Suchergebnisse

Address before the Royal institute of international affairs, London, Jan 17, 1950.

Background: The emergence and spread of DR and MDR-TB threat global TB control. The susceptibility patterns of M. tuberculosis isolates against anti-tuberculosis drugs informs an important aspect of TB controls and surveillance and analysis of local rates of TB drug resistance helps in the detection and monitoring of the extent of DR and MDR strains, indicating the quality of TB control in the country. Methods: A cross sectional study was conducted to find out antibiotic susceptibility pattern of Mycobacterium tuberculosis in pulmonary tuberculosis patients at national tuberculosis center. All the samples were stained by auramine fluorochrome method; processed by NaOH Ogawa Method; primary cultured; subcultured in 2% Ogawa media; cultured in drug LJ media and finally results observed and interpreted. Here Drug susceptibility test was done on M. tuberculosis isolate from each patient by Proportion method as standard protocol. Results: Ethambutol (66.10%) was found to be the most effective anti-TB drug according to the susceptibility test followed by RMP (60.33%), SM (59.66%) and INH (41.69%) against M. tuberculosis. Among 45 isolated untreated patients, primary drug resistance was observed in 20%, to two drugs in 17.77%, to three drugs in 11.11%, to four drugs in 6.66% and primary Multi-drug resistant in 22.22%. Among 250 isolated from previous treated patients, acquired resistance to one drug was found in 23.60%, to two drugs in 12.40%, to three drugs in 16.40%, to four drugs in 18.80% an acquired Multi-drug resistant in 37.20%. Among 250 treated 68.40% (n=171) were relapse,18% ( n=45) were chronic, 7.6% (n=19) were follow-up, 3.2% (n=8) were defaulter, and 2.8% (n=7) were treatment failure. MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and default cases (12.5%). A statistical analysis reveals significant relationship between prior history of treatment and the development of drug resistance. However, no significant relationship between age and sex with the emergence of drug resistance isolates. Conclusion: MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and Default cases (12.5%). Key words: multi drug, relapse, resistant, sensitivity, tuberculosis DOI: 10.3126/jnhrc.v7i1.2277 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 33-41

This paper on preventive programs for mental disease provides 'an orientation to what we know how to do, what we now hope we are doing, and what we are likely to be doing in the next few years.' Primary prevention (reduction in rate of people becoming diseased) includes such problem areas as general paresis and other organic psychoses, emotional deprivation, parent education, counseling, eugenic sterilization, security (financial, etc.), preventive analysis, and leadership and morale building. There are no programs of secondary prevention (reducing duration of extent of unhealthy states) for psychogenic diseases, but 'we can anticipate that such attempts (prevention of relapses) will be made during the coming years.' The prevention of the consequences of advanced disease and problems of disability and rehabilitation are discussed. D. Wolsk.

* Dr. Noble E. Cummings, Chief Sanitary Inspector for Davidson County in the health campaign being conducted by the "United States government," and who has been in immediate charge of territory contiguous to the Powder Plant during the influenza outbreak, says epidemic is over at Edenwold*He says it is conservative to estimate that 50% of population here contracted flu, but that now there are only 4 or 5 cases remaining*EDENWOLD/Powder Plant background: "There are between 500 and 1,000 people now in the "Edenwold community, three-fourths of them being newcomers who have moved in this year to work at the plant."* Captain Dr. R. C. Derivaux, USPHS surgeon who was put in charge of the campaign against influenza in Davidson County and Tennessee in general, instructed Cummings and his assistants to suspend all sanitary work and instead care for flu victims*Cummings stresses that those convalescing from flu should be completely well before they begin working again; otherwise, relapse ; Newspaper article ; 2

SummaryOld Patrons and NewIn societies where patronage occurs it is found in all social strata; it does not disappear with the suppression of rural poverty. This article deals with the various ways in which patronage may manifest itself during and after the execution of local development projects. It is argued that the agency which executes the project will itself often be assigned the role of patron; that the disruption of traditional local power relationships may lead to new political alliances at the regional and national level; and that, even if patronage is suppressed locally, the institution will continue to exist in the wider society. Recourse to it will therefore remain unavoidable if the community wants to obtain new facilities which it cannot pay for itself. For this reason it is held that the agency which executes the project should not withdraw after the completion of the work but should remain and continue to play the role of patron to the community. In this way, two goals may be accomplished: 1) a local relapse into the old social structure (i.e. the emergence of a new local boss) can be prevented, and 2) allowance is made for the fact that at the regional and national level patronage still discharges important functions.

