[Marketing as an effective tool to overcome systems problems in the organization of antituberculous care to the pediatric population].

The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.

[Effectiveness of new diagnostic drug Diaskintest in children for tuberculosis diagnostic].

DST was ascertained to have a high sensitivity in virtually all patients with tuberculosis and a positive reaction was first noted in the infected. With stabilization and regression, the response to DST was much less pronounced than that in clinical and primary infection (that to the Mantoux test being more evident). DST showed its use as a marker of active tuberculosis not only in its local forms, but also in latent tuberculous infection. This makes it possible to apply DST when preventive treatment is performed. The agent may be used to monitor the progress of treatment. DST has a high specificity--healthy individuals had a negative response to DST while the Mantoux test was positive in many cases. The high specificity of DST was suggested by the fact that the persons vaccinated with (this caused BCG ostitis) had a negative reaction to DST while the Mantoux test was positive in all cases BCG-vaccinated BCG. The findings warrant the use of DST for the differential diagnosis of tuberculosis and BCG-associated complications and the possibility of differentiating postvaccinal and infection allergy in children and adolescents.

[Detection of tuberculosis in Moscow adolescents].

Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.

[Tuberculin diagnosis in children. Latent tuberculosis?].

The 2000-2006 results of tuberculin diagnosis made in a city numbering 10.5 million people were retrospectively analyzed on the basis of an epidemiological tuberculosis survey among children. The higher cut-offs are not helpful in interpreting the tuberculin test. With more than 5 mm, it is necessary to have criteria for clear differences between the active tuberculous process, inactive tuberculous changes, and recent or previous Mycobacterium tuberculosis infection. With the low prevalence of tuberculosis among children in a megapolis, the sensitivity of the method was 97.4%. Its specificity was 41.7%; out of these children, a risk group forms in 1% of cases and the children who had been referred by a pediatrician and had failed to be examined by a specialist at a tuberculosis dispensary. With positive and negative tests, the likelihood of the disease in a child is 0.01 and 99.9%, respectively. At the same time, morbidity in risk group children formed by the results of tuberculin tests is high and indicative of a need for searching for objective indicators (except for tuberculin diagnosis and history data) to identify the disease just before registration as a risk group. The practical value of chemotherapy for latent tuberculosis infection in the megapolis requires studies and evidence-based results. Preventive chemotherapy is currently the priority in preventing tuberculosis for individual risk groups (among the HIV-infected and those who are from tuberculosis infection foci).

[Comparative analysis of tuberculosis morbidity in children and adolescents from Moscow and the Penza Region].

Tuberculosis morbidity was comparatively analyzed in the children and adolescents of Moscow and the Penza Region. The epidemiology of tuberculosis in the children and adolescents was established to be universal in the compared regions in the study period. This manifested itself as a stable tendency for higher morbidity rates (MR), increased incidence of destructive tuberculosis, inadequate use of the existing methods for active detection of tuberculosis in these age groups, and, among those who had fallen ill with this disease, an increase in the number of persons from the foci of tuberculous infection and persons with established contact with patients with tuberculosis. Along with a steady MR growth for tuberculosis among the children and adolescents, there has been a quantitative modification to the proportion of all epidemiologically hazardous forms of tuberculosis, such as the bacillary and destructive forms of pulmonary tuberculosis complicated by extrapulmonary tuberculosis. Hypodiagnosis of tuberculous pleurisy and extrapulmonary tuberculosis has been recently noted in the general health care network. The analysis also leads to the conclusion that the quality of mass tuberculin diagnosis remains poor. In both regions, general pediatricians are not adequately alert to tuberculosis, extrapulmonary tuberculosis in particular. With a rise in tuberculosis endemic, the incidence of tuberculosis in 18-21-year-old persons is 2-3 times greater than that in adolescents, which is associated with the greater activity of this population group and with the underdetection of the asymptomatic forms of tuberculosis in adolescents.

[Adolescence tuberculosis in Moscow: epidemiological situation and problems].

The paper provides the data of analysis of antituberculous care to teenagers in Moscow and characterizes its problems. Emphasis is placed on the tense and unstable situation associated with the detection of the disease in this age group. In the bulk of adolescents, the disease is identifies when they come to see a doctor, including at somatic hospitals. Active tuberculosis detection techniques (tuberculin diagnosis and fluorography) fail to produce adequate effect mainly due to organizational problems (the bulk of teenagers are outside the organized collective bodies or the latter are frequently changed; the detection of tuberculosis in Moscow nonresidents or in whose who enter secondary specialized colleges claims attention). Age-related sociomedical risk factors, such as hormonal rearrangement, comorbidity, a negative attitude towards preventive medical measures, deviant behavior, social family, and dysadaption, are of importance for the development of tuberculosis. A sociomedical portrait of an adolescent with tuberculosis is given. Attention is drawn to the fact that on implementing antituberculous measures, it is a need for an interaction of a tuberculosis-controlling service with general care health network facilities, including those that deal with the problems of social diseases and educational establishments.

[Principles in the performance of chemotherapy in dispensary group VI children and adolescents].

Based on the annual reports of Moscow tuberculosis dispensaries, the analysis of their follow-up of dispensary registration group VI patients, the authors have developed preventive chemotherapy regimens in relation to the specific features of tuberculin sensitivity, the presence or absence of additional risk factors (concomitant somatic diseases, social risk factors). Regimen I (1 antituberculous drug (isoniazid) for 3 months) may be used in dispensary registration groups VIA and VIB patients without additional risk factors. Regimen II (2 antituberculous drugs (isoniazid + pyrazinamide/ethambutol) for 3 months) may be employed in dispensary registration groups VIA and VIB patients with additional risk factors, as well as in children from dispensary registration group VIB, whether additional risk factors are present or absent. A repeated course of preventive chemotherapy regimen II is indicated when tuberculin sensitivity is increased or a hyperergic reaction is retained after termination of treatment in patients having additional risk factors.

[Antituberculosis care of children and adolescents in tuberculosis risk groups]. / Protivotuberkuleznaia pomoshch' detiam i podrostkam iz grupp riska po tuberkulezu.

Because of deterioration of epidemiological situation by tuberculosis, individuals from tuberculous infection foci and social risk group require special care. It is important to integrate efforts of phthisiatric and general therapeutic and prophylactic services in detection of tuberculosis in children and adolescents, to create controlled conditions for conduction of antituberculous measures.