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1.
PLoS One ; 15(1): e0226307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895932

RESUMO

BACKGROUND: Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. METHODS: A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. RESULTS: Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers. CONCLUSION: Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.


Assuntos
Instalações de Saúde/provisão & distribução , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/provisão & distribução , Aceitação pelo Paciente de Cuidados de Saúde , Tuberculose/diagnóstico , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/fisiologia , Pesquisa Qualitativa , Tuberculose/epidemiologia , Tuberculose/microbiologia , Adulto Jovem
2.
PLoS One ; 14(11): e0224277, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721767

RESUMO

BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a major health security threat worldwide. The effectiveness of implementation of DR-TB control strategies has been a subject of research and controversy. In resource-limited settings, using conventional medicine as the only framework to explain DR-TB gives a rather incomplete picture of the disease. This study intended to explore the perceptions and experiences of healthcare workers on the management and control of DR-TB in Addis Ababa, Ethiopia. METHODS: The study employed a qualitative methodology with an inductive approach and a thematic analysis. It involved in-depth interviews with healthcare workers providing clinical services to DR-TB patients in 10 public healthcare facilities in Addis Ababa, Ethiopia. RESULTS: A total of 18 healthcare workers participated until data saturation, which included 12 clinical nurses, four health officers and two medical laboratory technicians. The findings show that healthcare workers perceive DR-TB as a growing public health threat in Ethiopia, due to factors such as poverty, poor nutrition, crowded settings, healthcare worker and general public awareness of DR-TB, lack of good governance and culture. CONCLUSION: The perspectives drawn from the healthcare workers shed more light on the image of DR-TB in a developing country context. It has been shown that understanding DR-TB is not confined to what can be drawn from the sphere of biomedicine. There are also interconnected barriers, which predict a dystopia in the epidemiology of DR-TB. Bringing DR-TB under control requires taking a step back from an overwhelming focus on the biomedical facets of the disease, and employ critical thinking on the wider social and structural forces as equally important targets.

3.
Clin Infect Dis ; 69(Supplement_5): S385-S387, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612937

RESUMO

BACKGROUND: In the decades following the discovery of the bacillus causing typhoid, in 1880, understanding of the disease formerly known as enteric fever was transformed, offering new possibilities for prevention. Gradually, measures that aimed to prevent infection from human carriers were developed, as were inoculations designed to confer immunity against typhoid and paratyphoid fevers. These were initially introduced in European armies that were regularly ravaged by typhoid, especially garrisons stationed in the colonies. This article reviews the research undertaken in the armed forces and the measures that they implemented in the years up to and during the First World War. METHODS: The article is based on an analytical review of scientific literature from the early 19th century, focusing on the United Kingdom, Germany, and France. RESULTS: The armies of the United Kingdom, Germany, and France undertook important work on the transmission of typhoid in the years between 1890 and 1918. Many preventive measures were introduced to deal with the spread of typhoid but these varied between the 3 countries, depending largely on their political traditions. Inoculation was particularly successful in preventing typhoid and greatly reduced the number of casualties from this disease during the First World War. Despite this, it proved difficult to prevent paratyphoid infection, and debates continued over which vaccines to use and whether or not immunization should be voluntary. CONCLUSIONS: By the end of the First World War, the value of inoculation in preventing the spread of typhoid had been proven. Its successful implementation demonstrates the importance of vaccination as a public health intervention during times of conflict and social upheaval.

4.
J Hist Med Allied Sci ; 74(3): 316-343, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31216019

RESUMO

Tanzania's national tuberculosis control program, created in 1977, is credited with having been the main inspiration for the World Health Organization's Directly Observed Treatment, Short-Course (DOTS) strategy for the control of tuberculosis, which was implemented from 1994. The text focuses on what previously took place in Tanzanian tuberculosis control between 1977 and the early 1990s. What was it that the International Union against Tuberculosis and Lung Disease, which was central in the effort, assisted in creating? In what sense was the program innovative? How could a country whose health system was destroyed by a deepening economic crisis in the 1980s become a lighthouse of tuberculosis control? How much consideration was given to the rise of HIV/AIDS that occurred in parallel? The paper proposes answers to these questions, and suggests that we should see the creation of the Tanzanian program as a laboratory of nascent global health.


