PubMed Health⌕ Search

Biomedical subjects

I Sutherland

Publications and source records attributed to I Sutherland.

At least 55 records · Page 3Linked to original sources
PubMed1982

The development of clinical tuberculosis following infection with tubercle bacilli. 1. A theoretical model for the development of clinical tuberculosis following infection, linking from data on the risk of tuberculous infection and the incidence of clinical tuberculosis in the Netherlands.

Information on the risk of tuberculous infection in the Netherlands has been linked with information on the incidence of tuberculosis, in an attempt to estimate the risks of developing the disease following infection or reinfection. It was postulated that: (a) those with a recent primary infection had a characteristic risk of developing progressive primary tuberculosis; (b) those with a distant (i.e. not recent) primary infection and a recent reinfection had a characteristic risk of developing exogenous tuberculosis; and (c) those with a distant primary infection but no recent reinfection had a characteristic risk of developing endogenous tuberculosis. The information on the risk of tuberculous infection was used to estimate the size of the population in each of these infection classes for different age-groups and calendar years in the Netherlands. Using multiple regression to link these population figures with the information on tuberculosis incidence in the same age group and calendar year, it was possible to estimate the above risks of developing tuberculosis. For Netherlands males aged 15-69 years during the period 1951-70 the three risks of developing pulmonary tuberculosis were estimated to be: (a) 5.06 per cent annually (for 5 years) following primary infection; (b) 1.91 per cent annually (for 5 years) following reinfection; (c) 0.0253 per cent annually, after the first 5 years following primary infection, in the absence of reinfection. The corresponding (and significantly different) estimated annual risks of development of pulmonary tuberculosis for females were 5.85, 1.10 and 0.0020 per cent respectively. From these risks, it may be estimated that the degree of protection conferred by a distant primary infection, against pulmonary tuberculosis arising from a recent reinfection, was 63 per cent for males and 81 per cent for females. The estimated relative proportions of cases of progressive primary, exogenous and endogenous tuberculosis varied considerably with age and calendar year. Progressive primary tuberculosis was dominant at the younger ages, exogenous and endogenous tuberculosis at older ages. At these older ages, the great majority of cases in the Netherlands in the early 1950s appeared to be exogenous in origin, but by 1970, with the decrease in the risk of infection, the exogenous contribution had dwindled substantially, especially among males.

Adolescent↗
PubMed1981

A third study of case-finding methods for pulmonary tuberculosis in Kenya, including the use of community leaders.

Five methods of identifying tuberculosis suspects were investigated in the Machakos District of Kenya by: (1) 3-monthly interrogation of the Community Elders, (2) interrogation of household heads, (3) identifying suspects amongst outpatients attending local health units, (4) examination of patients registered during the previous 10 years in the District Tuberculosis Register and also (5) their close contacts. Sputum was bacteriologically examined by smear and culture from suspects found by all the methods. The initial interrogation of the Elders yielded 216 suspects, of whom 9 were culture-positive, including 6 smear-positive. Reinterrogating the Elders 4 times at 3-monthly intervals produced a further 114 suspects including 4 culture-positive cases (3 being smear-positive). The examination of a second sputum specimen from suspects after a 3-month interval yielded 4 further culture-positive cases (all smear-negative) but the examination of a third specimen after a further 3 months yielded no further cases. A single interrogation of 1093 household head suspects yielded 22 culture-positive cases, including 11 smear-positive. The response in 5 health units covering a population of about 24 500 was poor. During a 2-year period only 109 suspects were recorded; 7 were culture-positive, including 3 smear-positive. Of 61 cases of tuberculosis registered during the previous 10 years, 8 were currently culture-positive, 5 being smear-positive. Of 318 household contacts of these cases, 6 were culture-positive cases, 2 being smear-positive. The problems presented by different active case-finding methods are discussed, identifying those that appear promising and those unpromising.

Adolescent↗
PubMed1981

BCG vaccination of children against leprosy in Uganda: final results.

A total of 19 200 children, all contacts or relatives of known leprosy patients, and all free of visible leprosy lesions, were included in a controlled trial of BCG vaccination against leprosy in Uganda between 1960 and 1964. They were followed for an average of 8 years, during which time 261 developed early leprosy lesions. A less comprehensive follow-up was carried out for a further 5 years, when 8 more cases of leprosy were identified.In the main intake, between 1960 and 1962, 16 150 tuberculin-negative or weakly tuberculin-positive (Heaf Grades O-II) children were allocated by an effectively random process to either a BCG-vaccinated or an unvaccinated control group. Both groups were seen and examined in an identical fashion for leprosy at approximately 2-year intervals, and precautions were taken to ensure unbiased assessment of new cases of leprosy. After 8 years, 41 cases of leprosy had been identified in the BCG-vaccinated group, and 201 in the control group, a percentage reduction in the BCG-vaccinated group compared with the control group of 80%. The percentage reduction was similar for those initially tuberculin-negative, and for those initially weakly positive, and did not depend upon the age at vaccination. It was also similar for both sexes, for contacts of lepromatous and contacts of non-lepromatous leprosy, for children having contact with one or more than one patient, and for differing grades of physical contact and genetic relationship with a patient. The protective effect of BCG vaccination continued over the 8-year period, although it may have fallen off slightly at the end.In a group of 1074 strongly tuberculin-positive (Heaf Grades III-IV) children followed in parallel with the other two groups a total of 16 cases of leprosy were identified. When adjusted for age, this incidence is 58% lower than that in the unvaccinated control children who were initially tuberculin-negative, indicating a protective effect against leprosy of naturally-acquired strong tuberculin sensitivity.Between 1970 and 1975, one new case of leprosy was identified in a child who had initially been strongly tuberculin-positive and had therefore not been vaccinated, one in a BCG-vaccinated child, and 6 in control children. Although the follow-up in this period was less comprehensive than that in the main part of the trial, the ascertainment of cases was unlikely to have been biased towards either vaccinated or control children. These results indicate a continuing protective effect of BCG up to 12-13 years after vaccination.

