European badgers and the control of bovine tuberculosis in the United Kingdom

2018 ◽  
Author(s):  
Rosie Woodroffe ◽  
Christl A. Donnelly
Keyword(s):  
Trial Data ◽  
Sufficient Evidence ◽  
Surrounding Area ◽  
Tb Control ◽  
Badger Culling ◽  
The United Kingdom ◽  
Badger Vaccination ◽  
Alternative Approaches ◽  
European Badgers ◽  
Control Tool

The European badger has become infamous because of its incompletely understood role in the spread of bovive tuberculosis to cattle, despite in actuality being directly implicated in only 5.7% of herd breakdowns. Randomised Badger culling trial data suggest that badger culling could make only a limited contribution to TB eradication in Britain. Surviving badgers in both proactive and reactive culling areas immigrate into the surrounding area, which generally worsens the rate of cattle herd breakdowns by around 25% in these areas. While badger vaccination appears promising as a potential TB control tool, there is not yet sufficient evidence to judge its effectiveness. Free shooting of badgers has proven less effective than hoped, failing to reach cull targets. Furthermore, instances of badger suffering have been reported. Consequently, controlling TB through badger management remains technically, ethically and politically challenging and alternative approaches directed at cattle are likely to be more effective.

Social and Medical Factors in the use and Effectiveness of IUDs

1973 ◽  
Vol 5 (1) ◽  
pp. 31-49 ◽  
Author(s):  
Robert Snowden ◽  
Peter Eckstein ◽  
Denis Hawkins
Keyword(s):  
Large Scale ◽  
Data Retrieval ◽  
Work Load ◽  
Sufficient Evidence ◽  
Contraceptive Device ◽  
Psychological Variables ◽  
The United Kingdom ◽  
Intrauterine Contraceptive ◽  
Efficient Data ◽  
The Difference

The possible influence of psycho-social factors on the use and effectiveness of the intrauterine contraceptive device (IUD) has not been seriously examined until recently. Inquiry into these factors has become feasible as large-scale projects—primarily designed to consider medical factors in IUD use—have been developed. Data obtained from a number of centres within and outside the United Kingdom indicate the existence of variation in the clinical efficacy of the same type of device. This variability suggests that success or failure of a given model does not necessarily depend on the device alone. Factors other than those generally considered ‘medical’ may play a significant role in IUD use and effectiveness.The procedures involved in organizing large-scale multi-clinic IUD trials and including efficient data-retrieval systems are described in detail.In addition, findings are reported on the trial of a stainless steel type of device, the M 213, which has been fitted in sufficient numbers in several UK clinics to permit analysis of variables associated with both the clinic and the doctor responsible for the IUD fitting. Evaluation of the data collected from two single-doctor clinics in two adjacent towns in the southwest of England using the M 213 and served by the same doctor, has revealed significant differences in the net cumulative pregnancy rate associated with the device. Age and parity of the IUD acceptors (and the interaction of age and parity) did not appear to be responsible for the difference. Although the general atmosphere and work load within the clinic setting may have differed it is not thought that this could fully account for the observed variations in the pregnancy rates between the two clinics.There appears to be sufficient evidence to suggest that the traditional purely ’medical’ approach to the examination of IUD use—effectiveness should be extended to include the study of social and psychological variables associated with both the providers and the acceptors of the IUD service.

scholarly journals Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

2019 ◽  
Vol 28 (152) ◽  
pp. 180107
Author(s):  
Simon M. Collin ◽  
Fatima Wurie ◽  
Morris C. Muzyamba ◽  
Gerard de Vries ◽  
Knut Lönnroth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Indirect Effects ◽  
Control Policy ◽  
Evidence Base ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Drug Susceptibility Testing ◽  
Sufficient Evidence ◽  
Healthcare Associated Infection ◽  
Tb Control

AimsWhat is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence?MethodsWe conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to “direct” or “indirect” effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as “sufficient”, “tentative”, “insufficient” or “no” using a framework based on the consistency of evidence within and between reviews.ResultsWe found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection.DiscussionOur review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.

scholarly journals Approaches to Reduce or Eliminate the Risks of Sight Tests in Alberta

2021 ◽  
Vol 83 (3) ◽  
Author(s):  
Alyssa Erin Anderson ◽  
Gordon Hensel
Keyword(s):  
Vision Loss ◽  
Case Reports ◽  
The United States ◽  
Research Report ◽  
The Public ◽  
The United Kingdom ◽  
Standards Of Practice ◽  
Independent Case ◽  
Alternative Approaches ◽  
Canadian Provinces

This research report is motivated by two independent case reports featuring individuals living in Alberta, Canada who experienced permanent vision loss as a result of inadequate standards of practice surrounding sight tests. Sight tests are usually performed by opticians and are conducted independently of a comprehensive eye exam. A description of the two case reports in addition to a discussion of the potential dangers of sight tests provide evidence of the public health risks associated with sight tests. To investigate potential approaches to reduce or eliminate the risks of sight tests in Alberta, we conducted a jurisdictional review examining the laws and standards of practice governing sight tests in Canada, the United States, New Zealand, and the United Kingdom. Based on the jurisdictional review, the outright prohibition of sight tests in Alberta may be the best approach to protect the public interest and reduce cases of avoidable vision loss. As seen in other Canadian provinces, alternative approaches to reduce the risk of sight tests may involve 1) developing and enforcing restrictions around the performance of sight tests or 2) developing clearly defined scenarios in which opticians can collaborate with authorized prescribers to deliver safe sight tests.