Assuntos
Saúde Global/história , Programas Nacionais de Saúde/história , Sociedades Médicas/história , Tuberculose/história , História do Século XX , Tanzânia , Tuberculose/prevenção & controle , Organização Mundial da Saúde
5.
Hist Philos Life Sci ; 40(1): 8, 2017 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-29181597

RESUMO

Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease-previously a matter of mostly theoretical interest-came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards.


Assuntos
Antibacterianos/uso terapêutico , Medicina Clínica/história , Infecção Hospitalar/história , Hospitais/história , Higiene/história , Antibacterianos/história , Infecção Hospitalar/tratamento farmacológico , História do Século XX , Humanos , Fatores de Risco
8.
Med Hist ; 60(2): 155-80, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26971595

RESUMO

This paper analyses how research on antibiotic resistance has been a driving force in the development of new antibiotics. Drug resistance, while being a problem for physicians and patients, offers attractive perspectives for those who research and develop new medicines. It imposes limits on the usability of older medicines and simultaneously modifies pathologies in a way that opens markets for new treatments. Studying resistance can thus be an important part of developing and marketing antibiotics. The chosen example is that of the German pharmaceutical company Bayer. Before World War Two, Bayer had pioneered the development of anti-infective chemotherapy, sulpha drugs in particular, but had missed the boat when it came to fungal antibiotics. Exacerbated by the effects of war, Bayer's world market presence, which had been considerable prior to the war, had plummeted. In this critical situation, the company opted for a development strategy that tried to capitalise on the problems created by the use of first-generation antibiotics. Part and parcel of this strategy was monitoring what can be called the structural change of infectious disease. In practice, this meant to focus on pathologies resulting from resistance and hospital infections. In addition, Bayer also focused on lifestyle pathologies such as athlete's foot. This paper will follow drug development and marketing at Bayer from 1945 to about 1980. In this period, Bayer managed to regain some of its previous standing in markets but could not escape from the overall crisis of anti-infective drug development from the 1970s on.


Assuntos
Anti-Infecciosos/história , Descoberta de Drogas/história , Indústria Farmacêutica/história , Resistência Microbiana a Medicamentos , Antibacterianos/história , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/história , Pesquisa Biomédica/história , Clotrimazol/história , Alemanha , História do Século XX , Humanos , Marketing/história , Micoses/tratamento farmacológico , Micoses/história , Estreptomicina/história
9.
J Law Med Ethics ; 43 Suppl 3: 27-32, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26243240

RESUMO

Antibiotic development and usage, and antibiotic resistance in particular, are today considered global concerns, simultaneously mandating local and global perspectives and actions. Yet such global considerations have not always been part of antibiotic policy formation, and those who attempt to formulate a globally coordinated response to antibiotic resistance will need to confront a history of heterogeneous, often uncoordinated, and at times conflicting reform efforts, whose legacies remain apparent today. Historical analysis permits us to highlight such entrenched trends and processes, helping to frame contemporary efforts to improve access, conservation and innovation.


Assuntos
Resistência Microbiana a Medicamentos , Cooperação Internacional , Formulação de Políticas , Saúde Global , Política de Saúde , Humanos
10.
Microbes Infect ; 16(11): 885-92, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25193030

RESUMO

This article explores one of a citation classics in medical literature-Koch's postulates. It analyses their creation in the nineteenth century and their popularity in the twentieth century. As a genre of historiography, references to the postulates are anecdotes. In referring to a historical event that never happened, such references serve to remind their audiences of a tradition of experimental medicine that supposedly originated with Robert Koch.


