[The material and technical base of fluorographic units of primary health care facilities and its development promises].

The goal of the study was to assess the status of equipment and the staff potential in the fluorography and X-ray units of primary health care facilities and to define priorities and the volume of investments for their modernization. Two hundred and seventy-two health care facilities were studied through the use of questionnaires. The data were processed using standard statistical methods, such as calculation of the mean, median, and 95% confidence intervals. Prognosis was made for the idling period of equipment during stagnation of measures to improve the material and technical base of fluorography units. Priorities for modernizing the material and technical base and the staff potential were defined for the fluorography units of primary health care facilities. The volume of investments required for the modernization was estimated.

[Legal aspects of compulsory hospitalization of incompliant patients with tuberculosis].

The main task of an antituberculosis service is to treat patients with tuberculosis and to follow up needy persons in order to prevent the spread of tuberculosis among the population. However, phthisiatricians are unable to solve some problems without assistance from the government as they are associated with social and behavioral causes--no or partial patient's motivation for treatment. Early therapy discontinuation in patients with tuberculosis, latent or obvious interruption of chemotherapy, patients' use of a partial dose of drugs give the vast majority of Russian phthisiatricians concern. These lower the efficiency of treatment, increase the likelihood of drug resistance in Mycobacterium tuberculosis, and contribute to the chronic pattern of the tuberculosis process, continuously replenishing the pool of untreatable patients with tuberculosis and bacterial discharge. An incompliant tuberculosis patient discharging bacteria may be compulsorily taken to a tuberculosis hospital by the court decision. This is in line with Article 10, the 18 June, 2001 Federal Law No. 77--"On Prevention of Tuberculosis Spread in the Russian Federation". This investigation was undertaken to enhance the effectiveness of involvement of incompliant bacteria-discharging patients with tuberculosis to compulsory examination and treatment. The mechanism of realization of Article 10 of the abovementioned Law was analyzed from the experience of an antituberculosis service of the Ryazan Region (178 writs). At present, it is impossible to fulfill this Article 10 in corpore due to there is an improper legal base that is in no subordinate legislation and actuate sentences for non-implementation of court decisions. Subordinate legislation regulating a compulsory hospitalization procedure by officers of justice should be elaborated. It is necessary to introduce amendments into the base to make patients with infectious tuberculosis who have not carried a court decision on compulsory hospitalization. Tuberculosis facilities should be used to set up social centers for the complex work and treatment of socially dysadapted patients with tuberculosis (including those who have been released from confinement institutions). For this, tuberculosis institutions should be staffed by social workers, psychologists, psychiatrists, lawyers, and narcology experts with the appropriate funds being allocated.

[A social backing program and motivation provision in patients with tuberculosis].

The purpose of the study was to obtain information on tuberculosis patients' needs, perception, and expectations from health care as a whole and social backing in order to improve the implementation of a program for enhancing tuberculosis patients' motivation for recovery and treatment. Anonymous voluntary questioning using the standard questionnaire was carried out among new tuberculosis cases registered to be treated in 4 subjects of the Russian Federation (the Oryol, Vladimir, and Belgorod Regions, and the Republic of Mariy-El). Eighty-seven patients who had stopped being treated before the appointed time and 1302 patients who were receiving chemotherapy at the time of questioning were interviewed using the questionnaire. The main reasons for treatment discontinuance in those who stopped treatment before the appointed time were the necessity of earning their living (30%), alcohol consumption (30%), inadequate health education of the patients who considered themselves to be healthy (25%). Most patients (67%) preferred rewards as social backing, products/hot food (41%), and fare (32%). Among the proposed social backing schemes, the most popular ones were those that envisaged small daily rewards (23%) or a large final bonus (21%). The majority (67%) of patients preferred outpatient treatment. Thus, patients with tuberculosis face a great deal of problems that affect their motivation for treatment. To satisfy some of these problems is not the direct duties of an antituberculosis service due to the fact that the manning table lacks appropriate posts and an item of expenses. Therefore additional funds should be allocated from the budgets of a subject of the Russian Federation and/or municipal entities for adequate organization of social backing of patients with tuberculosis to enhance the efficiency of their treatment. Collaboration of antituberculosis services of the Russian Federation's subjects with social organizations and an addiction service along the availability of psychological and legal consultations to patients is the most optimum variant of social backing organization to improve the patients' motivation for treatment.

[Problems in the formation of tuberculosis epidemiological parameters].

