Tobacco cessation and brief advice

Patients who are enrolled on tuberculosis (TB) treatment are often ill and are seeking ways to get better. They are more likely at that time to adopt risk-reducing health behaviours. Interventions that are neither complicated nor time-consuming are available to health service personnel to help patients undertake smoking cessation. Brief advice to patients repeated at various times throughout their TB care can increase cessation rates. All tobacco use needs to be identified and reasons for quitting enunciated. Patients are thus given a framework for considering smoking cessation. If patients then choose not to stop currently, they can be asked to reconsider at a later visit, and also be cautioned to avoid smoking in the presence of others. Smokers who want to stop can discuss strategies for avoiding craving and withdrawal, and pharmacological agents can be recommended if they are available. Because the brief advice is repeated, patients are reinforced either for having stopped or for their progress towards stopping.

The World Health Organization/International Union Against Tuberculosis and Lung Disease Global Project on Surveillance for Anti-Tuberculosis Drug Resistance: a model for other infectious diseases

Tuberculosis remains a global epidemic, with one-third of the population infected and 9 million active cases. Mono- and multidrug resistance in 6 World Health Organization (WHO) regions have been assessed in 40% of the global cases diagnosed by positive results of sputum testing. The 2004 report of the WHO Global Project on Anti-Tuberculosis Drug Resistance Surveillance confirms earlier findings that drug-resistant tuberculosis is ubiquitous and that multidrug-resistant tuberculosis has increased alarmingly. Control of tuberculosis, which is undermined by the human immunodeficiency virus (HIV) epidemic, is seriously jeopardized by multidrug resistant strains, for which treatment is complex, more costly, and less successful. Challenges for high-burden countries include implementation of the DOTS strategy and management of identified multidrug resistance with DOTS-Plus. Strengthening of the laboratory network in conjunction with improvement of surveillance, elucidation of the impact of HIV on transmission of tuberculosis and on amplification of resistance at individual and population levels, and implementation of private sector policies on drug resistance are imperative. New diagnostic tools and drugs are needed to expedite early detection and cure of multiresistant strains.

[The Dutch contribution to worldwide tuberculosis control: Royal Netherlands Association for the Prevention of Tuberculosis (KNCV) Tuberculosis Foundation]

During the 1960s and 1970s tuberculosis was severely neglected in developing countries. Less than 50% of patients diagnosed were cured. However, an international breakthrough occurred in the 1980s with the excellent results from a short-course treatment: 80% cured. This was first achieved in Tanzania. Since 1993, this innovative approach has been known throughout the world as the 'directly observed treatment, short-course' (DOTS) strategy. Over the past 15 years the interest in international tuberculosis control has substantially improved. There has been a strong increase in the number of initiatives to rapidly extend the use of DOTS so that internationally set targets for tuberculosis control can be met (by 2005, 70% of infectious patients detected and 85% of these cured). The highest priority has been given to the 22 countries with the highest incidence of tuberculosis. There has been a significant increase in the number of countries implementing DOTS. The average rate of cure using DOTS is 80%. Since the 1970s the Royal Netherlands Tuberculosis Association (Koninklijke Nederlandse Centrale Vereniging tot Bestrijding der Tuberculose (KNCV)) has been involved in many international initiatives, such as the Stop TB Partnership, and it has participated in the development and implementation of policies for tuberculosis and tuberculosis-HIV control. However, there are still causes for concern: the number of tuberculosis patients is increasing in particular due to the tuberculosis-HIV co-epidemic and it is estimated that only 1 in 4 infectious tuberculosis patients were detected and treated in DOTS programmes during the year 2000.

[Desensitization therapy for allergic reactions of antituberculous drugs--evaluation of desensitization therapy according to the guideline of the Japanese Society for Tuberculosis]

We prospectively evaluated the effectiveness of desensitization therapy for cases showing side-effects to antituberculous drugs (Isoniazid and Rifampicin) according to the guideline proposed by the Treatment Committee of the Japanese Society for Tuberculosis. Nineteen patients (23-88 years old, male 9, female 10) who had experienced adverse effects after receiving antituberculous drugs and underwent desensitization therapy between August 1998 and March 2000 were studied. Underlying diseases were 14 cases of pulmonary tuberculosis, 2 cases of cervical tuberculous lymphadenitis, 1 case of pulmonary atypical mycobacteriosis, 1 case of pulmonary tuberculosis and tuberculous pleuritis, 1 case of pulmonary tuberculosis and tuberculous lymphadenitis. The regimens of treatment for tuberculosis were INH + RFP + EB in 8 cases, INH + RFP + EB + PZA in 7 cases, INH + RFP + SM in 2 cases, INH + RFP + SM + PZA in 1 case, and INH + RFP in 1 case. Adverse reactions were 8 cases of eruption, 7 cases of drug fever, 3 cases of drug fever and eruption, and 1 case of drug fever and cervical lymphadenopathy. The causative drugs suggested from DLST or the clinical course were RFP in 17 cases and INH in 8 cases. The clinical effect of desensitization therapy for these antituberculous drugs was good in 14 out of the 17 cases (82%) for RFP, and in 6 out of 8 cases (75%) for INH. The effectiveness rate of the present desensitization therapy according to the guideline of the Japanese Society for Tuberculosis was almost equal to that of previous desensitization therapy, and the clinical results were almost same in present and previous studies despite the different methods of administration of the antituberculous drugs.

