老年结核病流行病学研究现状

人口老龄化的不断加剧和结核病流行高峰普遍移至老年人,加上老年人免疫力低下、贫困、营养不良、卫生服务可及性差以及慢性病(如糖尿病)等因素正导致老年人群罹患结核病的风险增加,也使老年结核病的防控形势更加严峻,目前对于老年结核病的研究也越来越受到关注,本文通过采集和分析最新的研究资料,从流行病学角度对国内外老年结核病流行特征、危险因素和"高复发率、高耐药性、高死亡率和低发现率"对结核病流行的影响进行综述,通过学习和借鉴国内外老年结核病防控研究的经验,达到控制老年结核病的目的。     

乌鲁木齐市老年结核病患者发病的影响因素

目的 老年人是结核病的高危人群,此研究是为发现乌鲁木齐市60岁以上老年人中影响结核病发生的因素,并为老年结核病的防治提供依据.方法 采用1:2配对的病例对照设计,并自行设计问卷进行调查;条件logistic回归分析发现结核病发病的影响因素.结果 此次共收集有效问卷575份,其年龄范围为60～89岁,男性302人,占52...     

陕西省农村老年人群慢性病患病现状及相关应对措施研究

目的了解陕西省农村老年人群慢性病现状及其影响因素,为针对性开展农村老年人健康促进和疾病防治提供理论依据。方法自2016年7月—2017年3月,采用多阶段分层随机整群抽样法对陕西省11个县24个行政村3 307名老年人进行慢性病患病现状调查。运用χ2检验、二元logistic回归分析探讨影响慢性病的独立因素。结果陕西省农村老年人慢性病患病率为68.70%。患病率居前5位的分别为高血压(27.67%)、关节疾病(22.59%)、冠心病(15.72%)、胃肠疾病(10.00%)、耳聋(7.81%)。Logistic回归显示,地域、年龄、文化程度、精神获得帮助、饮酒、跌倒、食欲减退、三餐规律均是陕西省农村老年人慢性病发病的影响因素(均P0.05)。结论陕西省农村老年人群慢性病患病率高,且患病情况受到多重因素的影响。应当改进与完善农村老年人群卫生医疗保障机制,探索"医护养结合"的农村养老模式,构建防治健一体的农村老年人健康卫生服务体系,切实提高农村老年人群健康状况。     

60岁以上老年人肺炎球菌多糖疫苗接种效果分析

肺炎球菌感染性疾病主要指肺炎双球菌引起的多种疾病,老年人是感染的高危人群。我国老年人肺炎免疫状况呈现疫苗低接种率、血清抗体低阳性率的状态。在开展免费接种的城市,老年人肺炎疫苗的接种率距发达国家还有一定差距。影响肺炎疫苗接种率的因素,价格是主要制约因素,其次老年人缺乏获取疫苗知识的有效途径和方法,影响了疫苗在老年人群中的使用。23价肺炎球菌多糖疫苗对老年人群具有较好的保护效果,接种后以一般反应和轻度全身反应为主,接种疫苗可降低由肺炎及其并发症导致的医疗费用和劳动生产力损失。在老年人群中应用有较好的经济学价值,可在老年人群中推广使用。     

无锡市城区老年人群糖尿病患病知晓及控制情况分析

目的 了解无锡市城区老年人群糖尿病患病、知晓和控制情况,为制订老年人糖尿病健康促进策略和措施提供依据。方法 对2020年江苏省无锡市6城区205123例65岁及以上老年人健康体检数据进行分析,采用SPSS 22.0软件分析比较分性别、分年龄组人群的糖尿病患病、知晓和控制情况及影响因素。结果 无锡市城区65岁及以上老年人群糖尿病患病率、知晓率及控制率分别为24.61%、64.16%和20.06%。年龄大、文化程度低、BMI高、有高血压、总胆固醇高、甘油三酯高、低密度脂蛋白胆固醇高、高密度脂蛋白胆固醇低是影响老年人群糖尿病患病、知晓和控制的因素(P均<0.05)。结论 老年人群糖尿病控制率有待提升,须开发适宜老年人群、通俗易懂的糖尿病健康教育工具,加强对老年人群降糖、降压、调脂等综合管理。     

昆山市锦溪镇老年人群高血压患病率及危险因素调查

高血压病是当今危害老年人健康，影响其生活质量的疾病之一，也是冠心病、脑血管疾病等最重要的危险因素。为进一步了解老年人群高血压患病情况，加强对高血压及相关疾病的早期诊断及防治，在本社区对老年人群高血压病的发病情况进行了调查，报告如下。     

