肺结核病人就诊过程调查

目的:了解现阶段肺结核病人的就诊过程,分析医患双方对肺结核病人就诊过程的影响.方法:采用多阶段整群分层随机抽样方法选取样本,使用自制调查问卷采取面对面方式进行访谈式调查.结果:75.2%的病人初次就诊时有咳嗽症状,48.0%的病人初次就诊单位为村卫生室或乡镇卫生院,45.8%的病人初次就诊时被误诊,34.6%的病人就诊延迟,75.6%的病人在县级结核病防治机构确诊,22.2%的病人确诊延迟.结论:重视基层卫生人员在结核病防治中的作用,加强对参与结核病防治工作医生的专业培训,加大对村民结核病相关知识宣传力度.     

咸宁农村肺结核患者社会经济状况的调查

[目的]调查了解农村肺结核患者社会经济状况. [方法]采用现况调查,对成宁农村肺结核病患者县、乡、村、性别、年龄、文化程度及病例在发现、就诊、治疗、管理等过程中相关社会经济状况进行调查.[结果]农村肺结核患者首发症状为咳嗽、咳痰、乏力等;首诊医院以乡镇卫生院、县及以上综合医院、村卫生室为主;首次出现症状到初次就诊时闻平均为8.4 d;曾接受检查项以临床结台X线检查为最多;以非结防机构确诊为主;治疗很不规则;未就诊原因主要是自己不在乎及经济困难;闻断或中断治疗原因为经济困难与症状改善;完成一个肺结核疗程约需3500元,因病误工人达74.56%,平均园误工减少直接收入646元. [结论]防痨宣传教育是确保农村肺结核患者及时就诊、及时确诊和规则治疗重要措施,要大力改善和提高农村肺结核病人在就诊、确诊、治疗等归口管理,重视社会经济等因素影响,把结核病控制工作纳入当地脱贫致富工程之中,以确保结核病控制策略有效实施.     

农村肺结核患者发现与治疗现状调查

目的了解咸宁市农村肺结核患者发现与治疗现状,为制定防治措施提供科学依据。方法按照分层随机抽样的原则,在咸宁市咸安、通山、崇阳、通城4个县市抽取583名农村肺结核患者,对其基本情况、诊断及治疗状况进行调查分析。结果农村肺结核患者的首发症状为咳嗽、咳痰、乏力等;首次出现症状到初次就诊的时间平均为8.4d;首诊机构以乡镇卫生院、县级以上综合医院、村卫生室为主,共占73.8%;肺结核患者确诊机构以非结防机构为主,平均确诊时间为12.8d;接受规则治疗的肺结核患者仅为26.8%,间断或中断治疗的主要原因为经济困难与症状改善。结论做好结核病健康促进和转诊工作是确保农村肺结核患者及时就诊、及时诊断和规则治疗的重要措施。     

农村老年肺结核患者就诊延迟及其影响因素分析

目的：分析农村老年肺结核患者就诊延迟及其影响因素,以便加强农村老年肺结核病防治工作。方法：采用横断面调查方法,除采用统一的专用门诊病历外,还运用自制的调查表,对2005年1月-2008年6月在结核病防治所诊治的农村老年新发涂阳肺结核病人逐一面对面调查。以首发症状到就医的时间在14d以上为就诊延迟。结果：老年肺结核病人就诊延迟比例高,有58．1％的病人存在就诊延迟,平均就诊延迟7．8周。导致就诊延迟的影响因素主要有结核病防治知识缺乏、经济困难、就医不便等。结论：农村地区老年人普遍存在结核病就诊延迟的现象．应该通过有针对性的健康促进工作提高结核病防治知识知晓率,并采用多种方式改变农村老年人的就医行为。     

