Decline Of Tuberculosis Research Articles

Tuberculosis in developing countries and methods for its control

Tuberculosis is a major cause of morbidity and mortality in developing countries. It is estimated that one-fifth of the world population is infected, 12–16 million people have the disease, every year 6–8 million develop tuberculosis and 2–3 million die from it. Four methods for the prevention of tuberculosis are available: improvement of socio-economic conditions, case-finding and treatment, chemoprophylaxis, and vaccination. Each of these methods is examined in relation to a model of the chain of transmission and development of disease. Improvement of socio-economic conditions, responsible for the decline of tuberculosis in the developed world, must be seen as a long-term solution. Case-finding and treatment is the only method expected to have an important short-term impact on transmission. A summary of the results of 35 studies shows the estimated efficacy of bacillus Calmette-Guérin (BCG) vaccination ranging from 96% to none. Follow-up results from 10 controlled trials are consistent with waning of BCG protective efficacy with time since vaccination. Chemoprophylaxis and vaccination are expected to protect the individual but not to have a significant short-term impact on transmission.

Anti-antivivisection: Maybe It Is Time to Stop Waiting

To the Editor.—In response to Harken and Harken's1article in the December 1989 issue of theArchives, I find the sweeping statement ... the biological sciences are bereft of relevance without animal validation and experimentation to be quite open to question. Many colleagues who rely on clinical observation and research would disagree. implication that animal research has made our world dramatically more civilized and humane is grossly incorrect. Melvin Konner,2in a recentNew England Journal of Medicinebook review, states, The great declines in mortality from infectious diseases preceded the development of antibiotics and even most vaccines; they resulted instead from changes in sanitation, nutrition, and other socioeconomic measures. Vincent J. Knapp3states, The initial decline of tuberculosis within European society was evidently not the result of any medical miracle... the disease was in eclipse because of rising levels of immunity within the general population

The Historical Decline of Tuberculosis in Europe and America: Its Causes and Significance

The Historical Decline of Tuberculosis in Europe and America: Its Causes and Significance

The decline and fall of the chest clinic

In an area which, for many years, showed the highest incidence of tuberculosis in England, the chest clinic has been completely absorbed into a general hospital. The decline in tuberculosis and the change in methods, personnel and organisation which this entails are described. Good tuberculosis control can be continued without any special chest clinic facility.

The elusive diagnosis of leprosy.

As the incidence of tuberculosis decreased the last 10 years, new cases of leprosy increased. The highest incidence of new cases in the United States was reported in Texas. It may be that with the decline of tuberculosis, the natural ecology of mycobacteria is reversed, and if measures are not taken, the leprosy/tuberculosis ratio may again favor leprosy.

An epidemiological method to improve tuberculosis control.

An account is given of the prevalence, incidence and decline of tuberculosis in Scotland with particular regard to the West. It is concluded that there is still considerable morbidity from the disease as measured by a persisting annual attack rate of post-primary tuberculosis of 1 per thousand in Mantoux positive (5 to 20 mm. and exclusive of larger reactors) male and female schoolchildren aged 14 to 15 years with negative chest radiographs 1 year previously. It is predicted that in 1975 there may still be 160 deaths and 927 new notifications of tuberculosis in Scotland, 460 of which could be detected by the mass radiography service. A predictive epidemetric model is described whereby the annual radiological surveillance of 18,596 older residents of Paisley would be tested over two years in relation to tuberculin status at initial examination, as a method of intervening in the intergenerational cycle of infection. If resources are available it is considered that the model is feasible and should be implemented without delay if the present epidemiological situation, particularly in regard to the attack rate in schoolchildren, is unchanged over the next 2 years. If the model should prove successful then mass radiography resources could concentrate on the annual or bi-annual prophylactic radiological surveillance of older urban populations with positive reactions to tuberculin testing at or just before the critical age for change in tuberculin reactivity.

Reasons for the decline of mortality in england and wales during the nineteenth century

