mansoni. Annals of Tropical Medicine & Parasitology 2016; 43:41-6. [DOI: 10.1080/00034983.1949.11685393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Watson JM. A Modification of the Zinc Sulphate Centrifugal Flotation Technique for the Concentration of Helminth Ova and Protozoan Cysts in Faeces. Annals of Tropical Medicine & Parasitology 2016; 41:43-5. [DOI: 10.1080/00034983.1947.11685311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JAC, Fine PEM, Smith PG, Lipman M, Elliman D, Watson JM, Drumright LN, Whiting PF, Vynnycky E, Rodrigues LC. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guérin vaccination against tuberculosis. Health Technol Assess 2014; 17:1-372, v-vi. [PMID: 24021245 DOI: 10.3310/hta17370] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent evidence suggests that the duration of protection by bacillus Calmette-Guérin (BCG) may exceed previous estimates with potential implications for estimating clinical and cost-efficacy. OBJECTIVES To estimate the protection and duration of protection provided by BCG vaccination against tuberculosis, explore how this protection changes with time since vaccination, and examine the reasons behind the variation in protection and the rate of waning of protection. DATA SOURCES Electronic databases including MEDLINE, Excerpta Medica Database (EMBASE), Cochrane Databases, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Web of Knowledge, Biosciences Information Service (BIOSIS), Latin American and Caribbean Health Sciences Literature (LILACs), MEDCARIB Database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception to May 2009. Index to Theses, System for Information on Grey Literature in Europe (SIGLE), Centre for Agricultural Bioscience International (CABI) Abstracts, Scopus, Article First, Academic Complete, Africa-Wide Information, Google Scholar, Global Health, British National Bibliography for Report Literature, and clinical trial registration websites were searched from inception to October 2009. REVIEW METHODS Electronic databases searches, screening of identified studies, data extraction and analysis were undertaken. Meta-analysis was used to present numerical and graphical summaries of clinical efficacy and efficacy by time since vaccination. Evidence of heterogeneity was assessed using the tau-squared statistic. Meta-regression allowed the investigation of observed heterogeneity. Factors investigated included BCG strain, latitude, stringency of pre-BCG vaccination tuberculin testing, age at vaccination, site of disease, study design and vulnerability to biases. Rate of waning of protection was estimated using the ratio of the measure of efficacy after 10 years compared with the efficacy in the first 10 years of a study. RESULTS Study selection. A total of 21,030 references were identified, providing data on 132 studies after abstract and full-text review. Efficacy. Protection against pulmonary tuberculosis in adults is variable, ranging from substantial protection in the UK MRC trial {rate ratio 0.22 [95% confidence interval (CI) 0.16 to 0.31]}, to absence of clinically important benefit, as in the large Chingleput trial [rate ratio 1.05 (95% CI 0.88 to 1.25)] and greater in latitudes further away from the equator. BCG vaccination efficacy was usually high, and varied little by form of disease (with higher protection against meningeal and miliary tuberculosis) or study design when BCG vaccination was given only to infants or to children after strict screening for tuberculin sensitivity. High levels of protection against death were observed from both trials and observational studies. The observed protective effect of BCG vaccination did not differ by the strain of BCG vaccine used in trials. DURATION Reviewed studies showed that BCG vaccination protects against pulmonary and extrapulmonary tuberculosis for up to 10 years. Most studies either did not follow up participants for long enough or had very few cases after 15 years. This should not be taken to indicate an absence of effect: five studies (one trial and four observational studies) provided evidence of measurable protection at least 15 years after vaccination. Efficacy declined with time. The rate of decline was variable, with faster decline in latitudes further from the equator and in situations where BCG vaccination was given to tuberculin-sensitive participants after stringent tuberculin testing. LIMITATIONS The main limitation of this review relates to quality of included trials, most of which were conducted before current standards for reporting were formulated. In addition, data were lacking in some areas and the review had to rely on evidence from observational studies. CONCLUSIONS BCG vaccination protection against tuberculosis varies between populations, to an extent that cannot be attributed to chance alone. Failure to exclude those already sensitised to mycobacteria and study latitude closer to the equator were associated with lower efficacy. These factors explained most of the observed variation. There is good evidence that BCG vaccination protection declines with time and that protection can last for up to 10 years. Data on protection beyond 15 years are limited; however, a small number of trials and observational studies suggest that BCG vaccination may protect for longer. Further studies are required to investigate the duration of protection by BCG vaccination. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Watson JM, Crosby H, Dale VM, Tober G, Wu Q, Lang J, McGovern R, Newbury-Birch D, Parrott S, Bland JM, Drummond C, Godfrey C, Kaner E, Coulton S. AESOPS: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care. Health Technol Assess 2014; 17:1-158. [PMID: 23796191 DOI: 10.3310/hta17250] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is clear evidence of the detrimental impact of hazardous alcohol consumption on the physical and mental health of the population. Estimates suggest that hazardous alcohol consumption annually accounts for 150,000 hospital admissions and between 15,000 and 22,000 deaths in the UK. In the older population, hazardous alcohol consumption is associated with a wide range of physical, psychological and social problems. There is evidence of an association between increased alcohol consumption and increased risk of coronary heart disease, hypertension and haemorrhagic and ischaemic stroke, increased rates of alcohol-related liver disease and increased risk of a range of cancers. Alcohol is identified as one of the three main risk factors for falls. Excessive alcohol consumption in older age can also contribute to the onset of dementia and other age-related cognitive deficits and is implicated in one-third of all suicides in the older population. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of a stepped care intervention against a minimal intervention in the treatment of older hazardous alcohol users in primary care. DESIGN A multicentre, pragmatic, two-armed randomised controlled trial with an economic evaluation. SETTING General practices in primary care in England and Scotland between April 2008 and October 2010. PARTICIPANTS Adults aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test (10-item) (AUDIT) were eligible. In total, 529 patients were randomised in the study. INTERVENTIONS The minimal intervention group received a 5-minute brief advice intervention with the practice or research nurse involving feedback of the screening results and discussion regarding the health consequences of continued hazardous alcohol consumption. Those in the stepped care arm initially received a 20-minute session of behavioural change counselling, with referral to step 2 (motivational enhancement therapy) and step 3 (local specialist alcohol services) if indicated. Sessions were recorded and rated to ensure treatment fidelity. MAIN OUTCOME MEASURES The primary outcome was average drinks per day (ADD) derived from extended AUDIT--Consumption (3-item) (AUDIT-C) at 12 months. Secondary outcomes were AUDIT-C score at 6 and 12 months; alcohol-related problems assessed using the Drinking Problems Index (DPI) at 6 and 12 months; health-related quality of life assessed using the Short Form Questionnaire-12 items (SF-12) at 6 and 12 months; ADD at 6 months; quality-adjusted life-years (QALYs) (for cost-utility analysis derived from European Quality of Life-5 Dimensions); and health and social care resource use associated with the two groups. RESULTS Both groups reduced alcohol consumption between baseline and 12 months. The difference between groups in log-transformed ADD at 12 months was very small, at 0.025 [95% confidence interval (CI)--0.060 to 0.119], and not statistically significant. At month 6 the stepped care group had a lower ADD, but again the difference was not statistically significant. At months 6 and 12, the stepped care group had a lower DPI score, but this difference was not statistically significant at the 5% level. The stepped care group had a lower SF-12 mental component score and lower physical component score at month 6 and month 12, but these differences were not statistically significant at the 5% level. The overall average cost per patient, taking into account health and social care resource use, was £488 [standard deviation (SD) £826] in the stepped care group and £482 (SD £826) in the minimal intervention group at month 6. The mean QALY gains were slightly greater in the stepped care group than in the minimal intervention group, with a mean difference of 0.0058 (95% CI -0.0018 to 0.0133), generating an incremental cost-effectiveness ratio (ICER) of £1100 per QALY gained. At month 12, participants in the stepped care group incurred fewer costs, with a mean difference of -£194 (95% CI -£585 to £198), and had gained 0.0117 more QALYs (95% CI -0.0084 to 0.0318) than the control group. Therefore, from an economic perspective the minimal intervention was dominated by stepped care but, as would be expected given the effectiveness results, the difference was small and not statistically significant. CONCLUSIONS Stepped care does not confer an advantage over minimal intervention in terms of reduction in alcohol consumption at 12 months post intervention when compared with a 5-minute brief (minimal) intervention. TRIAL REGISTRATION This trial is registered as ISRCTN52557360. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 25. See the HTA programme website for further project information.