肺结核患者就诊与确诊延迟因素研究

目的探讨影响肺结核患者就诊与确诊延迟的相关因素,为及早发现与诊治肺结核制定针对性措施提供依据。方法对杭州市萧山区疾病预防控制中心门诊部新登记、确诊并治疗的128例肺结核患者的人口学资料、就诊经历和结核病相关知识等进行问卷调查,分析其就诊与确诊延迟情况和相关因素。结果 128例肺结核患者就诊延迟率为25.00%,女性、无咯血症状、赡养老人、发病前结核病相关知识知晓率低和受教育程度低的肺结核患者易发生就诊延迟(P0.05);多因素Logistic回归分析显示,女性是发生就诊延迟的危险因素(OR=6.39,95%CI:1.66~24.61)。确诊延迟率为50.78%,多因素Logistic回归分析显示,初诊选择村卫生室及私人诊所(OR=2.10,95%CI:1.00~4.39)、初诊未摄胸片(OR=3.91,95%CI:1.16~13.19)以及赡养老人(OR=57.43,95%CI:4.43~744.30)是发生确诊延迟的危险因素。结论女性肺结核患者易发生就诊延迟,初诊选择卫生室及私人诊所、初诊未摄胸片和赡养老人肺结核患者易发生确诊延迟。     

流动肺结核病人结核病防治机构利用情况分析

目的 了解山东省流动人口肺结核病人对结核病防治机构的利用程度及影响因素,为山东省结核病防治工作提出相关建议.方法 采用分层随机抽样方法,共抽取山东省7个地市12个县/区314例流动人口肺结核病人,于2008年7-9月利用自制调查问卷进行调查,采用SPSS 16.0软件进行分析.结果 调查的314例流行人口肺结核病人初次就诊时选择结核病防治机构的仅占18.5%,但74.8%的病人在结防机构确诊;流动人口初次就诊选择的影响因素是病人家庭总收入、家庭人口数、从现居住地到最近的卫生院所需时间(P<0.05);其中,家庭总收入较低为病人初诊选择结防机构的保护性因素(OR>1),家庭人口较少和到卫生院所需较少时间为危险因素(OR<1).结论 加大宣传力度和经费投入,贯彻免费查痰、体检措施,完善基层医疗卫生机构的转诊和激励制度,有助于提高流动人口结核病的发现率.     

涂阳肺结核病人诊断延迟相关因素调查与分析

目的研究传染性肺结核病人诊断延迟有关影响因素,为提高涂阳病人发现率,控制结核病传播提供依据。方法设计肺结核流行病学个案调查表,选择5个县的结核病防治专科门诊,对门诊就诊的涂阳肺结核病人进行个案调查,并进行流行病学统计分析。结果148例涂阳病人,就诊延迟117例,就诊延迟率79.1%;确诊延迟84例,确诊延迟率56.8%;发现延迟101例,发现延迟率68.2%。年龄因素中,>60岁年龄组病人,诊断延迟率高于其他年龄组病人。性别因素中,女性高于男性;文化程度因素中,文盲高于其他学历。病人自己不在乎是未就诊的主要原因,乡镇卫生院结核病诊治水平是确诊延迟的重要原因。结论加强政府承诺,改善医疗卫生服务,加大结核病防治宣传力度,增强群体自我保健意识,是降低就诊延迟率的关键。规范和提高结核病诊治能力,落实结核病归口管理,是降低确诊延迟率和发现延迟率的关键。     

2006年平阴县某中专学校学生结核病患病情况调查

平阴县某中专学校1名在校学生因咳嗽、不规则发热10d，在学校卫生室按感冒治疗5d未见好转，回家到村卫生室输液治疗仍未见明显好转，于2006年4月3日到平阴县医院就诊。医生疑为肺结核，于当天转至县卫生防疫站结核病防治门诊诊治。查痰见抗酸杆菌＋＋＋，确诊为初治涂阳肺结核病人。4月10日，我们对其所在学校进行了调查。     

藏区非结防医生结核疑似病人确诊延迟分析

目的 探讨四川省藏区非结核病防治机构医生对结核疑似病人确诊延迟的影响。方法 通过问卷收集初次到若尔盖和石渠县结防机构诊治的结核疑似病人的资料，调查首诊为非结防机构医生的结核疑似病人确诊延迟情况。结果 80．0％结核疑似病人首诊选择非结防机构医生，且其中最后被结防机构确诊为活动性肺结核的42例患者中，54．8％发生了确诊延迟；不同类非结防机构医生在各自接诊的病人中，藏医首诊结果怀疑结核病的比例低于个体医生、乡村医生与县级医生等（P〈0．001）；首诊选择藏医的结核疑似病人确诊延迟发生率高于选择乡村医生和县级医生等的（P=0．008）；未被非结防医生推荐到结防机构就诊者较被推荐者确诊延迟发生率高（P〈0．001）。结论 非结防机构医生的类型、首诊结果及其是否推荐结核疑似病人到结防机构就诊与结核疑似病人的确诊延迟有关；培训非结防机构医生的结核病知识、加强归口管理可减少结核疑似病人的确诊延迟。     

