经费对世行项目县结核病人治疗管理的影响

目的 研究世行项目县经费缺乏对结核病人治疗管理的影响。方法 通过收集1993—2001年9年的结核病投入财务报表，了解青州市结核病配套经费及卫生事业经费的落实情况；采访结防所工作人员，乡、村防痨医生及结核病人，了解其治疗和管理过程。结果经费的缺乏不但导致医务人员无法实施对涂阳结核病人的督导、访视，影响治疗效果，而且还会导致结防机构的趋利性，从而增加结核病人的诊治费用。结论 政府承诺，多方筹资，增加投入，实现结核病控制的可持续发展。     

广西河池地区结核病控制现状及分析

目的　反映河池地区结核病控制工作现状。方法 对河池地区1996～1998年结核病疫情报告和结核病人登记年报表进行分析。结果 河池地区每年发现的肺结核病人仅为估算病人数10%。病人新登记率、涂阳登记率和查痰率分别为20/10万、0.7/10万和15%。涂阳病人治愈率极低。结论 结防机构不健全、经费投入不足、不实行结核病归口管理是影响我地区结核病控制工作的主要因素。     

网络信息技术在加强肺结核病人家庭督导治疗中的运用

目的　探讨全国结核病管理信息系统在提高家庭督导的肺结核病人规则治疗率及治疗成功率方面的作用。方法 在对所有登记确诊的病人提供免费查治和实施家庭督导管理的基础上,结防所每天将病人的病案信息、每次复诊的痰检、取药等信息及时输入结核病管理信息系统中,乡镇结防医生每日通过该系统查阅本乡镇结核病人病案信息和痰检、取药信息,对延迟3d以上复诊者上门宣传,督促病人到结防所复诊。结果 全市活动性肺结核病人规则治疗率及治疗成功率均较上年提高了约10个百分点。结论 利用结核病管理信息系统,乡镇结防医生可及时掌握辖区内肺结核病人的诊疗情况,减少中断治疗的发生,提高病人规则治疗率及治疗成功率。     

山东省实施结核病归口管理检查情况评价

目的　评价卫生行政部门、结核病防治专业机构和综合医院对肺结核病归口管理工作的执行和落实情况。方法 检查1997年以来,全省卫生行政部门、结防专业机构和综合医院实施归口管理的情况。结果 行政部门能够运用法规和规范文件,对归口管理工作进行干预。1998年结防专业机构新登记涂阳肺结核病人中,其来源由综合医院转诊者占42.2%,其中新发涂阳占47.4%,复治涂阳占28.6%。结防专业机构检查综合医院的转诊率为60.4%,乡镇医院转诊率为79.6%。结论 实施结核病归口管理,行政干预措施;综合医院及时转诊发现的结核病人;结防机构积极落实,对提高结核病人的发现有着重要的意义。     

胜利油田地区结核病人诊治延误影响因素研究

目的　探讨影响胜利油田地区结核病人诊治延误的因素。方法 采用结构式结核病人调查表对2006年1月—2007年4月就诊于胜利石油管理局结防所的214例结核病人进行面对面的问卷调查。结果 结核病患者确诊延误的影响因素为就诊次数;治疗延误的影响因素为性别、工作家庭所在地、确诊机构。结论 减少结核病人的诊断及治疗延误,需要从病人和医疗机构两方面着手采取综合措施。     

江苏无锡市农村地区提高传染性肺结核病人发现水平的探讨

目的　探讨农村地区如何提高传染性肺结核病人发现率。方法 在乡镇卫生院设立结防门诊和查痰点,采取发放经费、转诊病人、加强痰检质控、督导检查等干预措施,提高涂阳病人发现率。结果 5年来共发放23.70万元结防经费。涂阳、新发涂阳登记率逐年上升,乡镇卫生院检出涂阳病人数大幅度升高,登记涂阳病人卫生院平均报告率为62.7%。结论 乡镇卫生院是农村地区结核病预防和控制工作中的一支重要力量,在提高结核病例发现水平中可发挥重要作用。     

深圳市外来人口结核病控制现状分析

目的　城市外来人口结核病控制是当前结核病控制的新焦点,探讨深圳市外来人口核病控制的模式,总结外来人口核病控制经验。方法 深圳市自1993年将外来人口结核病控制纳入区域结核病控制规划,政府承诺给予经费的投入,外来人口结核病人与本地结核病人同样实施DOTS。结果 7年间共登记肺结核病人7368例,其中3603例为新发涂阳病人,87.3%的新发涂阳病人为15～34岁年龄组。所有新发涂阳病人均实施DOTS,治愈率达97%,取得与本地居民同样的管治效果。结论 把外来人口结核病控制纳入区域结核病控制规划是可行和必要的,采取有效的管理措施,外来人口结核病人可获得与常住人口同样的治愈效果。     