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Affiliation(s)
- J M Watson
- Department of Health Sciences, University of York, York, UK
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Green HK, Ellis J, Galiano M, Watson JM, Pebody RG. Critical care surveillance: insights into the impact of the 2010/11 influenza season relative to the 2009/10 pandemic season in England. Euro Surveill 2013; 18:20499. [PMID: 23787130 DOI: 10.2807/ese.18.23.20499-en] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2010/11, the influenza season in England was marked by a relative increase in impact on the population compared to that seen during the 2009/10 pandemic, with the same influenza subtype, A(H1N1)pdm09, circulating. The peaks in critical care bed occupancy in both seasons coincided with peaks in influenza A(H1N1)pdm09 activity, but onset of influenza in 2010/11 additionally coincided with notably cold weather, a comparatively smaller peak in influenza B activity and increased reports of bacterial co-infection. A bigger impact on critical care services was seen across all regions in England in 2010/11, with, compared to 2009/10, a notable age shift in critical care admissions from children to young adults. The peak of respiratory syncytial virus (RSV) activity did not coincide with critical care admissions, and regression analysis suggested only a small proportion of critical care bed days might be attributed to the virus in either season. Differences in antiviral policy and improved overall vaccine uptake in 2010/11 with an influenza A(H1N1)pdm09 strain containing vaccine between seasons are unlikely to explain the change in impact observed between the two seasons. The reasons behind the relative high level of severe disease in the 2010/11 winter are likely to have resulted from a combination of factors, including an age shift in infection, accumulation of susceptible individuals through waning immunity, new susceptible individuals from new births and cold weather. The importance of further development of severe influenza disease surveillance schemes for future seasons is reinforced.
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Affiliation(s)
- H K Green
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
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Pebody RG, Chand MA, Thomas HL, Green HK, Boddington NL, Carvalho C, Brown CS, Anderson SR, Rooney C, Crawley-Boevey E, Irwin DJ, Aarons E, Tong C, Newsholme W, Price N, Langrish C, Tucker D, Zhao H, Phin N, Crofts J, Bermingham A, Gilgunn-Jones E, Brown KE, Evans B, Catchpole M, Watson JM. The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012. Euro Surveill 2012; 17:20292. [PMID: 23078799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
On 22 September 2012, a novel coronavirus, very closely related to that from a fatal case in Saudi Arabia three months previously, was detected in a previously well adult transferred to intensive care in London from Qatar with severe respiratory illness. Strict respiratory isolation was instituted. Ten days after last exposure, none of 64 close contacts had developed severe disease, with 13 of 64 reporting mild respiratory symptoms. The novel coronavirus was not detected in 10 of 10 symptomatic contacts tested.
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Affiliation(s)
- R G Pebody
- Health Protection Agency (HPA), London, UK.
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Story A, Aldridge RW, Abubakar I, Stagg HR, Lipman M, Watson JM, Hayward AC. Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study. Int J Tuberc Lung Dis 2012; 16:1461-7. [PMID: 22981252 DOI: 10.5588/ijtld.11.0773] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile digital chest radiography (CXR) is used routinely to screen for pulmonary tuberculosis (PTB) in London among homeless populations, persons accessing drug treatment services and prisoners. OBJECTIVE 1) To establish the sensitivity and specificity of mobile digital CXR, and 2) to test the hypothesis that actively identified cases have reduced odds of sputum smear positivity vs. those presenting passively to health care services from the same populations. METHODS Sensitivity and specificity were calculated using a gold standard comparator of culture-confirmed cases of PTB reported to the national surveillance system within 90 days of screening. Logistic regression was used to determine whether actively detected cases had reduced odds of smear positivity compared to passively detected cases after adjustment for confounding. RESULTS The intervention had a sensitivity of 81.8% (95%CI 64.5-93.0) and a specificity of 99.2% (95%CI 99.1-99.3). After adjusting for confounding, there was evidence that cases identified through screening were less likely to be smear-positive than passively identified cases (OR 0.34, 95%CI 0.14-0.85; likelihood ratio test P = 0.022). CONCLUSION Digital CXR achieves a high level of sensitivity and specificity in an operational setting; targeted mobile radiographic screening can reduce the risk of onward transmission by identifying cases before they become infectious.
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Affiliation(s)
- A Story
- Find and Treat, University College London Hospitals NHS Foundation Trust, London, UK
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Abstract
1 The effects of oral doses of the bronchodilator drugs, salbutamol (4 and 8 mg) and terbutaline (5 and 10 mg), on physiological tremor, bronchial tone, heart rate and blood pressure were studied in six normal subjects. 2 Both drugs produced a significant increase in physiological tremor, compared with placebo. Terbutaline, but not salbutamol, produced a dose related response. No significant differences were observed between drugs. 3 Terbutaline (5 and 10 mg) and salbutamol (8 mg) produced a significant bronchodilatation compared with placebo. Dose related responses were obtained with both drugs, although this reached significance only with terbutaline. 4 Both doses of each drug produced a tachycardia, although this was only statistically significant with the high doses. 5 No significant change in blood pressure was observed with either drug. 6 Peak effects of salbutamol occurred between 1 and 3 h and terbutaline between 1 and 4 hours. Both drugs were still active at 6 hours.
