Rifampicin plus isoniazid for the prevention of tuberculosis in an immigrant population.

OBJECTIVES: To compare the tolerance, adherence and effectiveness of two approaches for the treatment of latent tuberculosis infection (LTBI): 6 months of isoniazid (6H) vs. 3 months of isoniazid plus rifampicin (3RH). POPULATION: Immigrants with LTBI. METHODS: Participants were enrolled in a controlled, randomised clinical trial in Barcelona, Spain, from April 2001 to April 2005. Monthly follow-up was done to assess tolerance, side effects and adherence. Effectiveness was evaluated at 5 years. RESULTS: In the 590 subjects enrolled, the rate of adherence was greater in the 3RH than in the 6H arm (72% vs. 52.4%, P = 0.001). No differences between study arms were observed with respect to hepatotoxicity or side effects. Variables associated with non-adherence were diagnosis by screening (OR 1.88, 95%CI 1.26-2.82, P = 0.001), illegal immigration status (OR 1.48, 95%CI 1.01-2.15, P = 0.03), unemployment (OR 1.91, 95%CI 1.28-2.85, P = 0.0008), illiteracy (OR 1.73, 95%CI 1.04-2.88, P = 0.02), lack of family support (OR 3.7, 95%CI 2.54-5.4, P = 0.001) and the 6-month treatment regimen (OR 2.45, 95%CI 1.68-3.57, P = 0.0001). None of the patients who completed either treatment developed tuberculosis. CONCLUSIONS: The 3RH regimen facilitates adherence to LTBI treatment and offers a safe, well-tolerated and effective alternative.

[Control and elimination of tuberculosis in Spain: recommendations for the twenty-first century]. / Control y eliminación de la tuberculosis en España: las estrategias para el siglo XXI.

OBJECTIVE: The objective of tuberculosis (TBC) control is to eradicate the disease by interrupting transmission of Mycobacterium tuberculosis. The WHO's strategy to achieve global control of this disease is known as directly observed treatment, short-course (DOTS). The goals are to detect 70% of cases of bacilliferous TBC and to successfully treat 85% of these cases in order to reduce the number of sources of infection. Analysis of the epidemiology of TBC in Spain has revealed an incidence of > 20 cases per 100,000 inhabitants. METHODS: The strategies that should be applied are those for disease control: to improve case detection and treatment of cases with surveillance of cure (especially in contagious cases), to identify, investigate and treat individuals exposed to contagious persons, and to control epidemic outbreaks of TBC. Treatment of infected individuals is an elimination strategy and should be reserved for groups at high risk of developing the disease.

Prevención y control del tabaquismo: un reto para las unidades de pediatría / Prevention and control of smoking: a challenge for the pediatric units

El tabaquismo puede considerarse una enfermedad pediátrica puesto que en el 90% de los casos la forma activa del consumo se inicia en la infancia y adolescencia. La exposición del niño al humo del tabaco ambiental se produce ya en muchos casos desde los primeros días dela vida del niño. Sus consecuencias inmediatas y a largo plazo han sido demostradas en numerosos estudios. El pediatra y la enfermería pediátrica tienen un papel importante en la prevención y control del tabaquismo. El objetivo de este estudio es identificar las funciones que pueden desempeñar las unidades pediátricas, proponer estrategias para conseguir que nuestros niños respiren un aire libre del humo de tabaco y que los adolescentes se vean libres de esta adicción (AU)

Smoking has been termed a paediatric disease because 90% of cases begin in infancy and adolescence. Exposure of children to environmental smoke in most cases can occurs from the first days of children’s live. Their immediate and in the long term consequences had been showed in a lot of studies. The pediatrician and the pediatric nurse can play an important role in smoking prevention and control. The objective of this study is to identify the duties can play paediatric unities, to propose strategies to get our children breathe the air smoke free and the adolescents can be free of this addiction (AU)

Control y eliminación de la tuberculosis en España: las estrategias para el siglo XXI / Control and elimination of tuberculosis in Spain: recommendations for the twenty-first century

