| ObjectiveIn order to understand the epidemiological characters of pulmonary tuberculosis, to analyze the treatment of tuberculosis Patients and affecting factors, to analyze the effect of various factors in the treatment of tuberculosis patients in Jing'an of Shanghai. So that we can provide a scientific basis to develop practical tuberculosis controlling measures in Jing'an District Shanghai, as well as to provide some policy and advice.Methods(1) Data collection methods:conventional reports, monitoring data, medical history, questionnaire survey, group interviews and other methods to collect information.(2) Data analysis methods:SPSS 13.0 and EXCEL2003 and SAS statistical software were used in quantitative data descriptive study, univariate and multivariate analysis study. Qualitative data summarized by the stepwise method of classification analysis.Results1. Epidemiological characters of tuberculosis in Jing'an District, Shanghai(1) The incidence of tuberculosis were (/10 million) 28.22.29.63.30.83, 28.76,26.64,26.69,23.95,27.11,23.57和24.84, respectively from 1999 to 2008 in Jing'an District. Generally it showed a gradual downward trend. The incidence of tuberculosis of the every street showed slow decline in10 years. The proportion of the patients in old age group was higher than other age groups; The proportion of the patients in males was obviously higher than that of females; The proportion of the patients from retirements was the highest, followed is by the unemployed population and workers.(2)In 55 patients died of tuberculosis patients, male to female ratio was 6.9:1, means age was 73.0±12.9 years.35 patients were untreated patients,20 patients were retreated. There were 83.6% of them over 60 years.49% of patients die directly from tuberculosis.51% of patients died of other complications, Followed by chronic bronchitis, emphysema, lung cancer, heart failure, cerebro-vascular disease, etc.(3) In all hospitals, the most patients suspected tuberculosis and the proportion of patients with tuberculosis were reported by the general hospitals.the proportion of tuberculosis patients diagnosed by designated hospitals showed a significant downward trend in 10 years. More than half of patients (57.14%) diagnosed by other designated hospitals do not trust doctors and medicine or be not handled with side effects and complications by designated hospital in Jing'an District.2. Analysis on the treatment of tuberculosis patients and affecting factors in Jing An District Shanghai(1) The total cure rate was 88.3%.Univariate analysis showed that the following nine variables correlated to the efficacy of treatment:sex, age, occupation, retreatment, complication, lung lesions range, noncompliance anti-tuberculosis drugs, sputum smear and side effects.(2)In multivariate analysis, it was confirmed that sex, retreatment, lung lesions range, noncompliance anti-tuberculosis drugs and complications were significantly associated with treated outcomes.(3) The every factor score had significance difference with tuberculosis patient in the different sex, educational level, marital status and different treated outcomes, There were significance difference in the total score and objective support between in Sputum smear-positive and smear- negative. There is significant difference in the degree of support utilizing between in younger and elder.3. Qualitative Study on the effects of control and Influencing factors for pulmonary tuberculosis in Jing'an District.The economic conditions, educational level, cognitive knowledge of TB are associated with treatment. The management of smear positive pulmonary tuberculosis patients is one of the key issues in the prevention and treatment. The medical conditions of the designated hospitals for treatment of TB are limited.Conclusion:(1) TB control efforts still can not be relaxed and emphasis be put on the control of tuberculosis in the elderly and the unemployed population.(2) Sex, retreatment, lung lesions range, noncompliance anti-tuberculosis drugs and complications are important factors which influence the treated outcomes. Reasonable treatment regimen should be used for those patients. We need to strengthen the supervisory management on the patient, to improve the treatment compliance and reduce the recurrence to improve chemotherapy efficacy.(3) The degree of social support has an important impact on pulmonary tuberculosis patients treatment, and good social support helps patients take an active approach to deal with.(4) In order to improve the effects on the control of TB, the government should strengthen training, funding and management.Suggestions:(1)The tuberculosis control should be administrated by the government, using multiple social measures;(2) Our tuberculosis hospital should be fully improved.(3) The prevention and treatment of senile pulmonary tuberculosis should be strengthened.(4) Play the role of doctors fully in the supervision and management to improve Patients'compliance and ensure the completion of treatment.(5) The TB health education should be strengthened.(6) The professional training of doctors should be strengthened.(7)A effective system of medical care insurance for the poverty population should be established.(8) The medical protection and supervision incentives of management of doctors should be improved. |
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