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Affiliation(s)
- J M Watson
- Department of Clinical Pharmacology, St Bartholomew's Hospital, London
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Watson JM. STUDIES ON THE MORPHOLOGY AND BIONOMICS OF A LITTLE KNOWN HOLOTRICHOUS CILIATE-BALANTIOPHORUS MINUTUS SCHEW: Part II.-The Effect of Environmental Factors. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1365-2818.1944.tb06162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watson JM, Kang'ombe AR, Soares MO, Chuang LH, Worthy G, Bland JM, Iglesias C, Cullum N, Torgerson D, Nelson EA. VenUS III: a randomised controlled trial of therapeutic ultrasound in the management of venous leg ulcers. Health Technol Assess 2011; 15:1-192. [PMID: 21375959 DOI: 10.3310/hta15130] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of low-dose ultrasound delivered in conjunction with standard care against standard care alone in the treatment of hard-to-heal venous ulcers. DESIGN A multicentre, pragmatic, two-armed randomised controlled trial with an economic evaluation. SETTING Community nurse services; community leg ulcer clinics; hospital outpatient leg ulcer clinics, among both urban and rural settings in England, Scotland, Northern Ireland and Ireland. PARTICIPANTS Patients with a venous leg ulcer of > 6 months' duration or > 5 cm2 and an ankle-brachial pressure index of ≥ 0.8. In total, 337 patients were recruited to the study. INTERVENTIONS Participants in the intervention group received low-dose ultrasound (0.5 W/cm2) delivered at 1 MHz, pulsed pattern of 1 : 4, applied to periulcer skin (via a water-based contact gel) weekly for up to 12 weeks alongside standard care. Standard care consisted of low-adherent dressings and compression therapy, renewed as recommended by the patient's nurse and modified if required to reflect changes in ulcer and skin condition. The output of the ultrasound machines was checked every 3 months to confirm intervention fidelity. MAIN OUTCOME MEASURES The primary end point was time to healing of the largest eligible ulcer (reference ulcer). Secondary outcomes were time to healing of all ulcers, proportion of patients healed, percentage and absolute change in ulcer size, proportion of time patients were ulcer free, cost of treatments, health-related quality of life (HRQoL), adverse events, withdrawal and loss to follow-up. RESULTS There was a small, and statistically not significant, difference in the median time to complete ulcer healing of all ulcers in favour of standard care [median 328 days, 95% confidence interval (CI) 235 days, inestimable] compared with ultrasound (median 365 days, 95% CI 224 days, inestimable). There was no difference between groups in the proportion of patients with ulcers healed at 12 months (72/168 in ultrasound vs 78/169 standard care), nor in the change in ulcer size at 4 weeks. There was no evidence of a difference in recurrence of healed ulcers. There was no difference in HRQoL [measured using the Short Form questionnaire-12 items (SF-12)] between the two groups. There were more adverse events with ultrasound than with standard care. Ultrasound therapy as an adjuvant to standard care was found not to be a cost-effective treatment when compared with standard care. The mean cost of ultrasound was £197.88 (bias-corrected 95% CI -£35.19 to £420.32) higher than standard care per participant per year. There was a significant relationship between ulcer healing and area and duration at baseline. In addition, those centres with high recruitment rates had the highest healing rates. CONCLUSIONS Low-dose ultrasound, delivered weekly during dressing changes, added to the package of current best practice (dressings, compression therapy) did not increase ulcer healing rates, affect quality of life (QoL) or reduce recurrence. It was associated with higher costs and more adverse events. There is no evidence that adding low-dose ultrasound to standard care for 'hard-to-heal' ulcers aids healing, improves QoL or reduces recurrence. It increases costs and adverse events. The relationship between ulcer healing rates and patient recruitment is worthy of further study. TRIAL REGISTRATION Current Controlled Trials ISRCTN21175670. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 13. See the HTA programme website for further project information.
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Affiliation(s)
- J M Watson
- Department of Health Sciences, University of York, York, UK
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Chuang LH, Soares MO, Watson JM, Bland JM, Cullum N, Iglesias C, Kang'ombe AR, Torgerson D, Nelson EA. Economic evaluation of a randomized controlled trial of ultrasound therapy for hard-to-heal venous leg ulcers. Br J Surg 2011; 98:1099-106. [DOI: 10.1002/bjs.7501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
A pragmatic, multicentre randomized controlled trial (VenUS III) was conducted to determine whether low-dose ultrasound therapy increased the healing rate of hard-to-heal leg ulcers. This study was a cost-effectiveness analysis of the trial data.
Methods
Cost-effectiveness and cost–utility analyses were conducted alongside the VenUS III trial, in which patients were randomly allocated to either ultrasound treatment administered weekly for 12 weeks along with standard care, or standard care alone. The time horizon was 12 months and based on the UK National Health Service (NHS) perspective.
Results
The base-case analysis showed that ultrasound therapy added to standard care was likely to be more costly and provide no extra benefit over standard care alone. Individuals who received ultrasound treatment plus standard care took a mean of 14·7 (95 per cent confidence interval − 32·7 to 56·8) days longer to heal, had 0·009 (−0·042 to 0·024) fewer quality-adjusted life years and had higher treatment costs by £197·88 (−35·19 to 420·32). Based on these point estimates, ultrasound therapy plus standard care for leg ulcers was dominated by standard care alone. The analysis of uncertainty showed that this treatment strategy is unlikely to be cost-effective.
Conclusion
Ultrasound treatment was not cost-effective for hard-to-heal leg ulcers and should not be recommended for adoption in the NHS. Registration number: ISRCTN21175670 (http://www.controlled-trials.com) and N0484162339 (National Research Register).
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Affiliation(s)
- L-H Chuang
- Department of Health Sciences, University of York, York, UK
| | - M O Soares
- Department of Health Sciences, University of York, York, UK
| | - J M Watson
- Department of Health Sciences, University of York, York, UK
| | - J M Bland
- Department of Health Sciences, University of York, York, UK
| | - N Cullum
- Department of Health Sciences, University of York, York, UK
| | - C Iglesias
- Department of Health Sciences, University of York, York, UK
| | - A R Kang'ombe
- Department of Health Sciences, University of York, York, UK
| | - D Torgerson
- Department of Health Sciences, University of York, York, UK
| | - E A Nelson
- School of Healthcare, University of Leeds, Leeds, UK
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19
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Hardelid P, Fleming DM, McMenamin J, Andrews N, Robertson C, SebastianPillai P, Ellis J, Carman W, Wreghitt T, Watson JM, Pebody RG. Effectiveness of pandemic and seasonal influenza vaccine in preventing pandemic influenza A(H1N1)2009 infection in England and Scotland 2009-2010. Euro Surveill 2011; 16:19763. [PMID: 21251487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Following the global spread of pandemic influenza A(H1N1)2009, several pandemic vaccines have been rapidly developed. The United Kingdom and many other countries in the northern hemisphere implemented seasonal and pandemic influenza vaccine programmes in October 2009. We present the results of a case–control study to estimate effectiveness of such vaccines in preventing confirmed pandemic influenza infection. Some 5,982 individuals with influenza-like illness seen in general practices between November 2009 and January 2010 were enrolled. Those testing positive on PCR for pandemic influenza were assigned as cases and those testing negative as controls. Vaccine effectiveness was estimated as the relative reduction in odds of confirmed infection between vaccinated and unvaccinated individuals. Fourteen or more days after immunisation with the pandemic vaccine, adjusted vaccine effectiveness (VE) was 72% (95% confidence interval (CI): 21% to 90%). If protection was assumed to start after seven or more days, the adjusted VE was 71% (95% CI: 37% to 87%). Pandemic influenza vaccine was highly effective in preventing confirmed infection with pandemic influenza A(H1N1)2009 from one week after vaccination. No evidence of effectiveness against pandemic influenza A(H1N1)2009 was found for the 2009/10 trivalent seasonal influenza vaccine (adjusted VE of -30% (95% CI: -89% to 11%)).
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Affiliation(s)
- P Hardelid
- Health Protection Agency Centre for Infections, London, United Kingdom.