Summary Five diseases or disease groups accounted for almost the whole of the reduction in mortality between 1851–60 and 1891–1900: tuberculosis (all forms), 47.2 per cent; typhus, enteric fever and simple continued fever, 22.9 per cent; scarlet fever, 20.3 per cent; diarrhoea, dysentery and cholera, 8.9 per cent; and smallpox, 6.1 per cent. In order of their relative Importance the Influences responsible for the decline were: (a) a rising standard of living, of which the most significant feature was improved diet (responsible mainly for the decline of tuberculosis, and less certainly, and to a lesser extent, of typhus); (b) the hygienic changes introduced by the sanitary reformers (responsible for the decline of the typhus-typhoid and cholera groups); and (c) a favourable trend In the relationship between infectious agent and human host (which accounted for the decline of mortality from scarlet fever, and may have contributed to that from tuberculosis, typhus and cholera). The effect of therapy was restricted to smallpox and hence had only a trivial effect on the total reduction of the death rate. Reasons for the rise of population In the pre-registration years are discussed in the light of these conclusions. Neither therapy nor sanitary reform made any significant contribution, and It is suggested that the marked and sustained rise In population before 1850 cannot plausibly be attributed solely to a fortuitous shift In the relationship between infectious organisms and the human host. We conclude that, whether more importance Is attached to the birth rate or the death rate, the most significant Influence until 1850 (indeed until 1870) was a rising standard of living.

Early roentgen diagnosis of tuberculosis of the hip in children.

The early roentgen diagnosis of tuberculosis of the hip in children has received little attention in recent radiologic literature. This is primarily due to the decline of tuberculosis in this country and the advent of the antituberculous chemo-therapeutic agents. However, the disease is far from eradicated; new cases are still being seen, often after irreversible changes have occurred. The usual end-result of tuberculous disease of a joint has been ankylosis (1). There is a reasonable chance, however, since the discovery of antibiotics, of obtaining a mobile joint if the disease is recognized in its early stage. It is important, therefore, to be constantly reminded of the methods of making an accurate diagnosis of this disease in children, to familiarize oneself with the early diagnostic signs and symptoms, and to be aware of the differential diagnosis in their presence. In 1924, Phemister (26) recorded the principal distinguishing features of tuberculous arthritis. Since it appears that these criteria are not widely known, restatement and further illustrations seem indicated. During the past fifteen years, there have been seen at the Alfred I. duPont Institute 9 patients with early roentgen changes in the hips in whom there was microscopic proof of tuberculosis. Not included in this series are 3 cases which clinically and roentgenographically were thought to be tuberculosis but in which either biopsy was not performed or the biopsy report and/or culture were negative. Also excluded are patients with well advanced and of ten healed tuberculosis of the hip, admitted for reconstructive surgery. This paper will be limited to a discussion of early tuberculosis ofthe hip in children. Earlier literature, particularly in the nineteen twenties and nineteen thirties, is filled with reports of excellent results of treatment of tuberculosis of the hip. Rollier (3), for instance, in 1930 reported 74 per cent cures, with function of the hip joint. Not' all the cases, however, were verified by tissue biopsy or bacteriologie examination. In 1921, Sundt (4) stated that in a series of 243 cases of hip disease seen from 1903 to 1918, 29.6 per cent were nontuberculous. Among these were cases of congenital coxa vara, epiphysiolysis, fracture, arthritis deformans, osteomyelitis, syphilis, synovitis of tuberculous origin, hysteria, and Legg-Perthes disease. Neil-son (5) in 1923 gave a differential diagnosis of hip conditions which had been considered tuberculous. In 1930 O'Connor (6), reviewing 189 cases admitted with a tentative diagnosis of tuberculosis, found 54 that were not tuberculous. The following year Milgram (7) reported that, of 88 cases of Legg-Perthes disease, 31 had been diagnosed as tuberculosis on the first admission. In addition, proved tuberculosis was initially misdiagnosed in 38.7 per cent of 142 patients.

Decline of tuberculosis

Decline of tuberculosis

An Experiment in the Control of Tuberculosis among Negroes

^T HE most important tuberculosis problem at present is the control of the disease among Negroes. In 1939-1941 the death rate among nonwhite persons in New York City was 208 per 100,000 population, compared with a rate of 41 among white persons (7). It is generally recognized that most of the Negro population in any given community are living on the lowest economic level. This implies environmental conditions associated with poverty, poor housing, and inadequate income for food, clothing, and other necessities. Since tuberculosis mortality does vary with the level of living of groups of the population, and since nutrition is an important environmental factor determined to a considerable extent by the level of living, it seemed important to conduct an experiment to learn whether an improved nutritional status and by implication a higher level of living will affect the incidence of tuberculosis among persons at risk of attack because of exposure in the family. This particular experiment was conducted in Negro families in Harlem. The importance of environment when considering tuberculosis has been brought out by various persons interested in the subject. Frost (8) said: Probably nothing has been more influential in bringing about the decline of tuberculosis than progressive improvement in the social order as a whole; and nothing, perhaps, is more essential to the further effective control of the disease than to hold up, and so far as possible to improve the standards of living of the lower economic strata. ... It is probable that one of the most important factors in the decline of tuberculosis has been progressively increasing human resistance, due to the influence of selective mortality and to environmental improvements such as better nutrition and relief from

Comments on Mary Dempsey's article on Decline in tuberculosis; the death rate fails to tell the entire story.