Assuntos
Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Microbiologia/normas , Pesquisa Biomédica/história , História do Século XIX , História do Século XX , Humanos , Microbiologia/história
12.
Tidsskr Nor Laegeforen ; 134(7): 732-5, 2014 Apr 08.
Artigo em Norueguês | MEDLINE | ID: mdl-24721865

RESUMO

Diphteria played a key role in establishing the bacteriological model for explaining infectious disease. This understanding of bacteriological factors spurred research that culminated in the development of diphteria antitoxin, the first effective therapeutic cure for an epidemiological disease. Prior to the introduction of antitoxin, isolation and disinfection were regarded as the key defences against diphteria. The opportunity to combine antitoxin therapy with existing methods for combatting the disease was a key factor for the rapid spread of the antitoxin. Diphteria antitoxin was first used in Romsdal county in 1895. Initially the serum had to be ordered from manufacturers abroad, which restricted its application in the district. Few available doctors and long transport routes were reasons that prevented the antitoxin from reaching its full potential. Industrial manufacturing methods were an obstacle to serum production in peripheral areas. In Norway, production of serum gradually got underway in Kristiania, which was one factor that caused mortality from diphteria to decline faster there than in other parts of the country. In this article we will elucidate the relationship between the centre and the periphery in the spread of medical advances by studying the implementation of diphteria antitoxin in Romsdal county.


Assuntos
Antitoxina Diftérica/história , Difteria/história , Disparidades em Assistência à Saúde/história , Fatores Imunológicos/história , Difteria/tratamento farmacológico , Difteria/epidemiologia , Difteria/prevenção & controle , Antitoxina Diftérica/uso terapêutico , História do Século XIX , História do Século XX , Humanos , Fatores Imunológicos/provisão & distribução , Área Carente de Assistência Médica , Noruega/epidemiologia
14.
Dynamis ; 31(2): 305-21, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22332461

RESUMO

It was in the 1940s that antibiotic resistance arose as an object of study for clinical medicine. Somewhat earlier it had become an important analytical tool for bacterial geneticists. However, the concept of antibiotic resistance as an induced and inheritable trait of microbial species was introduced a generation earlier in the years preceding the First World War. The paper reconstructs the concept that was put forward by the German immunologist Paul Ehrlich in 1907. He came across the phenomenon when trying to develop chemotherapies for trypanosomiasis, the best known of which is African sleeping sickness. However, resistance was studied by him for other than therapy-related purposes. It provided a productive laboratory model for the study of cell functions. Induced resistance to chemicals facilitated the development of ideas on the relation of a parasite's cellular metabolism and of drug action, i.e. by providing a negative proof for the existence of chemoreceptors on the surfaces of parasite cells. This approach does also serve to explain why British and German researchers continued to study the phenomenon of induced resistance in microbes for decades -despite it being absent from clinical medicine. After all, there existed very few chemotherapies of infectious diseases prior to the arrival of the sulfa drugs. Moreover, resistance to such medicines was rarely observed. However, being part and parcel of Ehrlich's theories, his views on resistance were also criticised together with these. It was in particular Henry Dale who would challenge Ehrlich's views of resistance being an inheritable and stable trait of microbes. Instead he insisted that understanding this "wholly mysterious phenomenon" required taking into account some host interaction. Induced resistance, which had come into being as a chance discovery on the chemotherapy of sleeping sickness, thus became one of the more important laboratory models of twentieth-century immunological research. Its early history is largely discontinuous with later work, and antimicrobial resistance as it evolved from 1900 to 1940 followed other trajectories than those which became relevant after 1940.


Assuntos
Antibacterianos/história , Pesquisa Biomédica/história , Resistência Microbiana a Medicamentos , Tratamento Farmacológico/história , História do Século XX
16.
Stud Hist Philos Biol Biomed Sci ; 41(3): 232-40, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20934644

RESUMO

This paper reassesses Robert Koch's work on tropical infections of humans and cattle as being inspired by an underlying interest in epidemiology. Such an interest was developed from the early 1890s when it became clear that an exclusive focus on pathogens was insufficient as an approach to explain the genesis and dynamics of epidemics. Koch, who had failed to do so before, now highlighted differences between infection and disease and described the role of various sub-clinical states of disease in the propagation and--consequently--in the control of epidemics. Studying pathologies of men and cattle in tropical countries eventually facilitated the application of such measures in Europe through the screening of healthy carriers of typhoid, which was carried out in 1902. The concept of the carrier state can be understood as a spin-off from tropical medicine into the study and control of infectious disease in Europe. With it travelled assumptions that were typical for colonial and veterinary medicine where the health of indigenous individuals or cattle would be a secondary objective compared to the control of diseases in populations.