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20
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Ellis J, Galiano M, Pebody R, Lackenby A, Thompson C, Bermingham A, McLean E, Zhao H, Bolotin S, Dar O, Watson JM, Zambon M. Virological analysis of fatal influenza cases in the United Kingdom during the early wave of influenza in winter 2010/11. Euro Surveill 2011; 16:19760. [PMID: 21223836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The 2010/11 winter influenza season is underway in the United Kingdom, with co-circulation of influenza A(H1N1)2009 (antigenically similar to the current 2010/11 vaccine strain), influenza B (mainly B/Victoria/2/87 lineage, similar to the 2010/11 vaccine strain) and a few sporadic influenza A(H3N2) viruses. Clinical influenza activity has been increasing. Severe illness, resulting in hospitalisation and deaths, has occurred in children and young adults and has predominantly been associated with influenza A(H1N1)2009, but also influenza B viruses.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antigens, Viral/genetics
- Child
- Disease Outbreaks
- Female
- Genotype
- Hospitalization
- Humans
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza B virus/genetics
- Influenza B virus/immunology
- Influenza B virus/isolation & purification
- Influenza Vaccines/immunology
- Influenza, Human/diagnosis
- Influenza, Human/mortality
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Middle Aged
- Phenotype
- Phylogeny
- Seasons
- Sentinel Surveillance
- Sequence Analysis, DNA
- Severity of Illness Index
- United Kingdom/epidemiology
- Young Adult
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Affiliation(s)
- J Ellis
- Health Protection Agency, Centre for Infections, London, United Kingdom
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21
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Abubakar I, Story A, Lipman M, Bothamley G, van Hest R, Andrews N, Watson JM, Hayward A. Diagnostic accuracy of digital chest radiography for pulmonary tuberculosis in a UK urban population. Eur Respir J 2010; 35:689-92. [DOI: 10.1183/09031936.00136609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Gilbert RL, Antoine D, French CE, Abubakar I, Watson JM, Jones JA. The impact of immigration on tuberculosis rates in the United Kingdom compared with other European countries. Int J Tuberc Lung Dis 2009; 13:645-651. [PMID: 19383200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To investigate whether trends in tuberculosis (TB) rates across Europe are linked to patterns of migration. DESIGN Descriptive analysis of Organisation for Economic Co-operation and Development population statistics and EuroTB data for 21 European countries for 1996-2005. RESULTS TB notification rates increased in only three of the 21 countries: the United Kingdom, Norway and Sweden. In all three countries, approximately three quarters of cases were foreign-born. The UK had the third highest number of foreign nationals overall, but the highest number from a country with a TB incidence > or =250 cases/100000 (219000, 13%). European countries with declining TB rates had varying patterns of migration, but did not generally receive migrants from very high-incidence countries and/or had a smaller proportion of their total TB cases in their migrant population. CONCLUSIONS The increase in the rate of TB in the UK, which contrasts with most other European countries, may, at least in part, be due to the fact that a high proportion of UK cases occur in the foreign-born, coupled with a comparatively large number of foreign nationals from countries with a very high incidence of TB.
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Affiliation(s)
- R L Gilbert
- Health Protection Agency Centre for Infections, London, UK.
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23
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Teo SSS, Riordan A, Alfaham M, Clark J, Evans MR, Sharland M, Novelli V, Watson JM, Sonnenberg P, Hayward A, Moore-Gillon J, Shingadia D. Tuberculosis in the United Kingdom and Republic of Ireland. Arch Dis Child 2009; 94:263-7. [PMID: 19052030 DOI: 10.1136/adc.2007.133645] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To describe the clinical features, diagnosis and management of children with tuberculosis in the United Kingdom and Republic of Ireland. METHODS Cases of culture-confirmed and clinically diagnosed tuberculosis were reported to the British Paediatric Surveillance Unit from December 2003 to January 2005. RESULTS 385 eligible cases were reported. Pulmonary disease was present in 154 (40%) children. Just over half (197, 51%) of children presented clinically and most of the remainder (166, 43%) at contact tracing. A probable source case was identified for 73/197 (36%) of the children presenting clinically. The majority (253, 66%) of children had a microbiological and/or histological investigation, and culture results were available for 240 (62%), of whom 102 (26%) were culture positive. Drug resistance was reported in 15 (0.4%) cases. 44% (128/292) of non-white children did not receive the recommended quadruple drug therapy. Seven children died. Only 57% (217) of children were managed by a paediatric subspecialist in respiratory or infectious diseases or a general paediatrician with a special interest in one of these areas. Fewer than five cases were reported from 119/143 (83%) respondents and 72 of 96 (75%) centres. CONCLUSIONS Many paediatricians and centres see few children with tuberculosis. This may affect adherence to national guidelines. Managed clinical networks for children with tuberculosis may improve management and should be the standard of care.
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Abubakar I, Moore J, Drobniewski F, Kruijshaar M, Brown T, Yates M, Anderson C, Smith EG, Magee J, Lipman M, McMenamin J, Ruddy M, Watson JM. Extensively drug-resistant tuberculosis in the UK: 1995 to 2007. Thorax 2009; 64:512-5. [DOI: 10.1136/thx.2008.108712] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Bhaumik S, Watson JM, Devapriam J, Raju LB, Tin NN, Kiani R, Talbott L, Parker R, Moore L, Majumdar SK, Ganghadaran SK, Dixon K, Das Gupta A, Barrett M, Tyrer F. Brief report: Aggressive challenging behaviour in adults with intellectual disability following community resettlement. J Intellect Disabil Res 2009; 53:298-302. [PMID: 19250390 DOI: 10.1111/j.1365-2788.2008.01111.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach. METHOD The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement. RESULTS All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1-year follow-up. CONCLUSIONS Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.
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Affiliation(s)
- S Bhaumik
- Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Leicester, UK.
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26
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Teo SSS, Alfaham M, Evans MR, Watson JM, Riordan A, Sonnenberg P, Clark J, Hayward A, Sharland M, Moore-Gillon J, Novelli V, Quinn D, Shingadia D. An evaluation of the completeness of reporting of childhood tuberculosis. Eur Respir J 2009; 34:176-9. [PMID: 19251788 DOI: 10.1183/09031936.00031808] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The sensitivity of the Enhanced Tuberculosis Surveillance (ETS) scheme for monitoring tuberculosis in children is unknown. We used the British Paediatric Surveillance Unit (BPSU) reporting scheme to conduct a prospective observational study of tuberculosis in children aged <16 yrs in the UK. Reported cases were then matched with records from the ETS database. A total of 320 cases were reported to the BPSU between January and December 2004. We estimated that there were 557 paediatric cases in England, Wales and Northern Ireland in 2004: 222 (40%) cases reported to both BPSU and ETS, 98 (18%) reported to BPSU but not ETS and 237 (42%) reported to ETS but not BPSU. Children aged <5 yrs were significantly less likely to be reported to ETS compared with older children (p<0.01). There is substantial under-reporting of childhood tuberculosis, especially of children aged <5 yrs. ETS provides a representative picture of the demographics but may miss approximately 20% of cases. This should be taken into account when planning training and resource requirements for tuberculosis. Increased efforts are needed to ensure that all paediatric cases are reported to ETS.
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Affiliation(s)
- S S S Teo
- Centre for Child Health, University of London, London, UK
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27
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Love J, Sonnenberg P, Glynn JR, Gibson A, Gopaul K, Fang Z, Le Brun F, Pitman R, Hayward AC, Innes J, Van den Bosch C, Delpech V, Drobniewski F, Watson JM. Molecular epidemiology of tuberculosis in England, 1998. Int J Tuberc Lung Dis 2009; 13:201-207. [PMID: 19146748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING England. OBJECTIVE To investigate the proportion of tuberculosis (TB) cases attributable to recent transmission and factors associated with clustering. DESIGN Demographic, clinical and microbiological surveillance data were collated from all new culture-confirmed cases in 1998. Using insertion sequence (IS) 6110 restriction fragment length polymorphism (RFLP) typing, strains were classified as clustered (identical patterns) or unique and risk factors were determined using multivariable logistic regression. RESULTS RFLP patterns were available for 2265 of 3713 (61%) cases: 1808 had >or=5 IS6110 copies, while 372 cases were in 152 clusters, giving an estimated proportion due to recent transmission of 12.2%.Pulmonary disease (aOR 1.6; 95%CI 1.1-2.2), previous treatment (aOR 3.7; 2.2-6.5) and homelessness (aOR 5.5; 1.2-24.1) were independent risk factors for clustering. Fourteen per cent of patients of Indian subcontinent origin were clustered compared with 27% of white patients. Many clusters spanned ethnic groups (45%) and geographical regions (47%). CONCLUSION The calculated proportion of TB cases due to recent transmission is low.Adjusting for missed cases and study duration, it increases to 27.6%. Many cases may arise from reactivation or acquisition outside England. Transmission within England accounted for approximately one in four cases and occurred over wide geographic areas, between ethnic groups and among the homeless. Molecular epidemiology can inform local and national public health action.