Adolescent↗
PubMed1980

Efficacy of BCG.

Explore the source record for details and available documents.

BCG Vaccine↗
PubMed1979

The protective effect of BCG vaccination as indicated by autopsy studies.

In a detailed study of the pathology of tuberculous infection made in Finland in 1961, tuberculous foci were found at autopsy in 61 of 67 non-vaccinated subjects and in 35 of 83 BCG-vaccinated subjects, all of whom had died between the ages of 1 and 45 years (with 2 exceptions from causes other than tuberculosis). In the present note on the same material, national information on tuberculin sensitivity and tuberculosis mortality has been used to calculate the risk of tuberculous infection in Finland at different times and ages during the lifetime of these subjects. From these risks of infection in Finland it was estimated that 63 or 64 of the non-vaccinated subjects had been infected during their lifetime and that between 25 and 31 of the BCG-vaccinated subjects were expected to have been naturally infected (had they not been vaccinated) between the time of vaccination and death. It is concluded that virtually all tuberculous infections in unvaccinated subjects lead to pulmonary foci, which are demonstrable at autopsy. Further, the same appears to be so in vaccinated subjects; there is no evidence to support the suggestion that in man BCG vaccine can prevent the establishment of infection in an exposed subject. The effects of BCG (as demonstrated in the earlier paper) appear to be confined to limiting the multiplication and dissemination of the bacilli and the development of lesions following infection.

Adolescent↗
PubMed1978

A second study of the use of community leaders in case-finding for pulmonary tuberculosis in Kenya.

This is the second study of case-finding activities for tuberculosis suspects undertaken in 2 locations of Machakos District. Three methods were investigated, namely (1) the requestioning of the Community Elders 1 year or more after a first questioning in the original study, (2) the examination of patients registered in the District Tuberculosis Register from 1969--1974 and (3) the examination of their close contacts. Requestioning the Elders produced a total of 421 suspects, 129 (31%) of whom had not been identified a year previously. The yield of freshly identified smear-positive, culture-positive cases was 0.7 per 100 suspects examined and of all culture-positive cases was 1.7. However, all the smear-positive and 1.0 per 100 of the culture-positive cases were old patients who had previously been registered in the District Tuberculosis Register. Of the 181 patients with tuberculosis in the Register bacteriological results were available for 97; of these 6 were smear-positive, 9 culture-positive--yields of 6.2 smear-positive, culture-positive cases per 100 registered persons examined. The corresponding yields for the 63 persons who had been registered as having pulmonary disease were 9.5 and 14.3. Of the 9 culture-positive, 7 had strains resistant to isoniazid, but all were sensitive to streptomycin. The examination of the 628 close contacts of the registered patients produced only 3 culture-positive cases, none of whom was smear-positive--a yield of 0.5 culture-positive cases per 100 contacts examined. All 3 strains were sensitive to isoniazid and streptomycin.

Communicable Disease Control↗
PubMed1978

Hyperbaric oxygen and radiotherapy: a Medical Research Council trial in carcinoma of the cervix.

In a randomized controlled clinical trial of hyperbaric oxygen in the radiotherapy of advanced carcinoma of the uterine cervix a total of 320 cases were contributed by four radiotherapy centres in the United Kingdom. The use of hyperbaric oxygen resulted in improved local control and survival. The benefit was greatest in patients under the age of 55 who presented with stage III disease. There was a slight increase in radiation morbidity but it seemed that the benefit of hyperbaric oxygen outweighed this increase in morbidity and that there was a true improvement in the therapeutic ratio.

Adult↗
PubMed1977

BCG and vole bacillus vaccines in the prevention of tuberculosis in adolescence and early adult life.

The Medical Research Council's trial of BCG and vole bacillus vaccines in the prevention of tuberculosis in Great Britain has ended after 20 years' follow-up of the 54 239 participants, who were aged 14 to 15 years when the entered the trial in 1950-2. Participants who were tuberculin positive on entry were left unvaccinated; those who were tuberculin negative were allocated at random to an unvaccinated or to a vaccinated group. The protective efficacy of each of the two vaccines, among those initially tuberculin negative, was 84% during the first five years, and gradually decreased, averaging 77% for each vaccine over the whole period. The incidence of tuberculosis decreased substantially in all groups during the trial, however, and of the total of 610 cases of tuberculosis only 27 developed between 15 and 20 years. Thus we cannot make a reliable assessment of efficacy during this final period. The prevalence and incidence of tuberculosis in Great Britain have decreased radically since this trial began. The expected benefit from large-scale BCG-vaccination of children is now far less, and may decrease further if the incidence of tuberculosis continues to decline.

Adolescent↗