scholarly journals Zen and the “Image” in Tang Poetry

2020 ◽  
Vol 10 ◽  
pp. 1-14
Author(s):  
Tim Barrett
Keyword(s):  
United Kingdom ◽  
English Language ◽  
Sufficient Evidence ◽  
Chinese Poetry ◽  
Tang Poetry ◽  
The United Kingdom ◽  
Poetry Translation ◽  
Poetic Inspiration ◽  
Poetic Imagery ◽  
Poetic Practice

The purpose of the title of this piece is to suggest that behind the bland exterior of the average medieval Chinese poem (at least in English translation) there may lurk processes of composition entirely unsuspected by the modern reader, aspects of the Tang poem that might repay greater study. This approach, namely meditation as a method of creative inspiration, was far from universal in the poetry of the Tang period, since it seems to have arisen within specific historical circumstances, and though references to it remained and were handed down to later ages in widely read works, it is at present unclear how actively it was practised in later times. However, there is sufficient evidence to suggest that an interest in poetic imagery remained strong in East Asia, raising the possibility that it was this aspect of poetic practice there caught the attention of English language poets in the United Kingdom at the start of the twentieth century as they cast about for new models to replace the poetry of Victorian times. The hope is that drawing attention to this approach to poetic inspiration in this essay may serve as a challenge to the current lack of interest in Chinese poetry translation in the United Kingdom.

Saviour siblings

2004 ◽  
Vol 53 (6) ◽  
pp. 1179-1188
Author(s):  
Agneta Sutton
Keyword(s):  
Bone Marrow ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Spare Parts ◽  
Sufficient Evidence ◽  
The United Kingdom ◽  
The Creation ◽  
Psychological Risks ◽  
Seriously Ill

The creation of saviour siblings to provide umbilical cord blood or bone marrow to save a sick sibling is fraught with moral dangers. This paper discusses the physical and psychological risks involved to saviour siblings and argues that each child ought to be welcomed for its own sake, rather than for the sake of being used as a means to save another. The argument centres around recent case histories in the United Kingdom and the Human Fertilisation and Embryology Authority’s (HFEA) decision on July 21st 2004 to allow embryos created by IVF to be tested in order to help families to have a child who can serve as a tissue match for a seriously ill sibling. It is argued that The HFEA has not provided sufficient evidence to show that pre-implantation diagnosis itself is free of risks to the child’s longterm health; nor has it substantiated its claim that the creation of saviour siblings may benefit whole families. The paper also points out that the renowned British fertility expert, Professor Lord Winston, has come out strongly against the creation of saviour siblings. Pointing to an unsavoury scenario, he asked what would happen if the umbilical cord blood of the saviour sibling failed to repair the sick sibling? Would the saviour sibling then have to donate bone marrow? And suggesting and even grimmer situation, he asked what might happen if the kidney of the sick sibling failed? His comments clearly show that a child who is not created for its own sake risks being abused and treated as a supply of spare parts.

scholarly journals Burden and Characteristics of the Comorbidity Tuberculosis—Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Monica Sane Schepisi ◽  
Assunta Navarra ◽  
M Nieves Altet Gomez ◽  
Andrii Dudnyk ◽  
Anne Margarita Dyrhol-Riise ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United Kingdom ◽  
Case Control Study ◽  
Case Control ◽  
Control Analysis ◽  
Foreign Born ◽  
Cross Sectional Survey ◽  
Tb Control ◽  
The United Kingdom ◽  
Control Study

Abstract Background The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe. Methods We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007–2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine. Results Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients’ median ages ranged from 36 to 49 years, and all centers had &gt;60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM. Conclusions Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

scholarly journals Badger culling does not control cattle TB

2004 ◽  
Vol 142 (2) ◽  
pp. 251-252
Author(s):  
M. HANCOX
Keyword(s):  
Hot Spots ◽  
Control Programme ◽  
Tb Control ◽  
Badger Culling ◽  
Foot And Mouth

A somewhat unpredicted effect of the 2001 Foot and Mouth crisis, has been to ‘derail the TB control programme both as regards cattle measures and the badger culling trial’ (EFRA 2003). Sadly, cattle TB is now out of control, rising by c. 20% a year, and back to 1960s levels. Unfortunately attention has focused to such an extent on badgers that many now seemingly do not understand how TB works in cattle and why annual testing and movement bans are the answer: they brought cattle TB down to tiny southwest hot-spots by the mid-1970s without any badger culling (Hancox 2000, 2002, 2003).

Quality improvement in primary care. Financial incentives related to quality indicators in Europe

2013 ◽  
Vol 154 (28) ◽  
pp. 1096-1101 ◽  
Author(s):  
László Róbert Kolozsvári ◽  
Imre Rurik
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Financial Incentives ◽  
Quality Measurement ◽  
Care Quality ◽  
European Countries ◽  
Sufficient Evidence ◽  
The United Kingdom ◽  
Indicator Systems

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1–25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus. Orv. Hetil., 2013, 154, 1096–1101.

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