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Affiliation(s)
- J Love
- Respiratory Diseases Department, Health Protection Agency (HPA) Centre for Infections, London, UK
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28
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Mook P, Ellis J, Watson JM, Thompson CI, Zambon M, McMenamin J, Smyth B, Thomas DR, Pebody RG. Public health implications of influenza B outbreaks in closed settings in the United Kingdom in the 2007/08 influenza season. Euro Surveill 2008; 13:18986. [PMID: 18801323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Piers Mook
- Health Protection Agency Centre for Infections, London, England
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Crofts JP, Gelb D, Andrews N, Delpech V, Watson JM, Abubakar I. Investigating tuberculosis trends in England. Public Health 2008; 122:1302-10. [PMID: 18672258 DOI: 10.1016/j.puhe.2008.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/07/2007] [Accepted: 04/16/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the factors associated with the increasing incidence of tuberculosis in England. DESIGN Prospective national surveillance study. METHODS Measurement of relative trends in demographic, clinical and microbiological characteristics of tuberculosis cases reported in England between 1999 and 2003. RESULTS Between 1999 and 2003, the number of tuberculosis cases reported in England increased by 19% from 5539 to 6608. Significant increases in tuberculosis cases were seen in the non-UK-born population who were recent entrants to the UK (arrival less than 5 years prior to diagnosis) relative to cases in the UK-born population, both in London [1.08; 95% confidence interval (CI) 1.02-1.14] and outside London (1.22; 95% CI 1.16-1.28). Cases of tuberculosis co-infected with human immunodeficiency virus (HIV) increased significantly both in London (1.19; 95% CI 1.12-1.27) and outside London (1.22; 95% CI 1.12-1.33) relative to cases not known to be co-infected with HIV. Small increases in the number of cases living in less-deprived areas were observed relative to those in the most-deprived areas (1.11; 95% CI 1.02-1.21) in London. The number of cases of isoniazid-resistant (1.09; 95% CI 1.02-1.16) and multi-drug-resistant tuberculosis (1.22; 95% CI 1.02-1.45) increased relative to drug-susceptible cases in London. CONCLUSIONS Tuberculosis remains strongly associated with deprivation, but no real change in the distribution of tuberculosis cases by deprivation was observed over the study period. The proportion of tuberculosis cases co-infected with HIV has increased, but migration explains most of the recent trends in tuberculosis in England. Measures that target latent tuberculosis infection could have an increased role to play alongside measures against active disease in reducing the incidence of tuberculosis in the UK.
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Affiliation(s)
- J P Crofts
- Respiratory Diseases Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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30
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Abubakar I, Welfare R, Moore J, Watson JM. Surveillance of air-travel-related tuberculosis incidents, England and Wales: 2007-2008. Euro Surveill 2008; 13:18896. [PMID: 18761951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The potential spread of tuberculosis (TB) from infectious passengers during air travel has recently received increasing attention in the media and from public health authorities. We reviewed all air travel-related tuberculosis incidents reported to the Health Protection Agency Centre for Infections between January 2007 and February 2008 in England and Wales and investigated the effectiveness of contact investigation. Incidents involving air travel were defined according to the World Health Organization's guidelines on TB and Air Travel. We collected data on the index case, the incident and the outcome of contact investigation where available. We identified 24 incidents involving 39 flights. The median flight duration was 8.9 hours (inter-quartile range (IQR) 8 to 11.7). Most flights (36) were from or to a high burden country and 19 of the 24 incidents reported had a smear-positive index case. Two index cases had multidrug-resistant tuberculosis. In 17 incidents, no further investigation could be undertaken due to the lack of passenger information. In the remaining seven incidents, the quality of contact information obtained was variable. No further cases of TB infection or disease were identified. This study suggests that the process of investigating passenger contacts of a TB infected individual travelling by air is complicated and usually unsuccessful without dedicated resources and availability of high-quality contact information from airlines. Further research into the effectiveness of contact investigation in this setting is needed.
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Affiliation(s)
- I Abubakar
- Tuberculosis Section, Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London, United Kingdom.
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31
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Bhaumik S, Watson JM, Thorp CF, Tyrer F, McGrother CW. Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study. J Intellect Disabil Res 2008; 52:287-298. [PMID: 18339091 DOI: 10.1111/j.1365-2788.2007.01018.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Previous studies of weight problems in adults with intellectual disability (ID) have generally been small or selective and given conflicting results. The objectives of our large-scale study were to identify inequalities in weight problems between adults with ID and the general adult population, and to investigate factors associated with obesity and underweight within the ID population. METHODS We undertook a population-based prevalence study of 1119 adults with ID aged 20 and over on the Leicestershire Learning Disability Register who participated in a programme of universal health checks and home interviews with their carers. We performed a cross-sectional analysis of the register data and compared the observed and expected prevalences of body mass index categories in the ID and general populations using indirect standardisation for age. We used logistic regression to evaluate the association of a range of probable demographic, physical, mental and skills attributes with obesity and underweight. RESULTS In those aged 25 and over, the standardised morbidity ratio (SMR) for obesity was 0.80 (95% CI 0.64-1.00) in men and 1.48 (95% CI 1.23-1.77) in women. The SMR for underweight was 8.44 (95% CI 6.52-10.82) in men and 2.35 (95% CI 1.72-3.19) in women. Among those aged 20 and over, crude prevalences were 20.7% for obesity, 28.0% for overweight, 32.7% for normal weight and 18.6% for underweight. Obesity was associated with living independently/with family, ability to feed/drink unaided, being female, hypertension, Down syndrome and the absence of cerebral palsy. Underweight was associated with younger age, absence of Down syndrome and not taking medication. CONCLUSION Obesity in women and underweight in both men and women was more common in adults with ID than in the general population after controlling for differences in the age distributions between the two populations. The associated factors suggest opportunities for targeting high-risk groups within the ID population for lifestyle and behaviour modification.
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Affiliation(s)
- S Bhaumik
- Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester Frith Hospital, Leicester, UK.
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32
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Crofts JP, Pebody R, Grant A, Watson JM, Abubakar I. Estimating tuberculosis case mortality in England and Wales, 2001-2002. Int J Tuberc Lung Dis 2008; 12:308-313. [PMID: 18284837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
SETTING England and Wales, 2001-2002. OBJECTIVE To obtain a more accurate estimate of tuberculosis (TB) case fatality within 12 months of starting treatment or notification among TB cases reported to the national surveillance system. METHODS Records of deaths for all TB cases reported to the national surveillance system were identified using linkage to two other sources of mortality information: the National Health Service (NHS) central register and death registrations from the Office for National Statistics (ONS). These data were compared to reports of deaths ascertained by national TB surveillance through treatment outcome monitoring. Capture-recapture methodology was used to estimate any remaining unascertained deaths for the final calculation of the case fatality rate (CFR). RESULTS In total, 1169 deaths (95%CI 1140-1224) were identified among 13176 cases (CFR 8.9%, 95%CI 8.7-9.3%). Data linkage with the NHS central register and death registrations from the ONS identified a further 255 deaths not recorded by national TB surveillance. Capture-recapture estimated 61 (95%CI 32-116) unascertained deaths. CONCLUSION Mortality among TB cases is underestimated by national TB surveillance. Real-time data linkage between case reports and death registrations would allow a more accurate and timely estimate of TB mortality.