江苏省结核病人发现工作现状调查分析

目的　了解并分析江苏省结核病人发现工作现状。方法 对2000年全国第四次结核病流行病学抽样调查在江苏省调查点发现确诊的结核病人,采用统一的肺结核病人社会经济情况调查问卷进行调查。结果 在调查确诊的86例活动性肺结核病人中,72例(80.0%)有结核病症状,42例(48.3%)就诊,其中29例(33.7%)确诊为肺结核,仅10例(11.6%)在结防机构登记。结论 必须重视和加强病人发现工作。     

河南省活动性肺结核病人发现状况分析

目的　反映河南省活动性肺结核病人发现水平。方法 根据河南省2000年第四次全国结核病流行病学抽样调查数据中病人发现情况进行分析。结果 结防机构仅登记、管理了5.1%的活动性肺结核病人;88.6%的肺结核病人在非结防机构确诊,其中93.6%未转诊、登记。结论 加强各级综合医疗机构结核病归口管理是提高病人发现水平的关键。     

肺结核病人转诊相关问题分析

目的　了解综合医疗机构医务人员对结核病人转诊工作的认识、态度和行为,分析影响结核病患者转诊的各种社会、经济和文化因素。方法 对《新疆维吾尔自治区结核病控制项目社会学评价调查》相关内容进行分析。结果 有症就诊率为82.8%,综合医疗机构转诊率29.5%,转诊到位率60.4%,60.6%的肺结核病人就诊延迟;50.2%的患者确诊延迟。主要影响因素是经济认识,交通不便等。结论 必须加强群众健康促进工作,努力提高医疗网对结核病诊断、报告和转诊能力建设,结防机构要提高追踪率和结核病规范管理工作能力。     

2003～2010年廊坊市结核病控制项目实施效果分析

目的评价廊坊市2003～2010年结核病控制项目的工作成效,为制定廊坊市结核病控制规划提供科学依据。方法整理2003～2010年上报的月报表、季报表、年报表等常规监测资料,进行统计描述与分析。结果共发现活动性肺结核病人18 151例,活动性肺结核病人登记率56.51/10万;涂阳结核病人12 580例,其中新涂阳10 366例,复治涂阳2 214例;新涂阳治愈9 986例,治愈率96.33%,复治涂阳治愈2 061例,治愈率93.13%。结论廊坊市结核病控制项目工作社会经济效益显著,但结核病控制工作仍具有长期性和艰巨性。     

浙江省耐药肺结核病人人口学特征及家庭疾病经济负担对照研究

目的　研究耐药与非耐药肺结核病人的人口学特征及家庭疾病经济负担。方法 调查15个“WHO结核病耐药监测”县(市)耐药与非耐药病人207例,利用经济学评价方法,探讨其家庭疾病经济负担及人口学特征。结果 耐药与非耐药肺结核病人在性别、年龄和文化程度及劳动力、经济情况构成上均无差别;例均家庭疾病经济负担:耐药组为5972.5元、非耐药组为4058.0元。结论 耐药病人与非耐药病人都以青壮年(26～55岁)、低文化程度、贫困病人为主,而疾病经济负担,耐药病人比非耐药病人要高。     

Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi

SETTING: TB control programmes in Bangladesh, India and Malawi. OBJECTIVE: To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries. DESIGN: Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives. RESULTS: Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh. CONCLUSION: Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.     

Barriers to TB care for rural-to-urban migrant TB patients in Shanghai: a qualitative study

Objective  To understand barriers to tuberculosis (TB) care among migrant TB patients in Shanghai after the introduction of the TB-free treatment policy which has applied to migrants since 2003, and to provide policy recommendations to improve TB control in migrant populations in big cities.
Methods  In-depth interviews were conducted with 34 migrant patients who registered on the Shanghai TB programme as new bacteria positive pulmonary TB cases. Patients were purposively selected across six districts of Shanghai to give a balance of gender and TB treatment phase.
Results  Financial constraints were reported as the biggest barriers to TB service among migrant patients. Many migrant patients experienced high medical costs both before and after their TB diagnosis. The government free treatment policy only covered a small fraction of patients' total costs. However, respondents tended to stay in Shanghai for treatment because their families were in Shanghai, they were more confident with the quality of medical care there or they felt they could not earn cash at home. Migrant patients had a limited knowledge of TB and the free TB treatment policy, and reported being laid off from work or avoided after having TB.
Conclusions  Health system problems caused the biggest barrier to migrant patients' access to TB care. The free treatment policy alone has little, if any, effect in reducing migrant patients' financial stress: it is also essential to provide social welfare, including living subsidies, for poor migrant TB patients.     

