Outbreak of tuberculosis among middle aged employees in an office

We experienced an outbreak of tuberculosis in a salesmen's office during the period from 1993 to 1997. The outbreak was detected retrospectively. In July, 1997, a 47-year-old man was diagnosed as pulmonary tuberculosis. As he worked with a 42-year-old man who was already registered in our health center, we suspected an outbreak and started a survey. Contact examinations were carried out for 9 employees of his office and 3 members of his friends. As the result of these examinations, one employee showed strongly positive tuberculin skin test, and was indicated isoniazid chemoprophylaxis. Furthermore, some contacts told us that seven cases of active tuberculosis and three cases of primary infection indicated chemoprophylaxis had occurred among employees and their family members. The index case was a 41-year-old man who was diagnosed as tuberculosis in January, 1993. The second case among employees had previous history of pulmonary tuberculosis. Almost the patients among the employees had a hard life suffering from debts, and had heavy alcohol use. These facts may partly explain the spread of tuberculosis in this office. As each case was registered at different health centers, we hadn't noticed the outbreak for 4 years. But it is true that insufficient approach of health centers to contacts caused a serious delay of detecting the outbreak. A thorough investigation for contacts and complete contact examinations are needed.     

125例老年肺结核误诊原因分析

目的分析老年肺结核误诊原因,以提高诊断水平,减少老年肺结核误诊率。方法对老年肺结核125例误诊病例进行回顾性分析。结果误诊为慢性支气管炎53例,肺炎17例,支气管扩张15例,冠心病7例,肺心病5例,肺癌10例,间质性肺炎4例,发热5例,贫血2例,矽肺2例,其它疾病5例;误诊率为36%。结论医生对老年肺结核缺乏警惕性、老年肺结核临床症状不典型、胸片表现不典型、合并疾病多是老年肺结核误诊的常见原因;全面收集患者临床资料,充分利用相关检查,积极寻求病原学及组织学是减少老年肺结核误诊的关键。     

Suicide by overdoses of medicines among the aged.

The current literature on suicide by medicinal overdose among the elderly population of the United States and Britain is discussed. The older white male is a high risk in this regard. Physical and mental illnesses contribute to the problem of suicide among the aged, and some of the drugs prescribed for treatment (e.g., barbiturates and psychotherapeutic agents) are often accessible to the older person for misuse in suicide. The responsibilities of the prescribing physician and the practices of the dispensing pharmacist are considered in relation to the exposure of the elderly patient to potentially lethal drugs. Prediction of suicidal attitudes in the elderly is complicated by the fact that any attempt at suicide usually is serious and rarely preceded by gestures. Depression, based on social factors, is common among older people. Some of them face problems of declining income and prestige, as well as a loss of physical and mental powers. A change in the attitude of society towards the elderly may help to alleviate the depressive state which so often contributes to the suicidal potential.     

Clinical characteristics of tuberculosis in the aged

We prospectively studied the clinical characteristics of tuberculosis in the aged from July 1988 to March 1989. Twenty-five of 101 tubercle-bacilli positive patients were 70 years old or more. In these aged patients, decrease of body weight and of serum albumin was predominant. These findings suggest that undernutrition is remarkable in aged patients with tuberculosis, and it may influence their cellular immunity. In fact, the tuberculin reaction was significantly attenuated in the aged patients compared with patients less than 70 years old. Twelve percent of the aged patients showed a negative tuberculin reaction. In clinical diagnosis, it should be kept in mind that tuberculin reaction is sometimes negative in active tuberculosis patients particularly in the aged. The time required for negative conversion of tubercle bacilli was not retarded in the aged patients due to the use of potent chemotherapy regimens containing isoniazid and rifampicin.     

Predictors of self-reported problems of confusion among the aged.

Responses to questions on the 1984 Supplement on Aging to the National Health Interview Survey (NHIS) about the experience of personal confusion revealed that two-thirds of those interviewed reported never having an episode of confusion during the preceding year. Of those who reported episodes, fewer than one in five said they were happening with increased frequency. The many meanings of confusion found in the literature prompted a modest local study of what respondents understood by the term when asked the NHIS questions. Of those who admitted occasional confusion, almost two-thirds gave definitions that included memory loss or forgetfulness. Consequently, increased frequency of memory problems and difficulty in remembering were included with other variables in the analyses to identify significant predictors. They emerged the single best predictors of how often a respondent reported getting confused. Others were change in health status, number of functional limitations, educational attainment, and vision problems.     

Structural effects and life satisfaction among the aged.

This study investigates whether adjustment, or life satisfaction, is a function of the structural effect of community age density, the behavioral varaibles of total social interaction and age-graded interaction, or both. The sample contains one hundred eight-five persons seventy years of age and older in a midwestern state who have resided in their community at least five years. Thus, the study examines the influence of community structure on life satisfaction, age-graded interaction, and total interaction in a "real world" setting by using a relatively non-mobile sample. The findings suggest that no significant relationship exists between community structure and either total or age-graded interaction. Age-graded interaction, however, is significantly correlated with life satisfaction in large communities.     

Depression and mortality among institutionalized aged.

This study examined the association between depression and mortality among a group of nursing home and congregate apartment residents (initial n = 898) over a 30-month period. Baseline [Time 1 (T1)] and 1-year follow-up [Time 2 (T2)] assessments yielded research-based diagnoses of possible major, minor, or no depression, along with measures of functional disability, cognitive status, and physician-rated health. Event history analyses were used to assess differential mortality as a function of level of depression after T1 and of change in depressive status from T1 to T2. Significant effects for T1 depression at 6, 12, and 18 months after the interview reflected an increased death rate among possible major depressives as compared with other respondents. An effect of change in depressive status from T1 to T2 appeared to be caused by long-term negative effects of T1 depression. Finally, none of the observed associations remained significant when controlled for effects of physical health, functional disability, and cognitive status. Thus, the effects of depression on mortality among this sample appeared to be attributable strictly to the correlation of depression with ill health. However, cautious interpretation is recommended inasmuch as causal paths between depression, ill health, and death remain unclear.