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Affiliation(s)
- J P Crofts
- Department of Respiratory Diseases, Health Protection Agency Centre for Infections, London, UK
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Ditah IC, Reacher M, Palmer C, Watson JM, Innes J, Kruijshaar ME, Luma HN, Abubakar I. Monitoring tuberculosis treatment outcome: analysis of national surveillance data from a clinical perspective. Thorax 2007; 63:440-6. [PMID: 17615085 DOI: 10.1136/thx.2006.073916] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 1998, the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) published recommendations standardising the evaluation of tuberculosis treatment outcome in Europe. These guidelines fail to account for clinically appropriate alterations in the management of patients. OBJECTIVES To evaluate tuberculosis treatment outcome in England, Wales and Northern Ireland by redefining the outcome criteria and investigate factors associated with unsuccessful treatment outcome 12 months after notification. METHODS This was a prospective analysis of a cohort of patients diagnosed in England, Wales and Northern Ireland and reported to the Enhanced Tuberculosis Surveillance system in 2001 and 2002. Proportions of success and failure were calculated based on a new set of criteria following discussion with clinicians treating tuberculosis cases. Logistic regression was used to study risk factors for unsuccessful treatment outcome. RESULTS 13 048 cases were notified in the study period. Of the 2676 that were identified as new sputum smear positive pulmonary cases, 2209 (82.5%) had treatment outcome data reported. Using the WHO/IUATLD criteria, 76.8% were classified as successful. In contrast, applying the new criteria, the success rate was 87.5%. This rate exceeds the 85% success target set by the WHO. Risk factors for unsuccessful treatment outcome included male sex (OR 1.27; 95% CI 1.08 to 1.49), being elderly (p trend < 0.001), having pulmonary tuberculosis (OR 1.28; 95% CI 1.08 to 1.53) and having resistance to any antituberculosis drug (OR 1.90; 95% CI 1.44 to 2.52). CONCLUSION The proportion of tuberculosis cases with a successful treatment outcome exceeded the target of 85% success rate based on the modified outcome categories. Although the tuberculosis treatment outcome criteria set by WHO/IUATLD appear to be clear, they mix measures of process and outcome. Further refinement may be necessary in low incidence high income countries, especially those with a high mortality among the elderly.
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Affiliation(s)
- I C Ditah
- Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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French CE, Antoine D, Gelb D, Jones JA, Gilbert RL, Watson JM. Tuberculosis in non-UK-born persons, England and Wales, 2001-2003. Int J Tuberc Lung Dis 2007; 11:577-84. [PMID: 17439685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
SETTING England and Wales, 2001-2003. OBJECTIVES To describe demographic and clinical characteristics of tuberculosis (TB) in non-UK-born persons and compare with UK-born cases to inform public health action and health service provision. DESIGN Analysis of surveillance data. RESULTS Among the 67% of cases who were non-UK-born, TB incidence was 88/100000 compared to 4/100000 among the UK-born. UK-born minority ethnic groups were also at increased risk of TB. Although the highest TB incidence occurred in recent entrants to the UK, nearly half the cases had been resident for >or=5 years. The majority of non-UK-born cases originated from South Asia (48%) and sub-Saharan Africa (35%). The demographic characteristics of non-UK-born and UK-born cases differed. In addition, non-UK-born cases were less likely to have pulmonary TB than the UK-born (52% vs. 73%, chi(2) P<0.001), but were more likely to have isoniazid-resistant disease (8% vs. 6%, chi(2) P=0.002), depending on region of birth. CONCLUSIONS During 2001-2003, most TB cases were non-UK-born. TB services need to take the characteristics of TB in this group into account. Furthermore, awareness of the risk of disease is required among the non-UK-born for many years after arrival into the UK, and among UK-born minority ethnic groups.
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Affiliation(s)
- C E French
- Tuberculosis Section, Respiratory Diseases Department, Health Protection Agency Centre for Infections, London, United Kingdom
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Abubakar I, Crofts JP, Gelb D, Story A, Andrews N, Watson JM. Investigating urban-rural disparities in tuberculosis treatment outcome in England and Wales. Epidemiol Infect 2007; 136:122-7. [PMID: 17359565 PMCID: PMC2870772 DOI: 10.1017/s0950268807008333] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to compare the occurrence of tuberculosis (TB) and the outcome of treatment between TB patients living in urban and rural areas. Cases of TB reported from 2001 to 2003 in England and Wales were assigned to a rural or urban area classification. The outcome of interest, non-completion of treatment, was investigated to determine the odds ratio for urban vs. rural residence. The effects of age, sex, ethnicity, place of birth, time since arrival in the United Kingdom, disease site, isoniazid resistance and previous diagnosis were adjusted for by multivariable logistic regression. Crude odds ratios showed a significantly higher level of treatment non-completion in rural areas. These results became non-significant (OR 1.02, 95% CI 0.83-1.26, P=0.82) after adjusting for the confounding effects of ethnic group and age. In England and Wales residence in a rural location is not an independent determinant of TB treatment outcome failure.
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Affiliation(s)
- I Abubakar
- Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London, UK.
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Coker R, Bell A, Pitman R, Zellweger JP, Heldal E, Hayward A, Skulberg A, Bothamley G, Whitfield R, de Vries G, Watson JM. Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J 2006; 27:801-7. [PMID: 16585088 DOI: 10.1183/09031936.06.00104305] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Well-established tuberculosis screening units in Western Europe were selectively sampled. Three screening units in Norway, two in the UK, one in the Netherlands and one in Switzerland were evaluated. The aim of this study was to describe a range of service models used at a number of individual tuberculosis units for the screening of new entrants into Europe. Semi-structured interviews were conducted with clinicians, nurses and administrators from a selected sample of European tuberculosis screening units. An outline of key themes to be addressed was forwarded to units ahead of scheduled interviews. Themes included the history of the unit, structure, processes and outputs involved in screening new entrants for tuberculosis. Considerable variation in screening services exists in the approaches studied. Units are sited in transit camps or as units within hospital facilities. Staff capacity and administration varies from one clinic per week with few dedicated staff to fully dedicated units. Only one site recorded symptoms; tuberculin testing was universal in children, but varied in adults; chest radiograph screening was universal except at one site where a positive tuberculin skin test or symptoms were required in those <35 yrs of age before ordering a radiograph. Few output data are routinely and systematically collected, which hinders comparison and determination of effectiveness and efficiency. Service models for screening new immigrants for tuberculosis appear to vary in Western Europe. The systematic collection of data would make international comparisons between units easier and help draw conclusions that might usefully inform service development.
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Affiliation(s)
- R Coker
- ECOHOST, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, and North East London TB Network, Department of Respiratory Medicine, Homerton University Hospital, London WC1E 7HT, UK.
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37
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Jalava K, Jones JA, Goodchild T, Clifton-Hadley R, Mitchell A, Story A, Watson JM. No increase in human cases of Mycobacterium bovis disease despite resurgence of infections in cattle in the United Kingdom. Epidemiol Infect 2006; 135:40-5. [PMID: 16740186 PMCID: PMC2870542 DOI: 10.1017/s0950268806006509] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2006] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
- K Jalava
- Communicable Disease Surveillance Centre, Centre for Infections, Health Protection Agency, London, UK.
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38
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Nguyen-Van-Tam JS, Nair P, Acheson P, Baker A, Barker M, Bracebridge S, Croft J, Ellis J, Gelletlie R, Gent N, Ibbotson S, Joseph C, Mahgoub H, Monk P, Reghitt TW, Sundkvist T, Sellwood C, Simpson J, Smith J, Watson JM, Zambon M, Lightfoot N. Outbreak of low pathogenicity H7N3 avian influenza in UK, including associated case of human conjunctivitis. ACTA ACUST UNITED AC 2006; 11:E060504.2. [PMID: 16816456 DOI: 10.2807/esw.11.18.02952-en] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
On 26 April 2006, the veterinary authorities in the United Kingdom reported that there had been an outbreak of avian influenza type A/H7 among a 35 000-bird housed poultry flock in eastern England, United Kingdom.
