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Biomedical subjects

W Fox

Publications and source records attributed to W Fox.

At least 19 recordsLinked to original sources
PubMed1979

The symptoms of newly diagnosed pulmonary tuberculosis and patients' attitudes to the disease and to its treatment in Hong Kong.

A questionnaire was applied by Government Health Visitors in Hong Kong to 201 consecutive patients with smear-positive, and 199 with smear-negative pulmonary tuberculosis who were attending one of the 7 full-time Government chest clinics for the first time on account of their current illness. Information was obtained about the symptoms of the disease and its diagnosis and management outside the Government service, and about patients' knowledge and attitudes towards the Government service. Among the 343 patients who sought treatment because of respiratory symptoms, the first symptom for the great majority (81 %) was cough, 15 % having sputum and 27 % haemoptysis as well. However, treatment was sought by only 15 % because of cough alone, compared with 40 % because of haemoptysis. Most patients (76 %) attended their first source of treatment or investigation within a month of the onset of symptoms, but some allowed long delays, and only 35 % attended a Government chest clinic within a month (whether this was the first source of treatment or not). The first source attended was a private practitioner for 53 % of the patients, another private medical establishment for 4 %, a Government chest clinic for only 11 % and another Government medical establishment for 17 %, 9 % went first to a herbalist and 5 % went to a drug store or treated themselves. The delays between the patients' first attendance at a source of treatment and their first attendance at a Government clinic were important, because outside the Government chest clinics only 49 % were investigated by chest radiograph and only 7 % by sputum bacteriology. Only 33 % were even suspected of having pulmonary tuberculosis, and many were correspondingly inadequately treated. The patients were, in general, ill informed about the Government chest clinic service; 52 % did not know, before their current illness, of the existence of the service, only 9 % knew that it was free, and only 12 % that it specialised in the management of tuberculosis. This study thus revealed a need to educate the public about the symptoms of tuberculosis, and about the possibility of their being investigated and treated, free, in a Government chest clinic.

Adolescent↗
PubMed1979

Efficiency of address cards, experienced health visitors and motivated registry clerks in obtaining the home address of urban patients in South India.

The address card, a card on which the patient's home address is asked to be recorded by the local postman, or by a knowledgeable and literate neighbour, relative or friend, was investigated for acceptability and efficiency in 4 tuberculosis out-patient clinics, in an urban community with substantial levels of illiteracy in Madras City. In the 4 clinics combined, 96% of the patients who reattended returned the completed card. Letters posted to the address on the cared were received by 85% of 419 patients, while 5% were returned by the post office as undelivered and a further 4% were, in all probability, not delivered; no information was available about the remaining 6%. A formal comparison in 392 of the above patients demonstrated the address card method to be significantly more efficient than interrogation by experienced health visitors. A retrospective comparison suggested that the efficiency of experienced health visitors was slightly better than that of highly motivated registry clerks, the proportions of letters received being 72% and 65% respectively.

Community Health Nursing↗
PubMed1979

An investigation of the accuracy of the home address given by patients in an urban community in South India.

Studies were undertaken in three tuberculosis clinics in Madras, a large Indian city with a good civic organization, to assess the accuracy of address recorded routinely by registry clerks at the patient's first clinic attendance. The accuracy was poor, with 20% to 30% of the letters posted not reaching the patients. It was appreciably improved, by 10% to 20%, by supplementing the clerk's efforts with questioning by a motivated, experienced health visitor. An address card, a card on which the patient's address was recorded by the local postman or a literate neighbour, relative or friend, was returned by 90% to 94% of the patients, and the accuracy of addresses was found to be at least as good as that obtained with the health visitor. Even when all three sources of information were considered, the patient's home could not be traced in 3% of cases and was found with difficulty in 4%.

Community Health Nursing↗
PubMed1979

Double blind controlled comparison of aspirin, allopurinol and placebo in the management of arthralgia during pyrazinamide administration.

Chinese patients with arthralgia during treatment with an antituberculosis regimen containing pyrazinamide were allocated at random to 3 anti-arthralgia treatment series in a controlled double-blind study. One series (18 patients) received soluble aspirin 2.4 g daily, the second (23 patients) allopurinol 200 mg daily, and the third (19 patients) placebo only, for 8 weeks. The response was assessed both by independent assessors and by the patients themselves using a diary card. The serum uric acid concentration was measured before and during anti-arthralgia treatment. The joints most commonly affected were the shoulders, the knees and the fingers, and symptoms and signs were in general neither severe nor protracted. For most of the patients in all 3 series the joint symptoms and signs improved during the 8 weeks, but a higher proportion of patients in the aspirin and placebo series than in the allopurinol series experienced improvement, this being most rapid in the aspirin series. Only in the aspirin series was the mean serum uric acid concentration lower during treatment than before it, and this effect was related to the dose in mg per kg. It is concluded that the arthralgia was often self-limiting, that aspirin had a small beneficial effect, that allopurinol, in the dosage studied, may have had a slightly deleterious effect, but that it would be worth studying larger dosages of allopurinol because the dosage studied did not affect the serum uric acid concentration.

Adolescent↗
PubMed1979

The cost of antituberculous drug regimens.

The relative costs of several highly effective short-course regimens have been compared for a developing and a developed country both for 1976 and 1978, with particular reference to the proportion of the total cost due to individual drugs. A convenient method of calculating costs for any individual country is provided. Of isoniazid, pyrazinamide, and rifampin, the 3 most important drugs in short-course chemotherapy, the cost and duration of the latter two have a major effect on the total cost. A decrease in the duration of a regimen from 9 to 6 months may decrease therapeutic effectiveness by as little as 5% or as much as 20%; the decrease in cost is often not proportional, because it depends on the drugs used in the continuation phase. The duration of pyrazinamide therapy has a considerable influence on cost, but the benefit of giving it beyond 2 months now needs to be re-evaluated. Factors that influence the choice of regimens are discussed. The importance of quality of the drugs, including purity and bioavailability, is stressed.

Antitubercular Agents↗
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↗
PubMed1977

Acute leukaemia after busulphan.

During a double-blind study of two years' cytotoxic chemotherapy with busulphan or cyclophosphamide in patients who had had resection of carcinoma of the bronchus the long-term effects of these two drugs were also studied. Four of the 243 patients treated with busulphan developed leukaemia compared with none of the 234 treated with cyclophosphamide and none of the 249 on placebo. None of these four patients received radiotherapy or other cytotoxic chemotherapy before leukaemia was diagnosed, and all four were among the 19 patients who developed pancytopenia while taking busulphan, five to eight years before leukaemia became clinically apparent. These findings suggest that busulphan is leukaemogenic, though its mode of action is uncertain.

Acute Disease↗