Observational study to estimate the changes in the effectiveness of bacillus Calmette-Guerin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK

Background Until recently, evidence that protection from the bacillus Calmette–Guérin (BCG) vaccination lasted beyond 10 years was limited. In the past few years, studies in Brazil and the USA (in Native Americans) have suggested that protection from BCG vaccination against tuberculosis (TB) in childhood can last for several decades. The UK’s universal school-age BCG vaccination programme was stopped in 2005 and the programme of selective vaccination of high-risk (usually ethnic minority) infants was enhanced. Objectives To assess the duration of protection of infant and school-age BCG vaccination against TB in the UK. Methods Two case–control studies of the duration of protection of BCG vaccination were conducted, the first on minority ethnic groups who were eligible for infant BCG vaccination 0–19 years earlier and the second on white subjects eligible for school-age BCG vaccination 10–29 years earlier. TB cases were selected from notifications to the UK national Enhanced Tuberculosis Surveillance system from 2003 to 2012. Population-based control subjects, frequency matched for age, were recruited. BCG vaccination status was established from BCG records, scar reading and BCG history. Information on potential confounders was collected using computer-assisted interviews. Vaccine effectiveness was estimated as a function of time since vaccination, using a case–cohort analysis based on Cox regression. Results In the infant BCG study, vaccination status was determined using vaccination records as recall was poor and concordance between records and scar reading was limited. A protective effect was seen up to 10 years following infant vaccination [< 5 years since vaccination: vaccine effectiveness (VE) 66%, 95% confidence interval (CI) 17% to 86%; 5–10 years since vaccination: VE 75%, 95% CI 43% to 89%], but there was weak evidence of an effect 10–15 years after vaccination (VE 36%, 95% CI negative to 77%; p = 0.396). The analyses of the protective effect of infant BCG vaccination were adjusted for confounders, including birth cohort and ethnicity. For school-aged BCG vaccination, VE was 51% (95% CI 21% to 69%) 10–15 years after vaccination and 57% (95% CI 33% to 72%) 15–20 years after vaccination, beyond which time protection appeared to wane. Ascertainment of vaccination status was based on self-reported history and scar reading. Limitations The difficulty in examining vaccination sites in older women in the high-risk minority ethnic study population and the sparsity of vaccine record data in the later time periods precluded robust assessment of protection from infant BCG vaccination > 10 years after vaccination. Conclusions Infant BCG vaccination in a population at high risk for TB was shown to provide protection for at least 10 years, whereas in the white population school-age vaccination was shown to provide protection for at least 20 years. This evidence may inform TB vaccination programmes (e.g. the timing of administration of improved TB vaccines, if they become available) and cost-effectiveness studies. Methods to deal with missing record data in the infant study could be explored, including the use of scar reading

“Making voices heard…”: Index on Censorship as Advocacy Journalism

The magazine Index on Censorship has sought, since its launch in 1972, to provide a space where censorship and abuses against freedom of expression have been identified, highlighted and challenged. Originally set up by a collection of writers and intellectuals who were concerned at the levels of state censorship and repression of artists in and under the influence of the Soviet Union and elsewhere, ‘Index’ has provided those championing the values of freedom of expression with a platform for highlighting human rights abuses, curtailment of civil liberties and formal and informal censorship globally. Charting its inception and development between 1971 and 1974, the paper is the first to situate the journal within the specific academic literature on activist media (Janowitz, 1975; Waisbord, 2009; Fisher, 2016). In doing so the paper advances an argument which draws on the drivers and motivations behind the publication’s launch to signal the development of a particular justification or ‘advocacy’ of a left-libertarian civic model of freedom of speech

Agricultural Nematology in East and Southern Africa : Problems, Management Strategies and Stakeholder Linkages

This is the peer reviewed version of the following article: Herbert Talwana, et al, ‘Agricultural nematology in East and Southern Africa: problems, management strategies and stakeholder linkages’, Pest Management Science Vol. 72 (2): 226-245, February 2016, which has been published in final form at http://dx.doi.org/10.1002/ps.4104. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. © 2015 Society of Chemical Industry.By 2050, Africa’s population is projected to exceed two billion. Africa will have to increase food production more than 50% in the coming 50 years to meet the nutritional requirements of its growing population. Nowhere is the need to increase agricultural productivity more pertinent than in much of sub-Saharan Africa where it is currently static or declining. Optimal pest management will be essential, because intensification of any system creates heightened selection pressures for pests. Plant-parasitic nematodes and their damage potential are intertwined with intensified systems and can be an indicator of unsustainable practices. As soil pests, nematodes are commonly overlooked or misdiagnosed, particularly where appropriate expertise and knowledge transfer systems are meager or inadequately funded. Nematode damage to roots results in less efficient root systems that are less able to access nutrients and water, which can produce symptoms typical of water or nutrient deficiency, leading to misdiagnosis of the underlying cause. Damage in subsistence agriculture is exacerbated by growing crops on degraded soils and in areas of low water retention where strong root growth is vital. This review focuses on the current knowledge of economically important nematode pests affecting key crops, nematode control methods, and the research and development needs for sustainable management, stakeholder involvement and capacity building in the context of crop security in East and Southern Africa, especially Kenya, Tanzania, Uganda and Zimbabwe.Peer reviewe

Medical revalidation as professional regulatory reform: challenging the power of enforceable trust in the United Kingdom

For more than two decades, international healthcare crises and ensuing political debates have led to increasing professional governance and regulatory policy reform. Governance and policy reforms, commonly representing a shift from embodied trust in professionals to state enforceable trust, have challenged professional power and self-regulatory privileges. However, controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be. This paper explores the roll-out and operationalisation of revalidation as medical regulatory reform within a United Kingdom National Health Service hospital from 2012-2013, and its impact upon professional power. Revalidation policy was subject to the existing governance and management structures of the organisation, resulting in the formal policy process being shaped at the local level. This paper explores how the disorganised nature of the organisation hindered rather than facilitated robust processes of professional governance and regulation, fostering formalistic rather than genuine professional engagement with the policy process. Formalistic engagement seemingly assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. The paper concludes by challenging the concept of state enforceable trust and the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives, such as revalidation

A pilot study of users' experiences of urinary catheter drainage bags.

Despite the wealth of literature focused on the management of people living in the community with long-term indwelling urinary catheters, little attention has been paid to their impact on daily life. In a pilot study, a purposive sample of people with long-term indwelling urinary catheters were sent a questionnaire asking about their indwelling urinary catheter, method of drainage and impact of the catheter drainage bag on their daily life. Nearly one-quarter of respondents stated that wearing a drainage bag had a major impact on their normal daily living. The study also highlighted a number of methodological issues that need to be addressed in future research