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Tyrer F, McGrother CW, Thorp CF, Donaldson M, Bhaumik S, Watson JM, Hollin C. Physical aggression towards others in adults with learning disabilities: prevalence and associated factors. J Intellect Disabil Res 2006; 50:295-304. [PMID: 16507034 DOI: 10.1111/j.1365-2788.2005.00774.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many people with learning disabilities (LD) show aggressive behaviour, but the extent of the problem and its associated factors and effects are unclear. METHODS A cross-sectional analysis was carried out using interview data from 3065 adults with LD on the Leicestershire LD Register. Physical aggression towards others was defined as carers reporting frequent (more than three times per week) and/or severe episodes. Individuals with and without aggression were compared using multiple logistic regression models for potential physical and psychological factors. RESULTS Carers reported that 443 (14%) of adults were physically aggressive towards others. Men (P = 0.001), younger individuals (P < 0.001), people with more severe LD (P < 0.001) and those in institutional settings (P < 0.001) had a significantly higher prevalence of physical aggression. People with Down syndrome had a lower prevalence of physical aggression (P < 0.001). After adjustment, we found no relationship between aggression and the presence of epilepsy or autism. Among psychological factors, symptoms of frustration (P < 0.001) and mood swings (P < 0.001) were associated with higher levels of aggression. Failure to cope among carers was reported by 14% overall: 42% of people caring for adults with aggression said they were unable to cope compared with 10% of those caring for adults without aggression. CONCLUSIONS Physical aggression towards other people presents a significant challenge to carers of adults with LD. Further research is needed to identify aetiological factors with a view to finding effective interventions to reduce, and improve management of, this behaviour.
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Affiliation(s)
- F Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK.
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40
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Baciu MV, Watson JM, Maccotta L, McDermott KB, Buckner RL, Gilliam FG, Ojemann JG. Evaluating functional MRI procedures for assessing hemispheric language dominance in neurosurgical patients. Neuroradiology 2005; 47:835-44. [PMID: 16142480 DOI: 10.1007/s00234-005-1431-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 05/20/2005] [Indexed: 11/30/2022]
Abstract
Two methods of quantifying hemispheric language dominance (HLD) in neurosurgical patients are compared: (1) an average magnitudes (AM) method, which is a calculation of the average signal intensity variation in regions of interest for each patient that were predefined in a group analysis for each task, and (2) a lateralization indices (LI) method, which is based on the number of activated pixels in regions of interest predefined in each individual patient. Four language tasks [a living/nonliving (LNL) judgment, word stem completion (WSC), semantic associate (SA) and a phonological associate (PA) task] were compared with "gold standard" measures such as the Wada test or electrocortical stimulation. Results showed that the LI method was more accurate (73% agreement with gold standard methods) than the AM method (only 40% agreement) across tasks and subjects. Furthermore, by varying the threshold used for determining laterality, the ability of functional magnetic resonance imaging (fMRI) to predict HLD was influenced for the AM method, whereas the LI method was relatively unaffected by changing the threshold. Using the LI method, the SA task was the most accurate for quantifying HLD (100% agreement with gold standard methods) with respect to the other three language tasks (80% accuracy for WSC, 65% for the LNL and 63% for phonological task). Depending on the method and the task, fMRI may be a promising tool for assessing HLD in neurosurgical patients.
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Affiliation(s)
- M V Baciu
- Laboratory of Psychology and Neurocognition, UMR CNRS 5105, Pierre Mendes-France University, BP 47, 38040, Grenoble Cedex 09, France.
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Conaty SJ, Hayward AC, Story A, Glynn JR, Drobniewski FA, Watson JM. Explaining risk factors for drug-resistant tuberculosis in England and Wales: contribution of primary and secondary drug resistance. Epidemiol Infect 2005; 132:1099-108. [PMID: 15635967 PMCID: PMC2870201 DOI: 10.1017/s0950268804002869] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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).
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Affiliation(s)
- S J Conaty
- Centre for Infectious Diseases Epidemiology, Department of Primary Care and Population Science, University College London, UK
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42
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Nicholls S, Carroll K, Crofts J, Ben-Eliezer E, Paul J, Zambon M, Joseph CA, Verlander NQ, Goddard NL, Watson JM. Outbreak of influenza A (H3N2) in a highly-vaccinated religious community: a retrospective cohort study. Commun Dis Public Health 2004; 7:272-7. [PMID: 15779788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
An outbreak of influenza occurred at the end of the 2001-2 winter season in a highly-vaccinated, semi-enclosed, religious community. On the basis of retrospective self reporting, 43% met the case definition (151/350) and 81% (25/31) of throat swabs from cases were polymerase chain reaction (PCR) -positive for influenza A (H3N2). The risk of developing influenza in people aged 65 or more was lower than that of children aged 2 years and under (odds ratio 0.1, 95% confidence interval 0.02 to 0.38). The risk of developing symptoms of influenza was not significantly different between people who had been vaccinated in the United Kingdom and those who had not been vaccinated (OR 1.14, CI 0.41 to 3.14). Chronic disease was an independent risk factor for developing symptoms of influenza (OR 1.9, CI 1 to 3.63). Timing of the outbreak, the age structure and mode of communal living may have influenced the efficacy of the influenza vaccine, which was well matched to circulating strains at the time of the outbreak. It is important to consider the diagnosis of influenza even in a highly-vaccinated community.
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Affiliation(s)
- S Nicholls
- Brighton and Hove City Primary Care Trust
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Pomorski P, Watson JM, Haskill S, Jacobson KA. How adhesion, migration, and cytoplasmic calcium transients influence interleukin-1beta mRNA stabilization in human monocytes. ACTA ACUST UNITED AC 2004; 57:143-57. [PMID: 14743348 DOI: 10.1002/cm.10159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We investigated the mechanisms by which primary human monocyte migration and the production of important cytokines are co-regulated. Motile monocytes underwent cyclic morphologic and adhesive changes that were associated with intracellular free calcium changes; in such cells, cytokine transcripts were unstable and translationally repressed. Agents that activate monocytes, including lipopolysacharrides (LPS), cytomegalovirus (CMV), and tumor necrosis factor (TNFalpha), have been shown to de-repress translation and these agents stabilize adhesion-induced transcripts for IL-lbeta and IL-8 and markedly diminish cell migration in the presence of autologous serum. LPS suppressed Rho A activity and either this agent or C3 transferase elevated intracellular free calcium, stabilized transcripts, and, in tandem, inhibited cell migration by preventing tail retraction, a prerequisite for cell translocation. These results, therefore, suggest that monocyte activating agents inhibit the RhoA pathway and continuously elevate intracellular calcium leading to a concomitant decrease in monocyte migration and stabilization of cytokine transcripts prior to translation.
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Affiliation(s)
- P Pomorski
- Department of Cell and Developmental Biology, University of North Carolina, Chapel Hill, 27599, USA
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Goddard NL, Joseph CA, Watson JM, Zambon M. Epidemiological features of a new strain of the influenza A virus--influenza A (H1N2) circulating in England and its public health implications. Virus Res 2004; 103:53-4. [PMID: 15163488 DOI: 10.1016/j.virusres.2004.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The UK influenza season of 2001/2002 was characterized by widespread geographic circulation of a new subtype of influenza A (H1N2) virus throughout the duration of the season. Younger children were predominantly infected, suggesting primary infection. Despite this, the public health impact of this new virus was minimal. It remains to be seen whether influenza A (H1N2) virus will persist and co-circulate with the previously circulating subtypes of influenza A (H1N1 and H3N2), or whether it was a sporadic recombination event that will disappear. Ultimately, the emergence of a new strain highlights the importance of continual surveillance of circulating viruses.
