论文部分内容阅读
背景:在印度Kerala邦Pathanamthitta地区,1994年10月开始实行直接面视下的短程化疗(DOTS)。目的:确定在一个地区级的DOTS计划中实际采用直接面视的频率,以及在该计划条件下面视治疗与治疗结果之间的关系。设计:该回顾性研究的对象包括计划中1995年2月～1996年2月在地区结核病中心登记的200个新发持续涂阳病人,以及接受单独和秘密访谈的负责提供DOT的卫生工作人员。根据痰涂片抗酸染色检查的结果来确定治疗结果。结果:虽然所有的病人都登记为接受了DOT,但实际上有超过1/4的病人(26.5％)没有得到。与那些接受了DOT的病人相比,53位未得到直接面视的病人更易出现治疗失败和病情复发(45％:3％,相关危险度16.6,95％可信限为6-46,P<0.001)。女性在某种程度上比男性更少得到DOT(61％:76％,P=0.06)。未得到DOT的病人中86％(24/28) 出现治疗失败和复发。结论:未得到直接面视治疗的病人比得到直接面视治疗的病人具有潜在的出现相反结果的高风险。DOT计划的执行必须秘密并且方便才能发挥其最大效果。
Background: In October 1994, direct-view short-range chemotherapy (DOTS) was started in Pathanamthitta, Kerala, India. Purpose: To determine the actual direct face-to-face frequency of a DOTS program at a district level and to determine the relationship between treatment and treatment outcomes under this program condition. Design: This retrospective study included 200 new persistent smear-positive patients enrolled in regional TB centers from February 1995 to February 1996, as planned, and health workers in charge of providing DOTs, individually and in secret. According to sputum smear acid-fast staining test results to determine the treatment. Results: Although all patients were enrolled in DOTs, in fact more than a quarter of patients (26.5%) did not. Fifty-three patients who did not receive direct visual presentation were more likely to have failed treatment and relapse than those who received DOT (45% vs 3%, hazard ratio 16.6, 95% confidence limit 6-46, P < 0.001). Women were somewhat less likely to get DOT than men (61%: 76%, P = 0.06). 86% (24/28) of patients who did not receive DOT experienced treatment failure and relapse. CONCLUSIONS: Patients who did not receive direct face-lift treatment had a higher risk of potentially adverse results than those who received direct face-lift treatment. DOT plans must be executed confidentially and conveniently to their best effect.