A survey of recidivism leads to the conclusion that 'approximately 3/4 of those committed to jails and workhouses have been previously committed.' This raises questions about the reformative success of prisons. Also, all such studies show considerable % who did not recidivate. No one knows whether this is due to prison training or in spite of it, but the fact that 20-40% of offenders do not repeat indicates something is effective in altering conduct. Especially is this the case when we note that a negative selective process filters out the more desirable risks, leaving the higher risks for the prison to work with. The high, degree of failure is related to the composition of the prison pop. There are 3 pop. segments: (1) The psychologically disturbed. Many such persons are treated in mental hospitals and their relapse rate is high there. The same is true when they are released from prisons. (2) The unskilled and uneducated person, otherwise 'normal,' who needs sufficient skill to earn a living. Frustration and defeat are the re - lease experience of these persons. Recidivism is a likely result. (3) The psychologically 'normal' person who identifies with an antisocial way of life is an equally low risk. They wait only to get out and resume their customary way of life. Recidivism is a high probability here. H. M. Trice.

Treating Drug Problems -- Copyright -- Preface -- Contents -- Contents of Volume 2 -- Summary -- QUESTIONS THE REPORT ANSWERS AND THOSE IT LEAVES UNRESOLVED (CHAPTER 1) -- IDEAS GOVERNING DRUG TREATMENT POLICY (CHAPTER 2) -- DRUG PROBLEMS AND THE NEED FOR DRUG TREATMENT (CHAPTER 3) -- Patterns of Drug Consumption -- Dependence -- Recovery and Relapse -- Determining the Need for Treatment -- Estimating the Aggregate Need for Treatment -- THE GOALS OF DRUG TREATMENT (CHAPTER 4) -- Motivations for Treatment -- Treatment and Criminal Justice -- EFFECTIVENESS OF TREATMENT (CHAPTER 5) -- Methadone Maintenance -- Therapeutic Communities -- Outpatient Nonmethadone Programs -- Chemical Dependency Programs -- Detoxification -- Variations in Effectiveness of Programs within Modalities -- Treatment in Prisons -- Costs and Benefits of Treatment -- Comparison of Data on Effectiveness and Expenditures for the Major Treatment Modalities -- Needs and Priorities for Research on Treatment Services and Methods -- THE TWO-TIERED STRUCTURE OF THE TREATMENT SYSTEM (CHAPTER 6) -- PUBLIC FINANCING OF DRUG TREATMENT (CHAPTER 7) -- The Goals and Priorities of Public Coverage -- Federal and State Roles -- Mechanism for Providing Public Support -- Utilization Management -- PRIVATE COVERAGE OF DRUG TREATMENT (CHAPTER 8) -- Extent, Costs, and Trends of Coverage -- Mandating Drug Treatment Coverage -- Optimal Coverage Provisions -- CODA -- 1 Introduction -- THE LOGIC OF THE REPORT -- ADDITIONAL POLICY QUESTIONS -- Treating Adolescents and Women with Children -- The Criminal Justice System -- The Socioeconomic Environment -- 2 Ideas Governing Drug Policy -- THE CHARACTER OF GOVERNING IDEAS -- THE SPECTRUM OF IDEAS ABOUT DRUGS -- Libertarian Ideas -- Medical and Criminal Ideas -- The Classic Era of Narcotics Control -- THE RISE OF MODERN TREATMENT.