Objetivo El objetivo del control de la tuberculosis (TBC) es conseguir la eliminación de esta enfermedad interrumpiendo la transmisión de la infección por Mycobacterium tuberculosis. La estrategia establecida por la Organización Mundial de la Salud (OMS) para conseguir el control de la enfermedad es la denominada estrategia TODS (tratamiento observado directamente de corta duración). Los objetivos son conseguir el diagnóstico del 70 % de los enfermos con TBC bacilífera y su curación al menos en el 80 %, para disminuir el número de fuentes de infección. En el análisis de la situación epidemiológica de España se estima una incidencia de casos superior a 20 por 100.000. Métodos Las estrategias son las de control de la enfermedad: diagnóstico precoz y tratamiento de los enfermos vigilando su curación (especialmente en los que contagian); identificar, investigar y tratar a las personas expuestas a un enfermo con TBC contagiosa y controlar los brotes epidémicos de TBC. El tratamiento de los infectados es fundamentalmente una estrategia para la eliminación de la TBC y debe reservarse para los grupos con alto riesgo de desarrollar la enfermedad

Objective The objective of tuberculosis (TBC) control is to eradicate the disease by interrupting transmission of Mycobacterium tuberculosis. The WHO's strategy to achieve global control of this disease is known as directly observed treatment, short-course (DOTS). The goals are to detect 70 % of cases of bacilliferous TBC and to successfully treat 85 % of these cases in order to reduce the number of sources of infection. Analysis of the epidemiology of TBC in Spain has revealed an incidence of > 20 cases per 100,000 inhabitants. Methods The strategies that should be applied are those for disease control: to improve case detection and treatment of cases with surveillance of cure (especially in contagious cases), to identify, investigate and treat individuals exposed to contagious persons, and to control epidemic outbreaks of TBC. Treatment of infected individuals is an elimination strategy and should be reserved for groups at high risk of developing the disease

Los niños, la industria tabaquera y las recientes normativas nacionales e internacionales / No disponible

No disponible

Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13,038 cases.

SETTING AND OBJECTIVE: Smoking habit and tuberculosis (TB) appear to have common epidemiological and clinical links. The present study was to evaluate risk factors in TB patients with and without a smoking habit. DESIGN: A cross-sectional observational study of cases (TB with smoking) and controls (TB without smoking) from the same registry. Data were retrieved from case notes and interviews of patients registered in the Tuberculosis Control Programme in Cataluuña, Spain, between 1 January 1996 and 31 December 2002. Statistical analyses included univariate and stepwise multiple logistic regression analyses. RESULTS: There were 13,038 recorded patients. Social factors associated with TB in smokers were male sex (adjusted odds ratio [aOR] 2.2), age <64 years, alcohol use >30 g/day (aOR 7.4) and intravenous drug use (aOR 1.5). Smokers developed more pulmonary disease (aOR 1.5) and more cavitary lesions (aOR 1.9), and were more likely to require hospitalisation (aOR 1.8) which was more protracted. Differences in mortality and delay in diagnosis did not reach statistical significance. CONCLUSIONS: Smoking leads to faster and more severe progression of TB. The cost of TB-related hospitalisation for smokers increases by approximately one million euros per year.

[Active tuberculosis case finding among immigrants in Barcelona]. / Búsqueda activa de tuberculosis en inmigrantes en Barcelona.

OBJECTIVE: To assess the prevalence of tuberculous infection and disease in recent economic immigrants in Barcelona. SUBJECTS AND METHOD: Examination and testing of immigrants. Tuberculin tests (TTs) were given and the presence of scars from tuberculosis vaccinations were noted. Thresholds of 5 and 15 mm were established for positivity in unvaccinated and vaccinated individuals, respectively. RESULTS: A total of 3651 persons were examined, but only 3151 completed the study. Eighteen were diagnosed with tuberculosis (571.2 per 100,000) and 50.6% were classified as positive TT reactors, 34.4% because of infection and 16.3% possibly because of tuberculosis vaccination. The percentage of reactors was significantly higher in the sample of economic immigrants than in the local population. Age, male sex, place of origin, greater poverty, and higher prevalence of disease in the country of origin were associated with tuberculous infection in the sample. DISCUSSION: Active case finding proved efficient. Interference from tuberculosis vaccination greatly affects the findings, depending on the positivity threshold that is established. We recommend that chest radiographs be used in addition to TTs. Immigration will change the nature of endemic tuberculosis in Spain, and strategies should be specifically designed to deal with the new challenges that will appear.

[A study of the tuberculous infection in adults]. / Estudio de la infección tuberculosa en adultos.