浙江省卫生部结核病控制项目县与非项目县家庭疾病经济负担的比较分析

目的　比较分析结核病控制项目县与非项目县对结核病人家庭的疾病经济负担。评价项目县与非项目县的卫生经济学效果。方法 随机抽取8个结核病控制项目县和7个非项目县的2000年结束疗程的新发肺结核病人499例,对结核病人进行基本情况、结核病就诊治疗、家庭经济及疾病经济负担的调查分析。结果 项目县初、复治结核病人的家庭经济负担明显低于非项目县。结论 项目县不仅提高了结核病人的发现率和治愈率,同时显示出较高的成本经济效益。     

Lay health worker intervention with choice of DOT superior to standard TB care for farm dwellers in South Africa: a cluster randomised control trial.

SETTING: Farms in the Boland health district, Western Cape Province, South Africa. OBJECTIVE: To evaluate the effect of lay health workers (LHWs) on tuberculosis (TB) control among permanent farm workers and farm dwellers in an area with particularly high TB prevalence. DESIGN: Pragmatic, unblinded cluster randomised control trial. METHODS: This trial measured successful treatment completion rates among new smear-positive (NSP) adult TB patients on 106 intervention farms, and compared them with outcomes in patients on 105 control farms. Farms were the unit of randomisation, and analysis was by intention to treat. RESULTS: A total of 164 adult TB patients were recruited into the study, 89 of whom were NSP. The successful treatment completion rate in NSP adult TB patients was 18.7% higher (P = 0.042, 95%CI 0.9-36.4) on farms in the intervention group than on farms in the control group. Case finding for adult NSP TB cases was 8% higher (P = 0.2671) on farms in the intervention group compared to the control group. CONCLUSION: Trained LHWs were able to improve the successful TB treatment rate among adult NSP TB patients in a well-established health service, despite reduction of services.     

Tuberculosis, poverty, and "compliance": lessons from rural Haiti.

Tuberculosis (TB) is the leading cause of death among rural Haitian adults, and TB control in Haiti is widely acknowledged to be a failure. The causes of both the endemicity of TB and the failure of attempts to address it are briefly reviewed before data from a study conducted in rural, central Haiti are presented. Members of one group of patients with active TB were given free medical care; members of a second group were given free care as well as financial aid, incentives to attend a monthly clinic, and aggressive home follow-up by trained village health workers. Comparing the two groups shows significant differences in mortality, sputum positivity after 6 months of treatment, persistent pulmonary symptoms after 1 year of treatment, average amount of weight gained, ability to return to work, and cure rate. The roles of human immunodeficiency virus and cultural factors are also examined. When adequate nutrition and access to free care were assured, drug-dependent and patient-dependent factors were shown to be of secondary importance in determining treatment outcome. Based on these data from a small, community-based TB-control project, the authors conclude that high cure rates can be achieved if the primacy of economic causes of TB is acknowledged and addressed.     

辽宁省鞍山市社区结核病防治探讨

目的探讨鞍山市社区防治管理办法。方法鞍山市结防所成立结核病防治服务科，管理社区防痨工作者和社区防痨工作志愿者，设置兼职社区监化点。加强社区宣传教育，加大政府干预措施。结果1999-2003年共建防痨网点280个，培训防痨工作者158名，招募防痨志愿者493名。大大提高结核病人的发现水平。同时扩大了市级防治半径，方便周边农村结核病人就诊。市民对结核病知晓率从2000年71．2％上升到2004年的95．6％。结论鞍山市充分发挥社区防痨工作者和防痨志愿者的作用，使居民结核病知晓率、肺结核的发现率和治愈率均有提高，是可行的方法。     

标准短程化疗方案治疗初治复治肺结核失败原因分析

目的探讨标准短程化疗方案治疗初复治肺结核失败的影响因素,特别是与耐药的关系,以便针对有相关性的因素进行控制,为结核病的治疗,尤其是耐药结核病的治疗提供依据。方法采用队列研究方法,追踪观察标准短程间歇化疗方案收治的初复治结核病患者的治疗效果,收集患者的各种信息,采用单因素和多因素方法分析,探讨导致患者治疗失败的因素。结果初治患者中,性别、职业、医疗费支出类型、是否漏服药和耐药情况与治疗失败有关,耐多药患者的失败风险是敏感患者的2.0倍;复治患者中,家庭年收入、耐药类型和最近一次治疗的结果是影响治疗失败的因素,耐药患者的失败风险是敏感患者的4.7倍。结论要降低结核病治疗失败率,控制结核病疫情,应该增加对贫困患者提供的救助,加强患者的督导管理,提高服药依从性,控制耐药的发生,开展对复治患者治疗方案的实施性研究。