RESUMO
The Mississippi State Department of Health tuberculosis program serves a rural southeastern US state of 2.9 million people in an area of 121,489 km(2) (46,907 square miles). Statewide, directly observed therapy (DOT) began in 1986. To evaluate the program's effectiveness, trends in Centers for Disease Prevention and Control program indicators for 1981-2005 were compared and found to be significant (P < 0.0001). Inclusion of rifampin and pyrazinamide in the regimens was reviewed. An annual decline in cases and case rates began in 1990, falling by 65% by 2005. Successful DOT is feasible over a large geographic area.
Assuntos
Antituberculosos/uso terapêutico , Terapia Diretamente Observada/estatística & dados numéricos , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Antibióticos Antituberculose/uso terapêutico , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , População Rural , Estados Unidos , Adulto JovemRESUMO
SETTING: Tuberculosis (TB) incidence and mortality in Russia have risen dramatically over the past 15 years. OBJECTIVE: To identify risk factors and causes of death among TB patients in Russia. DESIGN: A retrospective study conducted to determine the risk factors and causes of death in patients receiving TB therapy in Tomsk, Siberia. RESULTS: Of 1916 patients who initiated treatment between 1 January 2002 and 31 December 2003, 183 (9.6%) died during treatment, 38 (21%) in the first week of therapy. Twenty-five per cent of deaths were not directly attributable to TB. Risk factors for death included older age, previous treatment for TB, multidrug resistance and alcoholism. CONCLUSIONS: The high death rate during TB treatment observed in this cohort likely reflects an increased risk of dying not only from TB, but also from comorbid conditions, such as alcoholism and cardiovascular disease. Overall, alcoholism and late presentation both contributed substantially to the mortality in this cohort.
Assuntos
Tuberculose/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sibéria/epidemiologia , Análise de Sobrevida , Fatores de Tempo , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Tuberculose Pulmonar/mortalidadeRESUMO
Etching patterns by 20 percent phosphoric acid on caries-like lesions of enamel (white spot) untreated and treated with 0.4 APF were studied at 30, 60, 120 seconds of etch-times using the Scanning Electron Microscope (SEM). The surface topography of acid-etched teeth varied according to the etch time. Acid etching of caries-like lesions treated with fluoride showed etching patterns similar to sound enamel. Based on Silverstone's classification, thirty seconds etch-time produced type III pattern of surface morphology, while type I and type II were observed with 60 and 120 seconds of etch time. Fluoride treated lesions showed increased porosity and in addition to a surface coating of numerous small globules of calcium fluoride. Low level of topical fluoride before sealant application should be beneficial, since this allows a more rapid rate and increased degree of remineralization and possible arrest in the progress of caries lesions.