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Biomedical subjects

D B Cundall

Publications and source records attributed to D B Cundall.

17 recordsLinked to original sources
PubMed2001

Tuberculosis, deprivation, and ethnicity in Leeds, UK, 1982-1997.

AIMS: To determine whether tuberculosis is increasing in frequency and to explore the association between deprivation, ethnicity, and tuberculosis in the city of Leeds. METHODS: Descriptive epidemiology and ecological analysis of a register of children and young people (0-18 years) diagnosed with tuberculosis from 1982 to 1997 in Leeds Health Authority. RESULTS: A total of 107 children were identified, 61 through contact tracing, to give an age and sex standardised incidence rate of 3.9 per 100 000 per year. Rates decreased over the 16 year study period by an estimated 6.6% per year. The disease was more common in girls (56%) and most frequent in 5-9 year olds, with respiratory disease accounting for the largest proportion (82%). Children of south Asian origin (35%) had a crude incidence rate of 25.7 per 100 000 per year. The female:male ratios differed notably between south Asian (1.9:1) and non-south Asian children (1.02:1). For all subjects, univariate analyses showed significant positive associations between incidence and deprivation, population density, and ethnicity. There were no significant associations between deprivation, population density, and ethnicity and incidence of tuberculosis in south Asian children. For non-south Asian, mainly white children, only deprivation was significant. The proportion of non-south Asian children in the population was the overriding factor influencing incidence of tuberculosis. CONCLUSIONS: Tuberculosis remains an uncommon disease in Leeds children. An unexpected finding was a relatively higher incidence in Asian girls compared to boys. Overall, ethnicity explains a high proportion of disease independently of deprivation and population density but for non-south Asian Leeds children the strongest risk factor is deprivation.

Adolescent↗
PubMed1994

Childhood tuberculosis in Leeds, 1982-90: social and ethnic factors and the role of the contact clinic in diagnosis.

A retrospective analysis of childhood tuberculosis in Leeds over a nine year period (1982-90) was performed which showed that the contact clinic is important for the early detection and treatment of disease in children. Two thirds of the cases of tuberculosis in children under 15 years were diagnosed and treated at the clinic. The incidence of tuberculosis was greater in Asian than in white children and, independent of race, was greater in the most deprived area of the city.

Adolescent↗
PubMed1992

Heaf status 12 years after infant BCG immunization.

Uncertainty exists over the long-term influence of Heaf status and immunity of infant BCG immunization. BCG is offered to all Leeds Asian infants with uptake estimated at 86%. We have examined the effect of this immunization policy on the Heaf status of all 12- to 13-year-old children tested in the city in 1988. 6363 children (431 Asians) were eligible for Heaf testing of whom 5379 (366 Asians) were tested. 90 (25%) Asians and 4596 (92%) non-Asians had a Heaf grade 0-1 with no definite previous BCG and were, using current UK Department of Health recommendations, eligible for BCG immunization. With an annual incidence of tuberculosis in Asian children in Leeds of only 6 per 100,000 it is probable that most of the 75% of Asian children who did not require immunization had persisting immunity from their infant BCG rather than as a result of primary infection. We conclude that infant BCG immunization is effective at providing appropriate immunity, avoiding repeat BCG, in most children at age 12 years.

Adolescent↗
PubMed1991

Outbreak of tuberculosis in a poor urban community.

A woman from a poor urban community presented recently with pulmonary tuberculosis. Screening of contacts revealed 10 cases of tuberculosis, eight of whom were children. A further 10 children had grade 2-3 positive Heaf tests and were given chemoprophylaxis. Tuberculosis remains a potential problem, particularly in young unimmunized children in deprived areas.

Adolescent↗
PubMed1991

Time of development of tuberculosis in contacts.

The British Thoracic Association has recommended that close contacts of smear-positive cases of tuberculosis be followed up for at least 2 yrs (Tubercle 1978; 59: 245-259) but Selby et al. have recently suggested that a reduction in duration of follow up may be appropriate (Respir Med 1989; 83: 353-355). We have reviewed the results of contact procedures in Leeds to determine whether our experience supports reduction in the duration of follow up of contacts of patients with tuberculosis. In the 5-yr period 1983-87 there were 555 cases of tuberculosis (135 in Asians) of whom 42 (7.6%) were identified by contact procedures. In addition, contact procedures identified 35 children who were given chemoprophylaxis for positive Heaf tests (grade 2 or more). Of the 42 contacts with tuberculosis, 30 (71%) were diagnosed at the first visit, eight (19%) were diagnosed 6 months later and four (10%) were diagnosed 16-24 months after their initial clinic attendance. Five of the 42 contacts with TB were Asian, two of whom were diagnosed late. Seven out of ten non-Asian contacts who were diagnosed late had initial Heaf reactions of grade 1 or 2. All cases diagnosed late were contacts of a sputum-positive source. Poverty, as defined by residence in the Leeds Urban Priority Area, was associated with an increased risk of 3.3-fold for tuberculosis and a sixfold risk for chemoprophylaxis diagnosed by contact procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Identical twins with idiopathic external hydrocephalus.