三峡库区肺结核可疑者结核病知识、态度、行为调查

目的了解三峡库区肺结核可疑者的结核病知识及相关态度、行为现状,为开展库区结核可疑者的健康教育,提高结核病人发现率提供依据。方法采用目的性抽样的方法,对肺结核可疑者进行面对面问卷调查。结果三峡库区肺结核可疑者结核病知识知晓率为45.8%,其相关政策知晓率为25.3%;不就诊或延迟就诊的现象较严重(33.7%),其就诊的首选医疗机构是村卫生室(46.3%)和乡镇卫生院(35.6%)。结论库区肺结核可疑者的结核病知识及相应的态度、行为有待进一步改善。应加强其对结核病知识的学习和相关的健康促进工作。     

2003-2008年章丘市布鲁氏菌病患者及其诊断情况调查

[目的]总结经验教训,为非牧区布鲁氏菌病（布病）防治提供依据。[方法]对2003～2008年布病非牧区章丘市发生的36例布病患者资料与医疗机构相关资料进行调查。[结果336例患者中,50～75岁的占58．33％;患者对布病传染源、传播途径、临床表现、个人防护知识,的知晓率分别为27．78％、38．89％、8．33％、25．00％。患者就诊次数最多的是村卫生所（中位数4．12次）,发病至初诊时间最长的是市级医院（中位数56d）,初诊至确诊时间最长的是村卫生所（中位数123d）,发病至确诊时间最长的是村卫生所（中位数151d）;初次就诊或随后的复诊时被误诊的28例,误诊率为77．78％。村卫生所、乡镇卫生院、市级医院的误诊率分别为88．89％、77．78％、53．57％。[结论]章丘市布病病例误诊率较高,确诊时间延误,主要原因是医务人员缺乏布病防治知识。     

Determinants of unsuccessful tuberculosis treatment outcomes in Malaysian HIV-infected patients

ObjectivesTo determine predictors of unsuccessful treatment in HIV-infected tuberculosis (TB) patients.MethodsWe reviewed medical records at the time of TB diagnosis and subsequent follow-up of all registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in Malaysia between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes. Multiple logistic regression was conducted to identify risk factors for unsuccessful TB treatment.ResultsAmong the 219 patients analyzed, 53.4% achieved successful outcomes (cure, completed treatment) while 46.6% of patients had unsuccessful outcomes (default, treatment failure, died). After adjusting for other factors, unsuccessful outcome was associated with intravenous drug use (OR 2.72; 95% CI 1.44–5.16), not receiving antiretroviral therapy (OR 5.10; 95% CI 2.69–9.69), lymphadenopathy (OR 2.01; 95% CI 1.09–3.72) and low serum albumin (OR 4.61; 95% CI 1.73–12.27).ConclusionAnti-retroviral treatment must be provided to all HIV-infected tuberculosis patients. Good immune and nutritional status needs to be assured in all HIV-infected tuberculosis patients. More studies are required in intravenous drug users to understand why tuberculosis treatment outcomes are poor in this group.     

Microbiological confirmation of tuberculosis cases at diagnosis and at the end of treatment in Italy

