Tuberculosis control policies in major metropolitan health departments in the United States. IV. Standards in 1988

The most common pulmonary diseases length of stay, and characteristics of patients admitted to pulmonary service

BACKGROUND

Although chronic respiratory diseases are prevalent in Saudi Arabia, there are limited data on the patient burden and associated factors. The aim of this study is to identify the chronic respiratory diseases frequently admitted to pulmonary services and to determine the patient's characteristics, associated comorbidities readmission rate, and reason for a more extended stay in hospital.

METHODS

A prospective study was conducted over a 5-year period at King Abdulaziz Medical City-Riyadh, Saudi Arabia, in the Pulmonary Division, between March 2015 and December 2019. Data on demographics, comorbidities, and chronic respiratory diseases were collected.

RESULTS

Total patients admitted were 1315 patients, female 54.2%, the mean age was 62.4 (SD±17.6), and the ages ranged from 14 to 98 years. Overall, chronic obstructive pulmonary disease was the most common respiratory disease requiring admission (17.9%), followed by interstitial lung disease (15.8%), bronchiectasis (11.9%), and obesity hypoventilation syndrome (10.8%). The most common comorbidities were obesity (42.5%), diabetes 49.1%, and hypertension 54.9%. Only 135 (10.3%) were readmitted within 30 days posthospital discharge. Among the patients who were readmitted, 103 (76.3%) were readmitted due to issues related to previous admission diagnosis, noncompliance 75 (55.5%), social reasons, and premature discharges in 51 (37.8%) and 29 (21.5%) of the cases, respectively. The respiratory disease varied significantly by gender, age, obesity status, comorbidities, length of stay (LOS), and admissions.

CONCLUSION

Chronic respiratory diseases are prevalent in our population and are mainly influenced by gender, age, obesity status, comorbidities, LOS, and admissions. Policymakers and health professionals need to recognize the burden of chronic respiratory diseases on patients and health systems and implement effective prevention programs.

Mandated tuberculosis screening in a community of homeless people

BACKGROUND

To examine the effects of a community program on tuberculosis incidence, prevalence, and transmission requiring users of public facilities to carry cards certifying their compliance with a tuberculosis screening, prophylaxis, and treatment program. Community knowledge of tuberculosis and costs and benefits of the program are described.

SETTING

A West Coast "skid row" community with historically high rates of tuberculosis, homelessness, poverty, and use of drugs and alcohol.

DESIGN

Analysis of tuberculosis activity in communities in Oregon using Oregon Health Division Tuberculosis Data Bank data. Description of community response and cost considerations.

MAIN OUTCOME MEASURES

Rates of active disease, mortality, and skin-test response. Compliance with card use and understanding of tuberculosis control measures. Program expenditures.

RESULTS

An 89% drop in active disease in the highest-risk community in Oregon occurred over the first 10 years of the program. Compliance with the program permitting the use of public facilities, based on cooperation with skin testing, radiology, sputum collection, and therapy has been between 33% of converters completing prophylaxis in the worst year to 100% of active cases completing 4-drug therapy in the best. Facilities that provide services have been almost universal in requiring cooperation for participants. Costs have been reduced.

CONCLUSION

A program of mandated compliance with tuberculosis skin testing, radiologic and sputum examination and treatment, coupled with education and outreach, succeeded in drastically reducing active tuberculosis, transmission, deaths, and cost in a homeless community.

Tuberculosis control policies in major metropolitan health departments in the United States. VI. Standard of practice in 1996

Since 1980, we have surveyed at 4-yr intervals the metropolitan health departments initially reporting > 250 cases of tuberculosis to determine the perceived standard of practice for tuberculosis control and the factors affecting formulation of treatment policies. Between 1992 and 1996, use of supervised short-course (6 to 9 mo) intermittent therapy with multiple drugs including isoniazid, ethambutol, pyrazinamide, and rifampin increased from 4.3% to 46% of all new patients. Pyrazinamide use for initial treatment for children has increased substantially and now predominates (74.2% of patients in 1996 versus 48.1% of patients in 1992). Duration of treatment, which was 20 +/- 2.1 mo in 1980, is now 8.00 +/- 2.29 mo in 1996. The incidence of human immunodeficiency virus-associated tuberculosis, which was virtually unrecognized in 1984, has remained the same between 1992 and 1996 (18.0%). As in previous years, there was a wide variance among health departments in the incidence (< 5% to > 40%) of HIV-associated tuberculosis. After years of funding decreases, there has been an impressive increase in resources in the past 4 yr. In 1988, mean budget allocation for health departments decreased by 7.9% versus the prior 4 yr and, in 1992, there was no overall change in budget allocation after inflation versus 1988. In 1996, however, funds for treatment increased by 84 +/- 33%. This increase in funding has been translated into the greatly expanded use of supervised intermittent therapy and aggressive screening programs, which likely have resulted in the decreased incidence of tuberculosis since the prior survey.

