Countrywide management of pulmonary tuberculosis reverses increasing incidence.

OBJECTIVE: To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia. DESIGN: Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998-2006. RESULTS: The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100,000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998-2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis. CONCLUSION: Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.

[Tobacco or living? Decrease in smoking in Iceland 1985-1990]. / Tobaken eller livet? Minskad rökning i Island 1985-1990.

In 1985 a new tobacco act was passed in Iceland, which prescribed inter alia that warnings be printed on packages of tobacco goods. A prohibition on advertisement for tobacco has since been imposed; information on the injurious effects of tobacco has been disseminated in the schools and via TV. A law which limits smoking at work places and indoors in public buildings has also been introduced. Smoking habits have changed in the last five years. The number of daily smokers has fallen from 40.0 to 32.5 per cent, and rules concerning smokeless hospitals are coming into force. The authors believe that doctors and hospitals should lead the way if we are to reduce smoking in the society.