• All parts of the state, apart from the far western section, show marked improvement. • The death rate in Boston did not fall off considerably but there was a decrease in the number of new cases, giving medical authorities hope that epidemic will soon be under control. Authorities expect a decrease in deaths each day in the future. • Statewide: 4569 cases and 223 deaths• Numbers given for new cases are inaccurate because the majority of "new" cases have worsened over a period of several days. • Suggested that theatres might re-open on Monday. Dr. Woodward says the ban probably won't be lifted until Oct. 21, unless there's an extraordinary improvement• Woodward: "While 100 or more persons are dying each day from the disease, it would be extreme folly to countenance any public gatherings. We are able to combat the scourge because we have lessened the danger of contagion and until conditions are nearer normal it is not expected that theatres or other public places should open."• All public schools expected to stay closed until Oct. 21. Some private schools, according to reports, are considering re-opening Monday. Private schools are asked to remain closed until Oct. 21.• Political candidates are discouraged from holding meetings during the next week. Endicott, chairman of emergency health committee, suggests that it would look bad for candidates to hold meetings when other public places are closed. • Football games scheduled for today have been postponed (in most cases). Games are considered by authorities to be "unnecessary gatherings."• Health officials warn against recovering patients returning to their usual activities too soon. Many "new" cases are in fact relapses brought on by too much, too soon in the recovery process. In almost all cases, the second attack results in pneumonia. ; Newspaper article ; 1, 9

• "Health authorities announced yesterday that the crest of the epidemic had not yet been reached, and that the utmost vigilance must be observed to stamp out the disease."• 36 deaths reported to Health Dept., two weeks ending last night = 183• 455 new cases reported to clerk of the contagious disease dept., Edward Ackerman; Health Officer Craven said that, "it is…evident that many of the cases developed yesterday."• Total cases = 1,968• One physician reported 137 cases (!)• Health Officer Craven: "There must be no relaxation of public vigilance, and the public must cooperate with the Health Dept. by complying with its requests and suggestions."• 55 admitted to GH yesterday, 10 deaths, 12 discharged• Pneumonia increasing at GH• Superintendent List – 115/447 cases at GH have pneumonia, "several…critical"• 31 patients at County Infirmary• 2 cases at Univ. Cincinnati; Adjunct Smith – 1 new case, 1 relapse• 1 soldier student death, total number of soldiers at GH = 46• Health Officer Craven indicated "more drastic measures to check the spread of the disease will be taken by the Health Dept. unless its requests are complied with voluntarily."• He said also that if there were more violations of the order against saloons, that they would be closed today.• Craven met with Safety Director Holmes about complaints against saloonkeepers, "who, it is alleged, have disregarded the order." • Police have been told to "redouble their vigilance" regarding this matter.• Complaints also made against social gatherings.• Dr. Craven requested that barbers and elevator operators wear masks, but it was taken as an order, and Craven said later that it had been just a request.• Dr. Craven: "We are trying to avoid class legislation"• "Several" barber shop proprietors followed the request, Health Dept. gave them masks. Elevator operators downtown were wearing them as well, esp. in hotels.• Dr. Crave recommended that workers take their dinner in a pail, lessening the number of people in restaurants at lunch hour.• Councilman A. I. Murdock tried to make it, via Council Committee on Health, illegal for people with "any communicable disease" to be admitted by theaters. This was rejected.• Councilman Francis M. Hoover said that "it placed too great a burden on the theatrical managers and their employees." Those who are "offending patrons" should receive a punishment (?)• Health Officer Craven "commended the purpose of the ordinance," but also felt that it was too much work for theater proprietors to have to judge how healthy patrons were. He felt that this matter should be given to the Board of Health, and this was adopted.• Councilman Murdock and John S. Sheehan made complaints about street cars being too crowded, but nothing was yet done.• After Culkins' presentation, Murdock said his complaint was general because "the congested conditions in street cars were general." Murdock said the cars are "always crowded." He said things should be better during the epidemic.• Murdock wrote a letter to the Board of Health, requesting the order about public places be extended to streetcars.• Culkins said that the Cincinnati Traction Company did not have enough men to run the cars. ; Newspaper article ; 14