[Changes and patterns of drug resistance of mycobacterium tuberculosis in patients with pulmonary tuberculosis (by data of the microbiological laboratory of research production association "Phthysiology")]

Changes in and patterns of drug resistance of Mycobacterium tuberculosis were analyzed in Yakutia. It was shown that in the past 5 years, there had been no rise in the total resistance; however, its patterns changed: a proportion of polyresistant strains had increased with decreases in monoresistant strains. The rate of Mycobacterium tuberculosis resistance to most antituberculous drugs was found to be growing. The pattern of resistance is varying in different areas of Yakutia.

[Detection of tuberculosis in homeless persons and their sociopsychological characteristics]

Homeless patients with tuberculosis form a special group. Being out of therapeutical-and-prophylactic institutions sight and violating elementary sanitary regulations, they are, from an epidemic standpoint, the most dangerous part of a tuberculosis reservoir. Tuberculosis morbidity rates in the homeless are extremely high and tens times as great as those among other populations. The existing system for detecting tuberculosis among the homeless is not very effective. Much better results are achieved by nongovernmental philanthropic institutions where homeless persons apply to for medical and social aids. About half the homeless patients with tuberculosis were referred to Tuberculosis Hospital 11 of the International Organization "Physicians Without Boundaries". The patient's personality is, in general, the most vivid terms, characterized as asthenic; with low intelligence and constitution; asocial, aggressive, and being a carrier of the motive of acquired helplessness. This group of patients needs not only medical efforts, but sociolegal and sociopsychological rehabilitation. The activities of Tuberculosis Hospital 11 wherein a room of social aid and rehabilitation has been functioning since 1995 may be an example of a comprehensive approach to tackling the problem of homeless patients with tuberculosis.

Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison

The International Union against Tuberculosis and Lung Disease (IUATLD) Bronchial Symptoms Questionnaire (1984) was developed for use in studies of asthma and its reliability measured in an earlier survey in England. The association of the symptoms elicited by this questionnaire to bronchial response to histamine has also been described. This paper presents the results of studies of the questionnaire in four clinical centres in Europe. The reliability of the questionnaire and its ability to predict the bronchial response to histamine were compared for English, Finnish, French and German translations of the questionnaire in samples of diagnosed asthmatics and controls in Nottingham, Berlin, Helsinki and Paris. The answers to questions showed good repeatability, especially in Finland and Germany, particularly those questions on asthma and wheeze. The most sensitive symptom for predicting hyperresponsiveness was the question on wheeze, the most specific questions were those on waking at night with shortness of breath (Paris and Nottingham) and morning tightness (Helsinki and Berlin). This study shows that the IUATLD (1984) questionnaire may provide useful, valid and comparable data even in translation but these studies will need to be repeated in representative samples before such a possibility is accepted as fully demonstrated.

[Health leagues in the canton of Vaud]

The cantonal associations against tuberculosis and lung disease, rheumatism and cardiovascular disease have joined in the "Fédération Vaudoise des Ligues de la Santé". Associations of diabetes, dialysis, mucoviscidosis and M. Bechterew collaborate in the local sections for assistance to patients and their relatives, early diagnosis, prevention and information of the public. Efficiency of the work and contacts with the authorities and the populations could be enhanced by this collaboration which still preserves the dynamism of the individual associations.

[An example of partnership cooperation. Cantonal League against Tuberculosis and Lung Diseases/Association "Das Band"]

Together with the Cantonal League against Tuberculosis and Lung Diseases of Zurich, the Association "Das Band" has organized a first course for parents of children with asthma. The course is a component of the associations new "Prophylaxis Program for Children with Asthma and Their Parents". By exchanging ideas, the parents should become able to reflect their situation, characterized by excessive protectionism, aggressiveness, and guiltiness, and they also should learn to accept the disease as a part of their daily life. The first course, which meanwhile is followed by a second one, provided a first base for the solution of the many problems.

[What role are private organizations going to play tomorrow in the field of health?]

Health care-almost exclusively a private affair in earlier times-is now more and more influenced by public administration. The role of the private organizations and with it the role of the health leagues has changed, but their importance remains. Motivation is stronger among volunteers, and services are more easily adapted to specific needs. Personal-also financial-engagement is a needed basis for many preventive actions, and public interventions should ideally be kept to a necessary minimum. Finally, private organizations are more ready and able to try new approaches and respond to changing needs. Their potential for innovation and flexibility will guarantee the persistence of their action within the Swiss health system, also in a future characterized by increasingly rapid change.

[Proceedings: The cooperation of welfare institutions]

In the light of developments in the Canton of Berne, an account is presented of the expansion of the cantonal antituberculosis leagues, their welfare offices and parent institution, the Swiss Antituberculosis Association. Special attention is drawn to the activities of these organizations in the case of other longterm diseases such as chronic obstructive bronchitis, chronic bronchial asthma and their sequelae, e.g. in the procurement of inhalers and respirators. In conclusion it is stressed that the care of these patients calls for longterm planning which requires close cooperation among everyone concerned. The value of prophylactic measures is particularly emphasized.