Microbiological findings at diagnosis and at the end of treatment are relevant for evaluating tuberculosis (TB) treatment programmes. The objectives of this study were to describe the microbiological findings at diagnosis and at the end of treatment in pulmonary and extrapulmonary TB patients treated under programme conditions in Italy. The study was a prospective monitoring activity based on the collection of standard recording and reporting forms from a representative sample of Italian TB Units. The forms with individual data were reviewed and analysed on a quarterly basis, 9 months after enrolment. The complete bacteriological profile of patients was analysed at diagnosis and at the completion of treatment. Individual data on 992 patients were analysed. At diagnosis 320 (32.2%) of cases were pulmonary sputum smear positive, 361 (36.4%) pulmonary smear negative or not done and 311 (33.4%) extrapulmonary; 424 (42.7%) of all TB cases were culture confirmed at diagnosis (368, 50.2%, of pulmonary cases); 575 (84.4%) of pulmonary cases had a culture done at diagnosis and 156 (22.9%) at the end of treatment (p< 0.001); 572 (84%) had a sputum smear done at diagnosis and 164 (24.1%) at the end of treatment (p< 0.001). Although the rate of bacteriologically confirmed cases is similar to that of other European countries, the bacteriological confirmation at diagnosis and, particularly, at the end of treatment, is sub-optimal. The importance of further disseminating national guidelines among physicians managing TB is emphasized, in order to achieve a higher proportion of TB cases bacteriologically confirmed at diagnosis and monitored at the end of treatment.     

The relationship between (stigmatizing) views and lay public preferences regarding tuberculosis treatment in the Eastern Cape, South Africa

Background

Tuberculosis (TB) and human immune virus/acquired immune deficiency syndrome (HIV/AIDS) stigmas affect public attitudes toward TB treatment and policy. This study examined 'stigmatizing' ideas and the view that 'TB patients should line-up in the chronic illness queue' in relation to preferences and attitudes toward TB treatment.

Methods

Data were gathered through a survey administered to respondents from 1,020 households in Grahamstown. The survey measured stigmatization surrounding TB and HIV/AIDS, and determined perceptions of respondents whether TB patients should queue with other chronically ill patients. Respondents selected support and treatment options they felt would benefit TB patients. Statistical analysis identified the prevalence of TB and HIV/AIDS stigmas. Logistic regression analyses explored associations between stigmatizing ideas, views regarding TB patients in the chronic illness queue, and attitudes toward support and treatment.

Results

Respondents with TB stigmatizing ideas held positive attitudes toward volunteer support, special TB queues, and treatment at clinics; they held negative attitudes toward temporary disability grants, provision of information at work or school, and treatment at the TB hospital. Respondents who felt it beneficial for TB patients to queue with other chronically ill patients conversely held positive attitudes toward provision of porridge and disability grants, and treatment at the TB hospital; they held negative attitudes toward volunteer support, special TB queues, information provision at work or school, and treatment at clinics.

Conclusion

These results showed that two varying views related to visibility factors that expose patients to stigmatization (one characterized by TB stigma, the other by the view that TB patients should queue with other chronically ill patients) are associated with opposing attitudes and preferences towards TB treatment. These opposing attitudes complicate treatment outcomes, and suggest that complex behaviors must be taken into account when designing health policy.     

Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria?

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P < 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.     

Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh

In 1998, the Damien Foundation Bangladesh invited semi-qualified, private "gram dakter" (Bangla for "village doctors") to participate in tuberculosis (TB) programmes in a population of 26 million people in rural Bangladesh. The organization trained 12 525 village doctors to not only refer suspected TB cases for free diagnosis but also to provide directly observed treatment (DOT) free of charge. Source of referral and place of DOT was recorded as part of the standardized TB recording and reporting system, which enabled us to quantify the contribution of village doctors to case detection rates and also allowed disaggregated cohort analysis of treatment outcome. During 2002 and 2003, 11% of all TB cases with positive sputum smears in the study area had been referred by village doctors; the rate of positive tests in patients referred by village doctors was 14.4%. 18 792 patients received DOT from village doctors, accounting for between 20% and 45% of patients on treatment during the 1998-2003 period. The treatment success rate was about 90% throughout the period. Urine samples taken during random checks of treatment compliance were positive for isoniazid in 98% of patients treated by village doctors. Within the framework of Public-Private Mix DOTS, services provided by semi-qualified private health care providers are a feasible and effective way to improve access to affordable high quality TB treatment in poor rural populations. The large informal health workforce that exists in resource poor countries can be used to achieve public health goals. Involvement of village doctors in TB control has now become national policy in Bangladesh.     

Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province

Improving case detection is an urgent and serious challenge for tuberculosis (TB) control in China. We investigated the extent to which TB patients delayed seeking TB care and health services delayed reaching a diagnosis, and socio-economic factors associated with the delays. Standard questionnaires were administered to 190 new smear-positive TB patients who had completed treatment at TB dispensaries in four counties of Shandong Province in 2001. Multivariate analysis using Cox Regression showed that old age, lack of education and distance from home to a township health centre were significantly associated with delay in seeking care from service providers. In examining the delay between first contact with a service provider and diagnosis, we found that women experienced longer delays than men, and that the higher the level of facility patients first visited, the less time was needed to achieve a diagnosis. These two factors were statistically significant in multivariate Cox Regression analysis. We concluded that the elderly, the less educated, women, and those living far from health facilities face the longest delays in reaching TB services and achieving diagnosis.     

The effect of Tuberculosis and antiretroviral treatment on CD4+ cell count response in HIV-positive Tuberculosis patients in Mozambique

ABSTRACT: BACKGROUND: Tuberculosis (TB) presents a serious problem in Mozambique. HIV prevalence among TB patients is estimated at 47%. A delay in having their first CD4+ cell count could lead to a missed opportunity for ART initiation due to a CD4+ cell increase above the cut-off caused by TB treatment. The objective is to describe CD4+ cell response during TB treatment and quantify the effect of TB treatment and ART on this response. METHODS: All new HIV + adult TB cases in 2007 from three TB clinics in Mozambique were included. Data on TB diagnosis and treatment and HIV parameters were collected. A general mixed model was used for CD4+ cell count response. RESULTS: 338 HIV + patients were notified and 252 (75%) were included in the analysis. Using TB medication was not independently associated with the CD4+ count response (19 cells/mm3; 95% CI: -40 to 79; p = 0.529). ART-use was associated with statistically significantly higher CD4+ cells compared to no ART-use (81 cells/mm3; 95% confidence interval (CI): 12 to 151; p = 0.022). CONCLUSION: In this study, no independent effect of TB treatment on CD4+ cell count was found. HIV-infected TB patients on ART had a significantly higher CD4+ cell count than those not receiving ART. CD4+ cell counts for patients not on ART at TB treatment start, remained below the cut off for initiating ART during the first three months of TB treatment; therefore some delay in getting the first CD4+ cell count would not lead to missing the opportunity to start ART.     

2016—2020年南京市老年人群与非老年人群肺结核流行特征对比分析

目的 了解2016—2020年南京市60岁及以上老年人群肺结核流行特征,分析其与非老年人群的不同,为制定有针对性的老年结核病防治措施提供科学依据。方法 收集2016—2020年“中国疾病预防控制信息系统”子系统“结核病信息管理系统”登记的南京市肺结核病例数据信息, 采用描述流行病学方法统计分析60岁及以上老年人群肺结核疫情登记及治疗转归情况并与非老年人群进行对比分析。结果 2016—2020年南京市共报告60岁及以上老年肺结核患者4 078例,占同期全人群报告病例数的35.43%,年平均报告发病率为57/10万,高于非老年人群 (χ2 = 552.545,P＜0.001)。老年人群肺结核报告发病率随年份呈下降趋势,平均每年下降7.50% (APC = -7.50,95%CI: -10.09～-4.82,P = 0.003)。老年肺结核患者中男性数多于女性,男女性别之比为3.01∶1,年平均报告发病率男性为88/10万,女性为28/10万。老年肺结核发病率随年龄增加呈上升趋势（χ2趋势 = 247.809,P＜0.001）。10.30%的老年肺结核患者为复治患者,高于非老年患者（χ2 = 141.578,P＜0.001）。病原学阳性比例在老年肺结核患者中为55.20%,高于非老年患者（χ2 = 158.501,P＜0.001）,64.72%的老年病原学阳性肺结核患者进行了耐药检测,耐药率为12.29%。因症就诊是老年肺结核患者最主要的发现方式（50.57%）,其次为转诊（32.17%）和追踪（9.24%）。老年患者就诊延误率为64.47%,高于非老年患者(χ2 = 104.446,P＜0.001),成功治疗率为87.54%,低于非老年患者(χ2 = 267.191,P＜0.001)。结论 南京市老年人群肺结核疫情严峻,患者发现方式单一,就诊延误现象严重,治疗转归相对较差,应加强这一人群的主动筛查力度,以做到早发现、早干预、早治疗。