UNLABELLED: The information obtained from 83 subjects of the Russian Federation on 107,306 new tuberculosis (TB) cases and TB relapses, recorded for treatment in the tuberculous facilities of the Ministry of Health and Social Development of the Russian Federation (RF), was analyzed. The completeness and validity of indicators and their compliance with Russian Statistics Committee's form 8 were studied. RESULTS: among the new TB cases, bacterial discharge was found in 33.3 +/- 5.2% by microscopy and in 44.9 +/- 8.9% by cultures tests. Decay cavity was observed in 42.6 +/- 4.9% of the patients. In the RF, the coverage of patients to be tested for Mycobacterium tuberculosis susceptibility was 76.3-83.1% of culture-positive TB patients. Among the new TB patients, drug resistance (DR) of M. tuberculosis to one drug or more was detected in 30.6 +/- 6.7% of those tested for drug susceptibility. Multidrug resistance (MDR) was recorded in 11.4 +/- 4.2% of the examinees. Among the patients with TB relapses, DR and MDR were found in 45.4% and 24.7% of the examinees, respectively. The detection rate of epidemically dangerous patients in the general health care facilities was as high as 12.5%, which is an extremely low value. CONCLUSION: Order No. 50 reporting documents needs to be improved for the evaluation of the efficiency of treatment and monitoring a tuberculosis epidemic process. It is necessary to follow the uniform rules for calculating the values for all RF reporting forms. In particular, this concerns the indicators of the prevalence of DR tuberculosis. The efficiency of a microbiology study of patients varies in federal districts; however it is generally inadequate.

[A procedure for calculating needs for antituberculous drugs].

OBJECTIVE: to develop a procedure for calculating needs for antituberculous drugs (ATD). MATERIALS AND METHODS: A unified E-form (UEF) was developed as an "Excel" file with the underlying invariable formulas and coefficients for the computer-based calculation of ATD needs in any subject of the Russian Federation. The needs were estimated using the average number of tablets (capsules, vials) of each ATD required per man/course, by taking into account the conventional chemotherapy regimens, the duration of chemoprophylaxis, antirecurrent courses, ATD test therapy, a treatment regimen for complications due to BCG vaccination. Information on the inventory of ATDs at the end of the previous year and their estimated deliveries from various sources was additionally considered. Data to be filled in the UEF were obtained from the reporting documents: 1) TB Form No. 2 "Information on patients registered for treatment" approved by Order No. 50 "On Consummation of Recording and Reporting Documents as to Tuberculosis Monitoring" issued by the Ministry of Health of the Russian Federation on February 13, 2002; 2) Form No. 030-4/y "Tuberculosis Patient Follow-Up Schedule"; and 3) Form No. 33 "Information on Patients with Tuberculosis" approved by Regulation No. 80 issued by the Russian Statistics Agency on November 11, 2005. The filled-in UEFs were obtained from 82 subjects of the Russian Federation. RESULTS: among all the contingents of antituberculosis dispensaries, who were given ATDs, the absolute majority was the persons receiving chemoprophylaxis. Only 18.3% received chemotherapy for active tuberculosis. Of them, 56.8 and 15.3% were treated in accordance with chemotherapy regimens 1 and 3, respectively. The regimes (2B and 4) using second-line agents were given least frequently (7.1 and 7.1%, respectively). Comparing the data from Form No. 33 and those obtained on filling in UEF showed with a fair degree of assurance that the treatment of patients with a chronic tuberculous process had been incompletely registered. Personified registration of patients with multidrug Mycobacterium tuberculosis resistance should be performed in order to have objective information on the scope of required medical aid and the real calculation of needs for second-line ATDs. For unified calculation of needs for ATDs for chemotherapy, it is necessary to introduce a standardized approach to its performance at different dispensaries. By taking into account that ATDs are purchased and dispensed free of change, one should have a responsible attitude to consuming drugs, determining indications for their usage, and filling the UEF. TB Form No. 2 "Information on patients registered for treatment" and Register No, 03-TB/y "Register of patients with tuberculosis" should be improved, by adding data on the number of patients receiving chemoprophylaxis, antirecurrent courses, test therapy, and treatment of complications due to BCG vaccination.

[Respiratory mechanics in patients with stage III pulmonary sarcoidosis and idiopathic fibrosing alveolitis: similarities and differences].

Impaired function of the lung was studied in 28 patients with Stage 111 pulmonary sarcoidosis and 17 patients with idiopathic fibrosing alveolitis (IFA). The study involved spirography, body plethysmography, and esophageal probing of respiratory mechanics. In patients with Stage III pulmonary sarcoidosis, the mechanics of respiration has the following similarities: restrictive ventilation disorder is revealed in IFA; the functional syndrome with a predominance of restriction is also detectable in some patients with Stage III sarcoidosis; significant differences are found in patients with IFA and Stage III pulmonary sarcoidosis: there is no marked impaired patency of peripheral bronchi in IFA; and all the functional changes found suggest that there is an increase in lung tissue rigidity and a decrease in the capacity of the lung to straighten; in Stage III sarcoidosis, of great importance is a marked impairment of patency of peripherally located bronchi, which is associated with the increase of this or that degree of lung compliance and in the retraction index.

[Changes in respiratory mechanics in post-tuberculosis emphysema and pneumosclerosis]. / Izmeneniia mekhaniki dykhaniia pri posttuberkuleznykh émfizeme i pnevmoskleroze.

The mechanics of breathing was studied in 457 patients with pulmonary tuberculosis. The restrictive mechanism of lowering the ventilation reserves was essential in sclerotic changes in the lower lung. Obstructive changes increased with the extent of pneumosclerosis. X-ray emphysematous changes were confirmed by functional diagnostic findings. The elastic properties of the lung were of the greatest value. Functional diagnosis is important in making clear the clinical and X-ray symptoms of pneumosclerosis and emphysema.