The Two-Year Mass Radiography Campaign in Scotland, 1957-1958: A Study of Tuberculosis Case-Finding by Community Action

MacGregor, Ian Murray (1960) The Two-Year Mass Radiography Campaign in Scotland, 1957-1958: A Study of Tuberculosis Case-Finding by Community Action. MD thesis, University of Glasgow.

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This thesis presents an appreciation of the technical planning, execution and results of a programme of chest X-ray surveys carried out in 22 areas of high tuberculosis prevalence in Scotland during 1957 and 1958, with the object of finding and bringing under control a high proportion of the previously undisclosed reservoir of cases, reducing the pool of infection and contributing to the more rapid decline in the future incidence of this disease. This Campaign was unique in that each of the mass radiography surveys which it comprised was carried out within a few weeks, using a concentration of medical and publicity services not previously employed in a health programme of this kind. Moreover, it attracted a greater measure of public support than any of the local chest X-ray surveys which had previously been attempted, with the exception of those carried out over long periods using the individual rather than the community approach. This operation has demonstrated the practicability and the immediate profitability of the community approach to tuberculosis case-finding by the employment of the national resources of the clinical, radiological and publicity services in a series of chest X-ray surveys designed to examine whole adult populations at a tempo of operation not previously thought possible. The population in the areas selected for survey comprised about two-thirds of that in the whole country. During the two years 1,844,268 persons were X-rayed. Of these 1,639,957 were adults resident in the defined areas, representing a response rate of 68%. The response rate in the 15 urban areas was 75%, and in the four Scottish Cities, 76%. The number of adults examined represented 43%, of the adult population of Scotland. The relatively poor attendance in the County areas is attributed to the fact that the dispersal of the population made it impossible, using this method of operation, to provide a service which was convenient to those living in isolated places. The difference in the level of co-operation between younger and older persons can be explained by the incidence of illness and infirmity among the latter. In some places the response was adversely affected by the fact that non-residents took up too much of the available X-ray time. It seems likely that, in surveys of this kind, the provision of too much X-ray unit cover may have as detrimental an effect on the response as too little. The principal technical fault in the Campaign was the failure to employ dual photofluorographic film interpretation, but reference is made to the method suggested to overcome this deficiency which, on the basis of previous evidence, might have been responsible for the loss of about 10%. of the significant cases. This deficiency could not have been obviated in any other way with the resources available. This method of community survey is unsuitable for epidemiological inquiry without considerable interference with its effective operation and because, at the tempo of work required, neither staff or equipment are likely to be available for special studies. The Campaign produced 12,094 new cases of tuberculosis, of whom 4,328, or 2.35 per 1000, were regarded as suffering from active disease. In addition 7,776, or 4.26 per 1000 persons examined, presented evidence of tuberculosis requiring observation. Nearly two-thirds of the 4,033 active cases and the 7,267 observation cases discovered among residents were found in Glasgow and four-fifths in the four Scottish Cities. The rates for active cases varied between 0.26 and 3.69 and, for observation cases, from 0.14 to 10.37 per 1000 persons examined. A study of the associations between the survey yield of tuberculosis and the rates of notification, registration and death during the pre-Campaign period revealed a significant positive correlation only between the aggregate of the active and observation survey case rates and the notification rates in the different areas.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Medical imaging, Epidemiology
Date of Award: 1960
Depositing User: Enlighten Team
Unique ID: glathesis:1960-79351
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 05 Mar 2020 10:38
Last Modified: 05 Mar 2020 10:38

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