Comments on Mary Dempsey's article on Decline in tuberculosis; the death rate fails to tell the entire story.

Decline in tuberculosis; the death rate fails to tell the entire story.

Decline in tuberculosis; the death rate fails to tell the entire story.

Canadian Mortality in War Years

ACCORDING to an annotation in the September issue of the Statistical Bulletin, the health of the Canadian people has remained at a very favourable level during the four years of the present War, the mortality in this period being the lowest on record. The improvement in mortality has been particularly marked in the diseases most prevalent among the young. Not only has the death-rate decreased among the communicable diseases of childhood, but also there has been an increased fall in the mortality among the large number of young adults in training camps. Diarrhosa and enteritis, which have always been important causes of death among Canadian children, have also shown considerable improvement in recent years. The rate of decline in tuberculosis is illustrated by a new minimum of 47·1 per 100,000, which is about one fifth below that for the period 1934–36; In contrast with the catastrophic influenza epidemic towards the close of the War of 1914–18, there has so far been no cause for serious concern, although there was a mild epidemic of influenza in Canada late in 1940 and early the following year, the favourable result being mainly due to the use of serum and chemotherapy in the treatment of pneumonia. Chemotherapy has also succeeded in reducing the mortality from appendicitis and the diseases incidental to child-bearing. On the other hand, there has been an increase in the mortality from cancer, diabetes, diseases of the heart and arteries, and from accidents.

The statistics of tuberculosis

1. Rate of decline of tuberculosis (all forms) death-rate has accelerated from 2.0 per cent. per annum to 3.2 per cent. per annum in the decade 1927–1937 in 19 countries. 2. The decline in the tuberculosis death rate in Eire has fallen from 2.1 per cent. per annum to 1.5 per cent. per annum in the same period. In Northern Ireland the decline is 3 per cent. per annum. 3. The Dublin death-rate from pulmonary tuberculosis has not fallen significantly in this period. 4. Comparison of death-rate for the employed and unemployed male workers suggests that the rate amongst the unemployed may be as high as 500 per 100,000 as against 81 for insured workers between 15 and 54. 5. The age incidence in Eire is predominantly in the young adult age group, and the decline in the death-rate is lowest in these groups. 6. An attempt is made to calculate various morbidity/mortality ratios, and to estimate the probable bed needs of the Eire population on the basis of the death-rate. 7. There is a grave deficiency of beds in the Dublin area.

The decline in incidence of tuberculosis of bones and joints

An actual decrease in the number of patients suffering from tuberculosis of the bones and joints has been observed at the New York Orthopaedic Dispensary and Hospital. The percentage of patients with tuberculosis of bones and joints, as compared with total new patients applying for dispensary care, has fallen from 65.3 per cent to 0.6 per cent during the past seventy years. Similarly the incidence of bone and joint tuberculosis in children, in relation to all new dispensary patients, has fallen during the past twenty-five years from 9.7 per cent to 0.1 per cent. It is emphasized that these figures are unreliable in estimating the general incidence of tuberculosis of bones and joints throughout the country, and it is hoped that other hospitals will make comparable reports. A discussion of factors entering into the decline of tuberculosis of bones and joints has been presented.

The Decline of Tuberculosis and the Increase in its Mortality during the War

It is greatly to be desired that the causes of the decline of tuberculosis, which has been so striking a feature in the history of that disease in recent times, should be clearly ascertained; for only through an understanding of their nature and relative importance can our efforts to accelerate that decline hope to succeed.

A REVIEW OF FACTORS INVOLVED IN THE DECLINE OF TUBERCULOSIS

The present is a favorable time to review the factors involved in the decline of tuberculosis. This decline has been marked and persistent in the United States for more than fifty years. There has been increasing accuracy in reporting causes of death. The antituberculosis campaign has taken organized form in this country and has gained increasing momentum for a generation. The increased tuberculosis deaths resulting from the war can now be studied in the light of postwar declines. The writings of Calmette, Bushnell, Krause, Opie and many others have recently added much to the knowledge of the epidemiology and pathogenesis of the disease. The Bureau of Labor Statistics of the U. S. Department of Labor has assembled many data on changes in the material prosperity of the bulk of the population. Statistical methods, public health procedures, facilities for treatment, and health education have all improved markedly in the past two

The decline of tuberculosis in a Norwegian town

The decline of tuberculosis in a Norwegian town

Causes for the Recent Decline in Tuberculosis

Causes for the Recent Decline in Tuberculosis