老年结核病58例临床诊疗体会

老年人由于身体抵抗力减弱，合并疾病多等原因，成为结核病易感人群。现将我所治疗的58例老年肺结核病人资料分析如下。     

定西市2007—2010年老年肺结核病线索调査情况分析

近年来,随着我国社会经济的迅速发展,人民群众生活水平的不断提高,我国人口平均寿命不断延长,社会人群中老年人的比例越来越高,由于老年人机体各系统、器官逐渐发生衰退性的变化,对结核杆菌的抵抗力下降,易发生结核病。全国第四次结核病流行病学抽样结果显示,老年结核病患病率明显高于其他各年龄组患病率。     

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。     

哈尔滨市60岁以上老年人结核病发病危险因素病例对照研究

目的探讨哈尔滨市老年人结核发病的危险因素,为制定老年人结核病防治措施提供依据。方法从2008-2009年在哈尔滨市各区、县(市)结核病防治所登记的老年结核患者中,按每单位10%的比例抽取符合选取标准的病例200例作为本次病例组研究对象,另选哈尔滨市各区、县(市)综合医院、乡镇卫生院、社区登记的非结核和非呼吸系统疾病患者和健康人群250例作为对照组研究对象进行病例对照研究。采用SAS8.1软件,将数据用非条件Logistic回归进行单因素和多因素分析。结果单因素分析中性别、吸烟、饮酒、居住通风条件、有无密切接触者、月人均收入、文化程度等因素均有统计学意义(P<0.05)。多因素分析中性别、吸烟、居住通风条件、密切接触史、月人均收入为危险因素。结论性别、吸烟、居住通风条件、密切接触史、月人均收入为老年结核病发病危险因素,今后在制定老年结核病防治措施时应把上诉因素作为重点加以考虑。     

Aborigines and tuberculosis: why they are at risk

Abstract: Aborigines have higher rates of Mycobacterium tuberculosis than the rest of the community. There are insufficient contemporary data to assess how much risk tuberculosis poses to the Aboriginal community. Tuberculosis is of particular concern because of its interaction with human immunodeficiency virus (HIV). We aimed to ascertain the available data about tuberculosis in Australian Aborigines: to determine morbidity and mortality of tuberculosis in Australian Aborigines, to ascertain the extent of known risk factors for tuberculosis in Australian Aborigines and to consider the public health implications of our findings. Sparse evidence suggests that Aborigines have higher rates of infection and of clinical tuberculosis than non-Aboriginal Australians, along with a high prevalence of known risk factors for tuberculosis. However, there is a paucity of data about specific risk factors and tuberculosis in Aborigines. In addition, Aborigines have a high prevalence of risk factors for HIV infection. The existence of concurrent risk factors for tuberculosis and HIV, in a population that already has a high rate of infection with tuberculosis is cause for grave concern. Tuberculosis control is centred on correct and rapid diagnosis and appropriate treatment, as well as efficient contact tracing. These are the most important strategies for control of tuberculosis among Aborigines, and are especially important when there is concurrence of other risk factors. Appropriate preventive therapy for infected people should also be considered.     

2011—2020年贵州省老年肺结核流行特征及治疗效果分析

目的 分析贵州省老年肺结核流行特征和治疗效果,针对性地优化防治策略。方法 从结核病信息管理系统导出2011—2020年贵州省≥65岁肺结核资料,对其三间分布、发现方式和治疗转归等特征进行回顾性描述分析。结果 2011—2020年贵州省共报告老年肺结核78 731例,年均报告发病率为227.40/10万,总体呈下降趋势。老年病例集中在75～79岁年龄组;男性年均报告发病率290.00/10万高于女性169.95/10万;地区分布以遵义、黔南和铜仁居多,年均发病率分别为304.62/10万、303.21/10万、273.53/10万;绝大多数病人（97.07%）为因症就诊等被动发现;就诊延误率为70.62%;初、复治涂阳患者成功治疗率分别为84.72%和76.05%。结论 老年肺结核是贵州省防控工作的重要挑战,应以男性和高发地区为重点,通过健康教育提升患者主动就医从而加大发现力度和减少就诊延迟情况,并结合基本公共卫生服务促进患者主动发现,规范治疗避免复发、耐药等不良结局发生,整合各部门职能,共同推进老年肺结核防控工作。     