Monozygotic twins with idiopathic external hydrocephalus are reported. Characteristic computerised tomographic features were associated with early gross motor delay and rapid improvement. A genetic basis for the syndrome is supported by its occurrence in identical twins.

Child, Preschool↗
PubMed1988

Which bone age in chronic renal insufficiency and end-stage renal disease?

One hundred radiographs of the left hand and wrist from 40 children with chronic renal insufficiency or end-stage renal disease were examined to determine which method of bone age estimation provided the most useful information in these children. The Tanner and Whitehouse method showed better repeatability than the Greulich and Pyle atlas or the Buckler handbook when a sample of the radiographs were assessed twice by the same observer. The Tanner and Whitehouse 20 (TW20) bone age showed less inter-observer bias than the radius, ulna and short bone age or the carpal bone age when three observers independently assessed the same sample of radiographs. TW20 was the most useful method of bone age assessment in this study of British children. An unexpected finding was that the carpal bones were significantly more retarded than the radius, ulna and short bones. Separate assessment of the carpal bone age may provide extra information of clinical relevance.

Adolescent↗
PubMed1988

Inner city tuberculosis and immunisation policy.

Asian children, excluding recently arrived immigrants, had a similar incidence of tuberculosis to white children in Leeds from 1982-6. Children living in the urban priority area were 2.6 times more likely to develop tuberculosis than those living elsewhere. Selection for infant BCG immunisation should not depend on ethnic group alone.

Adolescent↗
PubMed1987

Children and mothers at clinics: who is disturbed?

One hundred and eighty one white children aged 6 to 11 years who were attending medical outpatient clinics with their mothers were studied to assess the prevalence of psychological disturbance in the children, and anxiety and depression in the mothers. Teachers were also asked to assess the children independently using the Rutter scales. Mothers assessed 70 (39%) of the children as being disturbed, 20 of whom were also assessed as being disturbed by their teachers. A further 15 children were assessed as being disturbed by their teachers but not by their mothers. Thirty five (19%) of the mothers assessed themselves as anxious and two as depressed using the hospital anxiety and depression scale. Anxious and depressed mothers were significantly more likely to assess their child as being disturbed. In contrast, the teachers' assessments of the children were not affected by the mental state of the mothers. These findings confirm that mothers' perceptions of their children are modified by their own moods.

Affective Symptoms↗
PubMed1986

Severe anaemia and death due to the pharyngeal leech Myxobdella africana.

Six cases of pharyngeal leech (identified as Myxobdella africana) are reported from a highland area of North Kenya. Three patients were severely anaemic and one died. There have been sporadic reports of leech infestation of man in East and Central Africa but these reports lack correct identification of the leech. This paper includes a detailed account of the systematics of the leech and of its habitat. The leeches were ingested accidentally by drinking water from two infested water sources. The major symptoms were a feeling of something in the throat, epistaxis and haemoptysis. On examination, pharyngeal blood was a consistent feature although the leech was rarely seen on initial inspection. Examination under anaesthesia was usually successful in locating and removing the leech. Prompt blood transfusion was life-saving in two cases. The water sources were used by both cattle and man; the cattle may also be parasitized by leeches. Methods of improving the water sources were discussed with community leaders.

Adolescent↗
PubMed1986

The diagnosis of pulmonary tuberculosis in malnourished Kenyan children.

Guidelines available for the diagnosis of pulmonary tuberculosis (TB) in children vary widely. In an area of high prevalence, pulmonary TB was often suspected but difficult to confirm. In a prospective study, diagnostic methods were recorded in 144 consecutive children admitted and diagnosed as having pulmonary TB. Six of the 144 children had bacteriologically confirmed tuberculosis. Seventy-five children had probable tuberculosis, the diagnosis being based on the tuberculin response in 19, a history of family contact in 34 and a diagnostic chest radiograph in 22. The remaining 63 children had suspected tuberculosis: 23 of these had an inconclusive chest X-ray. The suspected group were significantly younger than the probable group (mean ages 2.8 and 4.4 years respectively), experienced a longer delay between admission and the start of antituberculous chemotherapy and suffered a significantly higher mortality (30% and 8% respectively). A diagnostic process is proposed which takes account of the high proportion of nonresponders to tuberculin in a young, malnourished population. A trial of anti-tuberculous therapy is accepted as a valid diagnostic manoeuvre in suspected cases who are malnourished or have recently had measles.

Child↗