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Affiliation(s)
- N L Goddard
- Respiratory Diseases Department, Health Protection Agency, Communicable Disease Surveillance Centre, London, UK
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45
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Ruddy MC, Davies AP, Yates MD, Yates S, Balasegaram S, Drabu Y, Patel B, Lozewicz S, Sen S, Bahl M, James E, Lipman M, Duckworth G, Watson JM, Piper M, Drobniewski FA, Maguire H. Outbreak of isoniazid resistant tuberculosis in north London. Thorax 2004; 59:279-85. [PMID: 15047945 PMCID: PMC1763803 DOI: 10.1136/thx.2003.010405] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A description is given of a major outbreak of isoniazid monoresistant tuberculosis (TB) chiefly in north London, including prisons. The earliest case was diagnosed in 1995 with most cases appearing after 1999. METHODS Confirmation of a local cluster of cases was confirmed by restriction fragment length polymorphism (RFLP IS6110) typing or "rapid epidemiological typing" (RAPET). Further cases were found by retrospective analysis of existing databases, prospective screening of new isolates, and targeted epidemiological case detection including questionnaire analysis. RESULTS By the end of 2001, 70 confirmed cases in London had been linked with a further 13 clinical cases in contacts and nine epidemiologically linked cases outside London. The epidemic curve suggests that the peak of the outbreak has not yet been reached. Cases in the outbreak largely belong to a social group of young adults of mixed ethnic backgrounds including several individuals from professional/business backgrounds. Compared with other cases of TB reported to the enhanced surveillance scheme in London during 1999-2001, the cases are more likely to be of white (26/70 (37%) v 1308/7666 (17%)) or black Caribbean ethnicity (17/70 (24%) v 312/7666 (4%)), born in the UK (41/70 (59%) v 1335/7666 (17%)), and male (52/70 (74%) v 4195/7666 (55%)). Drug misuse and/or prison detention are factors common to many cases. CONCLUSIONS The investigation of the outbreak revealed significant problems on an individual patient and population based level including difficulties with contact tracing, compliance, and the risk of developing multidrug resistance. This incident has demonstrated the value of molecular strain typing in investigating an extensive outbreak of TB. This is the first documented outbreak involving a UK prison.
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Affiliation(s)
- M C Ruddy
- HPA Mycobacterium Reference Unit, King's College Hospital (Dulwich), Guy's King's and St Thomas' Medical School, London SE22 8QF, UK.
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Vander Weg MW, Watson JM, Klesges RC, Eck Clemens LH, Slawson DL, McClanahan BS. Development and cross-validation of a prediction equation for estimating resting energy expenditure in healthy African-American and European-American women. Eur J Clin Nutr 2004; 58:474-80. [PMID: 14985686 DOI: 10.1038/sj.ejcn.1601833] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop, validate, and cross-validate a formula for predicting resting energy expenditure (REE) in African-American and European-American women. DESIGN A cross-sectional study of REE in women. Participants were randomly assigned to one of two groups. One group served to develop and validate a new equation for predicting REE while the second was used to cross-validate the prediction equation. The accuracy of the equation was compared to several existing formulae. SETTING University metabolic laboratory, Memphis, TN, USA. SUBJECTS Healthy, premenopausal African-American and European-American women between 18 and 39 y of age. The validation sample included 239 women (age: 28.4 y, wt: 70.7 kg, body mass index (BMI): 25.2 kg/m(2), REE: 5840 kJ/day), while the cross-validation sample consisted of 232 women (age: 27.5 y, wt: 70.7 kg, BMI: 25.2 kg/m(2), REE: 5784 kJ/day). RESULTS The prediction equation derived from the current sample, which included adjustments for ethnicity, was the only formula that demonstrated a high level of accuracy for predicting REE in both African-American and European-American women. The mean difference between REE predicted from the new formula and measured REE was 28 kJ/day (s.d.=668) for European-American women and 142 kJ/day (s.d.=584) for African-American women. CONCLUSIONS Previous equations for predicting energy needs may not be appropriate for both African-American and European-American women due to ethnic differences in REE. A new equation that makes adjustments in predicted REE based on ethnicity is recommended for determining energy needs in these groups (Predicted REE (kJ/day)=616.93-14.9 (AGE (y))+35.12 (WT (kg))+19.83 (HT (cm))-271.88 (ETHNICITY: 1=African American; 0=European American)). SPONSORSHIP Support for this study was provided by Grant #HL53261 from the National Heart, Lung, and Blood Institute.
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Affiliation(s)
- M W Vander Weg
- The University of Memphis Center for Community Health, Memphis, TN 38157, USA.
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47
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Baciu MV, Watson JM, McDermott KB, Wetzel RD, Attarian H, Moran CJ, Ojemann JG. Functional MRI reveals an interhemispheric dissociation of frontal and temporal language regions in a patient with focal epilepsy. Epilepsy Behav 2003; 4:776-80. [PMID: 14698719 DOI: 10.1016/j.yebeh.2003.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a patient with frontal lobe epilepsy in whom the Wada test failed to lateralize representation of language (fluent speech was observed after amobarbital injection on both the right and left side). Functional magnetic resonance imaging (fMRI) during a lexical processing task revealed an atypical organization of language represented by an interhemispheric dissociation of language regions with a right frontal dominance and a left temporal dominance. Consistent with the fMRI results, the patient's ability to name pictures was not reliably impaired by electrocortical stimulation (ECS) of left frontal cortex. The findings from Wada, fMRI, and ECS were confirmed by a lack of language impairment after left frontal lobectomy for seizures. This case illustrates that fMRI can precisely map cortical language networks in epileptic patients and that fMRI may be used to help interpret laterality results provided by the Wada procedure.
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Affiliation(s)
- M V Baciu
- Department of Psychology, Pierre Mendes-France University, Grenoble, France
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Maccarone P, Wilcox SA, Watson JM, Marshall-Graves JA. Gene mapping using 3H-labeled heterologous probes. Methods Mol Biol 2003; 33:159-72. [PMID: 7534578 DOI: 10.1385/0-89603-280-9:159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P Maccarone
- Department of Zoology, La Trobe University, Bundoora, Victoria, Australia
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Aguilera JF, Paget WJ, Mosnier A, Heijnen ML, Uphoff H, van der Velden J, Vega T, Watson JM. Heterogeneous case definitions used for the surveillance of influenza in Europe. Eur J Epidemiol 2003; 18:751-4. [PMID: 12974549 DOI: 10.1023/a:1025337616327] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We reviewed the case definitions used by 21 influenza sentinel-based surveillance networks in Western Europe. Two clinical syndromes were used with a wide range of case definitions that nevertheless shared common criteria. Although there is currently no international consensus, efforts are being undertaken to standardise influenza case definitions in Europe.
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Affiliation(s)
- J F Aguilera
- Respiratory Division, Communicable Disease Surveillance Centre, Public Health Laboratory Service, London, United Kingdom.
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Chow JY, Anderson SR, Delpech V, Leese J, Horby P, Sedgwick JE, Rooney CI, Nicoll A, Watson JM. SARS: UK public health response--past, present and future. Commun Dis Public Health 2003; 6:209-15. [PMID: 14708270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The emergence of severe acute respiratory syndrome (SARS) in China, the occurrence of epidemics of SARS in China and a number of Southeast Asian countries, and its spread to countries elsewhere, have presented major challenges to public health systems throughout the world. Although very few true cases of SARS were detected in the United Kingdom, the public health response to the threat of SARS was considerable. The main components of this response were the early detection, isolation and reporting of cases, and the provision of comprehensive information to health professionals, cases, their contacts and the public. The development of the response to SARS raised a number of more general issues relevant to future infectious epidemic threats. Although the World Health Organisation has now declared SARS 'contained', the possibility of re-emergence is ever present. All countries will need to be vigilant and plan their response to the possibility of a renewed SARS epidemic.
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Affiliation(s)
- J Y Chow
- Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ.
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