科学推进结核病防控策略实现“十三五”结核病防治规划

结核病是严重危害居民健康的重大传染病。我国结核病疫情相当严重,是全球结核病高负担国家之一。我国如期实现了向国际社会承诺的结核病控制阶段性目标,结核病死亡率明显下降。高感染率、高患病率、高耐药率,发现率、认知率、规则服药率还差强人意以及患病率下降缓慢等构成中国结核病的流行特点。当前我国结核病防控形势严峻,为实现《"十三五"全国结核病防治规划》,必须依法和科学地推进结核病防控策略:将结核病防治工作作为重要民生建设内容,列入各地国民经济和社会发展规划,纳入政府目标管理考核内容;加强结核病防治工作信息化建设;健全包括结核病防治专业机构、结核病定点医疗机构和基层医疗卫生机构的服务体系,实施传染性肺结核患者住院治疗;做好结核病危险人群的关怀、监测、防治和健康教育工作;广泛深入开展有关结核病的严重性和危害性的宣传教育,做到每一个结核病人都得到关怀。     

结核病的流行与控制对策

[目的]指导当前的结核病监测、防治工作.[方法]对结核病的国内外流行现状、实验室诊断现状和研究方向及进展进行研究.[结果]结核病仍是世界上发病率最高的传染病之一,目前其诊断方法仍以痰检、影像学检查为主,但分子生物学技术已开始应用,并将在今后的结核病防治工作中,发挥重要的作用.[结论]结核病防治工作面临十分严峻的形势,应坚持预防为主的方针,坚持结核病控制的可持续发展.     

Trends in Tuberculosis Reported From the Appalachian Region: United States, 1993-2005

ABSTRACT:  Context: Appalachia has been characterized by its poverty, a factor associated with tuberculosis, yet little is known about the disease in this region. Purpose: To determine whether Appalachian tuberculosis risk factors, trends, and rates differ from the rest of the United States. Methods: Analysis of tuberculosis cases reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System (NTSS) within the 50 states and the District of Columbia from 1993 through 2005. Results: The 2005 rate of tuberculosis in rural Appalachia was 2.1/100,000, compared to 2.7/100,000 in urban Appalachia. Urban non-Appalachia had a 2005 tuberculosis rate of 5.4/100,000. Over the 13-year period, tuberculosis rates fell in Appalachia at an annual rate of 7.8%. In one age group (15- to 24-year-olds) the rates increased at an annual rate of 2.8%. Foreign-born Hispanics were the largest racial/ethnic group in this age group. When private providers gave exclusive care for tuberculosis disease, Appalachians were less likely to complete therapy in a timely manner when compared to non-Appalachians (OR 0.6, 95% CI 0.5-0.7). Conclusions: Tuberculosis rates and trends are similar in urban and rural Appalachia. It is crucial for public health officials in Appalachia to address the escalating TB rate among 15- to 24-year-olds by focusing prevention efforts on the growing numbers of foreign-born cases. Due to the increased risk of treatment failure among Appalachians who do not seek care from the health department, public health authorities must ensure completion of treatment for patients who seek private providers.     

Epidemiological analysis of tuberculosis in Ethiopia: a ten-year trend analysis

Tuberculosis has been one the major causes of morbidity and mortality in Ethiopia for long. Accordingly, the Ethiopian Ministry of Health and its stakeholders have their unreserved and integrated efforts on this health problem. Among these efforts was the well developed HMIS for Tuberculosis programs. However, the direction to where Tuberculosis in Ethiopia is heading hasn't been well analyzed and unpackaged by epidemiologically relevant factors. The overall aim of this study was to examine the epidemiological trends of Tuberculosis in Ethiopia for the ten-year period from 2000-2009. The trends were investigated from spatial, temporal, disease type and gender perspectives. A time-series study design was applied to analyze the ten-year trends of Tuberculosis in Ethiopia. Data on ten-key indicators for the period of 2000-2009 was obtained from the Ministry of Health public documents. Five stratifying variables were used to analyze the trends in the key TB indicators. The data on the indicators have undergone five stages of analysis: Aggregation, computation, summarization, graphics and model fitting. The incidence rate of tuberculosis is increasing in Ethiopia at a rate of 5 new TB cases per 100,000 population per year. Urban agro-ecological zones have been more affected by the disease throughout the ten-year period. Extra-pulmonary rate and smear-negativity has shown a modest increment during the study period. Masculine gender was also disproportionately affected by tuberculosis during the ten-year study period. On the other hand case detection rate and treatment success rate are found to be increasing at a rate of 0.5% per year.     