Assuntos
Portador Sadio , Doenças Transmissíveis/história , Epidemias/história , Epidemiologia/história , Medicina Tropical/história , Animais , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/veterinária , Europa (Continente) , Alemanha , História do Século XIX , História do Século XX , Humanos , Programas de Rastreamento , Febre Tifoide/epidemiologia , Febre Tifoide/história
17.
Sci Context ; 21(2): 145-60, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18831134

RESUMO

This essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, and clinicians. It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called "bacteriological medicine," tuberculin, in 1890.


Assuntos
Antitoxina Diftérica/história , Vacinas/história , Difteria/história , Difteria/terapia , Antitoxina Diftérica/uso terapêutico , França , Alemanha , História do Século XIX , Experimentação Humana/história , Humanos , Vacinas/uso terapêutico
18.
Medizinhist J ; 43(2): 121-48, 2008.
Artigo em Alemão | MEDLINE | ID: mdl-18839931

RESUMO

This paper analyses the historical origins and the popularity of 'Koch's Postulates'. In 1884 Friedrich Löffler wrote down the well-known three steps of isolation, cultivation and inoculation as conditions for establishing the existence of a pathogen. These postulates are frequently invoked in textbooks of medical history. Yet they seem to have had little relevance in medical research. Their assumed inventor, Robert Koch, produced numerous variations in his own methodology. However, underlying his work was a sort of trivial ontology of diseases which rendered an experimental reconstruction of human pathologies in animal models practical and meaningful. There were many ways to pursue this end. Koch usually limited his discussion to practical questions related to the course that investigations had to take, while matters of principle were only treated implicitly in his writings. Löffler's achievement was to popularise Koch's views in his postulates. Given that, it is not surprising that the countless references to Koch's postulates which one finds in the 20th century usually refer to the spirit rather than the literal meaning of the postulates. For example, proponents of virology or molecular medicine devise variations of Koch's postulates that serve to relate their own work to Koch's bacteriology. The latter is perceived as the origin of modern experimental medicine. The nature of such references is less historical than anecdotal: referring to a historical object that did not exist as such, these references produce ex traditione credentials for experimental medicine.


Assuntos
Infecções Bacterianas/história , Técnicas Bacteriológicas/história , Bacteriologia/história , Animais , Alemanha , História do Século XIX , História do Século XX , Humanos
19.
Microbes Infect ; 8(1): 294-301, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16126424

RESUMO

The German medical bacteriologist Robert Koch is commonly considered one of the founding fathers of medical bacteriology. His investigations into the aetiology of tuberculosis uncovered the pathogen of this condition, the tubercle bacillus today known as Mycobacterium tuberculosis, in 1882. This work can be seen as a cornerstone of contemporary medical bacteriology, its technologies and methods. It has often been asked how such successful research connected to the tuberculin episode of 1890/91, when Koch produced a medicine for that disease, which spectacularly failed when applied in practice. The analysis concentrates on the path of mostly experimental investigations which Koch followed between 1882 and 1890. From Koch's laboratory notes it becomes clear that tuberculin therapy did in fact work in Koch's laboratory, even though it failed to do so almost anywhere else. The clue to this contradictory picture lies in the peculiar nature of Koch's understanding of tuberculosis as a disease e.g. his reliance an animal experiments, which essentially differed from what many of his contemporaries held as essentials of that condition.


Assuntos
Antituberculosos/história , Tuberculina/história , Tuberculose/história , Tuberculose/microbiologia , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , História do Século XIX , História do Século XX , Mycobacterium tuberculosis , Tuberculina/farmacologia , Tuberculina/uso terapêutico , Tuberculose/tratamento farmacológico
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