Tuberculosis control policies in major metropolitan health departments in the United States. V. Standard of practice in 1992

Since 1978, we have surveyed the 28 metropolitan health departments initially reporting > 250 cases of tuberculosis/yr to determine the standard of practice in the control of pulmonary tuberculosis and the factors affecting treatment policy. In this survey, results were compared with data obtained in 1978, 1980, 1984, and 1988. As in the previous years, all departments completed the survey. The predominant treatment regimen was 6 months of chemotherapy (64 +/- 1.33% of patients) involving isoniazid (I), rifampin (R), and pyrazinamide (Z). Estimated duration of treatment, which had decreased from 20.2 +/- 2.1 months in 1980 to 7.58 +/- 1.02 months in 1988, increased to 9.34 +/- 2.32 months in 1992 (p < 0.01). This was attributed to an increase in drug-resistant cases (17 of 25 programs) and to increased incidence of HIV infection during the previous 4 yr. In 1984, HIV infection was estimated to coincide with tuberculosis in 2.54% of all patients, 7.72% in 1988, and 17.42% in 1992. Several other major departures from prior perceived practices were reported. In 1980, 32.1% of all patients were hospitalized initially for tuberculosis treatment, and this number decreased progressively to 17.8% in 1988; in 1992, 34.2 +/- 1.32% of patients with tuberculosis were hospitalized for initial treatment. In 1988, no program reported regular use of alternative therapy to isoniazid for chemoprophylaxis; in 1992, 21 programs used alternative regimens (predominantly R-containing). In 1992, nine programs reported increased funds for treatment of tuberculosis (27.2 +/- 1.97% after inflation), whereas 16 reported a mean decrease of 14% after inflation.(ABSTRACT TRUNCATED AT 250 WORDS)

A rapid tuberculosis screening program for new mothers who have had no prenatal care

We developed a Rapid Tuberculosis Screening Program for use in women who have not had prenatal care. All patients who presented for delivery without a documented tuberculin skin test (TBN-ST) were given a symptom questionnaire. Those who had a positive response to any of the questions received a chest roentgenogram to rule out active disease. All patients with a negative questionnaire had a TBN-ST soon after admission. The test was read at the time of discharge, whether or not 48 h had elapsed, and individuals who had 5 mm or more of induration at before 48 h and 10 mm or more induration at 48 to 72 h were considered reactors. Of 1,412 patients who received a TBN-ST, 259 were reactors. One case of active disease was diagnosed. Approximately 75 percent of "true" tuberculin reactors will be detected by this method. We suggest that by using the TBN-ST concurrently with a questionnaire, most patients infected with Mycobacterium tuberculosis can be identified.

Problems in running a tuberculosis dispensary in a developing country: Turkey

Declining use of the services of local dispensaries has often been suggested as a significant factor in the rising trend of tuberculosis in Turkey after 1970. Data confirming this view were insufficient until this study, which consists of an evaluation of the records of 51,086 subjects seen by the tuberculosis dispensary in Elaziğ between 1985-1989. We found that, despite an expected yearly population increase, there were no significant differences in the numbers of diagnostic and follow-up procedures as well as preventive and therapeutic interventions recorded in different years, and that cases of active tuberculosis lost to follow-up had gradually increased. The least effective method of case-finding, mass screening, had been employed most frequently. These results revealed a less than optimum use of the services of the tuberculosis dispensary and prompted us to suggest the following changes: (1) diversion of economic resources currently used for mass screening in order to use them for better purposes; (2) functional integration of tuberculosis dispensaries with local, general or university hospitals, since a separate system for tuberculosis care is accompanied by a segregating and stigmatising effect for all concerned; (3) entering all patients and contacts into a computerised database to alleviate the problems associated with inadequate follow-up. We conclude that existing control programmes should be reviewed and improved to prevent an increase of tuberculosis, particularly in developing countries like Turkey.