The World Health Organization and public health research and practice in tuberculosis in India

Two major research studies carried out in India fundamentally affected tuberculosis treatment practices worldwide. One study demonstrated that home treatment of the disease is as efficacious as sanatorium treatment. The other showed that BCG vaccination is of little protective value from a public health viewpoint. India had brought together an interdisciplinary team at the National Tuberculosis Institute (NTI) with a mandate to formulate a nationally applicable, socially acceptable, and epidemiologically sound National Tuberculosis Programme (NTP). Work at the NTI laid the foundation for developing an operational research approach to dealing with tuberculosis as a public health problem. The starting point for this was not operational research as enunciated by experts in this field; rather, the NTI achieved operational research by starting from the people. This approach was enthusiastically welcomed by the World Health Organization's Expert Committee on Tuberculosis of 1964. The NTP was designed to "sink or sail with the general health services of the country." The program was dealt a major blow when, starting in 1967, a virtual hysteria was worked up to mobilize most of the health services for imposing birth control on the people. Another blow to the general health services occurred when the WHO joined the rich countries in instituting a number of vertical programs called "Global Initiatives". An ill-conceived, ill-designed, and ill-managed Global Programme for Tuberculosis was one outcome. The WHO has shown rank public health incompetence in taking a very casual approach to operational research and has been downright quixotic in its thinking on controlling tuberculosis worldwide.     

河南省2009年肺结核疫情特征流行病学分析

[目的]了解2009年河南省肺结核发生水平及其流行特征。[方法]采用中国疾病预防控制中心开发的"国家疾病报告管理信息系统"和Excel软件对2009年河南省肺结核疫情进行分析。[结果]2009年河南省共报告肺结核77771例,发病率为82.48/10万,其中报告死亡268例,报告死亡率为0.28/10万,与2008年结果相比,发病率下降11.16%,死亡率上升67.27%。在28种甲乙类传染病中,发病率仅次于病毒性肝炎,居第2位,死亡率仅次于艾滋病,同样居第2位。全年肺结核发病数比较,冬春季节多于夏秋季节,但季节性高发特点不明显;不同地区分布特点,发病率豫南豫东高于豫北豫西;年龄分布患者以青壮年较多,男性多于女性,职业分布以农民最多。[结论]当前肺结核仍然是严重危害当地居民身体健康和生命安全的重要公共卫生问题之一。     

2011—2020年重庆市老年复发肺结核流行病学特征及治疗转归分析

目的 分析重庆市老年复发肺结核流行病学特征及治疗转归,为制定老年肺结核疫情防控策略提供依据。方法 收集重庆市2011—2020年结核病信息管理系统中登记的年龄≥60岁复发肺结核病案信息,采用描述性流行病学方法对数据进行分析。结果 2011—2020年登记老年复发肺结核患者3 461例,年均登记率5.32/10万,年递增率3.07%(χ²_趋势=73.477,P<0.05)。病原学阳性率为76.11%。登记的老年复发患者中男女性别比为4.81:1,年龄以60～69岁组为主(61.34%),70～79岁和≥80岁组占比10年间有上升趋势。渝东南武陵山区城镇群老年复发肺结核患者登记率最高(10.81/10万),主城都市区次之(4.80/10万),呈上升趋势(χ²_趋势=40.218、63.594,P<0.05)。老年复发患者年均就诊延迟率为76.80%,10年间呈下降趋势(χ²_趋势=28.737,P<0.05)。复发患者中有肺部空洞占比33.95%,重症患者占比9.79%,均呈上升趋势(χ²_趋势=52.389、77.693,P<0.05)。年均成功治疗率80.05%(2 340/2 923),呈下降趋势(χ²_趋势=82.871,P<0.05)。结论 重庆市老年复发肺结核疫情严峻,应加强健康教育工作,提高老年人群主动就诊和筛查意识; 重点关注有结核病史的男性、超高龄老年人群,加大老年人群患者发现力度; 探索老年潜伏感染者预防性治疗以减少发病,加强患者关怀,提高成功治疗率,最终达到降低肺结核疫情目的。     

静安区中小学生结核病防治知识知晓率调查

目的了解静安区中小学生结核病防治知识的知晓情况，为改进结核病健康教育提供依据。方法在全区每所中小学校中采用分层随机整群抽样方法，对2046名学生开展关于结核病预防与控制知识的问卷调查。结果2029份有效问卷中，小学生、初中生、高中生总体结核病知识知晓率分别为64．9％、70．3％和70．9％，总体结核病知识全部知晓率分别为5．0％、6．9％、7．8％。结核病防治知识平均得分均为5分以上。绝大多数学生知道肺结核是呼吸道传染病及其主要症状。但“痰检的重要性”、“遵守治疗原则的重要性”和“结核病诊治的国家减免费用政策”知晓率均较低。结论静安区中小学生预防与控制结核病健康教育已取得初步成效，但仍有薄弱环节，需要在今后工作中予以改进。