UNLABELLED: Tuberculous infection in adults is not a well known entity in our country, despite its epidemiological importance. We have designed an observational study in a homogeneous group of adult civil servants of Catalonia (n = 8,202) from 20 to 54 years old that were submitted to a health examination which included a tuberculin test, in order to study the tuberculous infection in these people and to evaluate the factors associated with this infection. RESULTS: The global prevalence of reactivity in tuberculin test was 22.36% and the prevalence of the tuberculous infection was 14.76%. The factors related to the tuberculous infection were the following: age, male sex, background of exposure to sources of contagion, and previous BCG vaccination. CONCLUSIONS: The prevalence of tuberculous infection in adults has declined, and is currently greater in men than women, among patients who recognize previous contact with a tuberculous patient, and among patients with previous BCG vaccination.

[Pulmonary symptomatic tuberculosis' diagnostic delay study]. / Estudio del retraso diagnóstico de la tuberculosis pulmonar sintomática.

OBJECTIVE: To study symptomatic pulmonary tuberculosis (PTB) diagnostic delay. PATIENTS AND METHODS: Prospective study of new symptomatic PTB cases (aged > or = 15 years) by structured interview with the patients and their families. The main variables analyzed were patient's delay (PD), doctor's delay (DD), diagnostic process delay (DPD), health care system delay (HCSD) and total delay between the onset of symptoms and start of treatment (TD). Univariate and multivariate statistical analyses were performed for each component of delay. RESULTS: Two hundred eighty-seven patients were studied. The mean delays in days standard deviations were TD 81.8 77.3; PD 43.3 55.7; DD 28.4 59.6; DPD 10.0 17.7, and HCSD 38.5 62.5. CONCLUSIONS: Patients are responsible for 50% of excess delay in diagnosing symptomatic PTB. Patients in the health care system experienced diagnostic delays over 60 days in 18.5% of cases, doctors being responsible for 75% of the diagnostic delay attributable to the system.

Estudio del retraso diagnóstico de la tuberculosis pulmonar sintomática / Pulmonary symptomatic tuberculosis' diagnostic delay study

OBJETIVO: Estudiar el retraso diagnóstico de la tuberculosis pulmonar (TBP) sintomática. PACIENTES Y MÉTODOS: Estudio prospectivo de casos nuevos sintomáticos de TBP (edad 15 años) mediante entrevista estructurada al paciente y su familia. Las variables fundamentales analizadas fueron: retraso del enfermo (RE), retraso atribuible al médico (RM), retraso durante el proceso diagnóstico (RPD), retraso en el sistema sanitario (RSS) y retraso total (RT), esto es, el tiempo transcurrido desde el comienzo de los síntomas hasta el inicio del tratamiento de la TBP. Se realizó un análisis estadístico univariante, así como análisis multivariante para cada uno de los componentes del retraso diagnóstico. RESULTADOS: Se estudió a 287 enfermos. La media en días ñ desviación estándar (DE) fue para el RT y sus distintos componentes de 81,8 ñ 77,3 en el RT, 43,3 ñ 55,7 días en el RE, de 28,4 ñ 59,6 días en el RM; para el RD, de 10,0 ñ 17,7 días y en el RSS de 38,5 ñ 62,5 días. CONCLUSIONES: Dentro del elevado retraso diagnóstico de la TBP los enfermos son responsables del 50 por ciento. En el sistema sanitario el 18,5 por ciento de los enfermos sufrió un retraso diagnóstico mayor de 60 días, siendo los médicos responsables del 75 por ciento de la demora atribuible al sistema (AU)

Epidemiología de la tuberculosis / Epidemiology of tuberculosisobjective

OBJETIVO: Análisis de la situación epidemiológica actual de la tuberculosis infantil en España. MÉTODOS: Se han utilizado las encuestas anuales del Grupo de Tuberculosis e Infecciones Respiratorias de la Sociedad Española de Patología Respiratoria y del Grupo de estudio PMIT (año 1996-1997). Se ha aplicado la "técnica del espejo" para estimar las interferencias por otras infecciones micobacterianas en la interpretación de la prueba de tuberculina en un cribado practicado a 51.877 escolares de entre 4 y 18 años de edad y se estiman sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la prueba. RESULTADOS: La tasa de incidencia de casos nuevos en 13 comunidades autónomas fue de 12,79/100.000 habitantes. En 1998 se detectó una prevalencia de la infección del 0,53 por ciento a los 6 años y del 4,7 por ciento a los 14 años. El dintel crítico de positividad de 13 mm es el que presenta mayor sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. CONCLUSIÓN: En los últimos años existe una tendencia favorable de la endemia tuberculosa infantil. Se detecta la interferencia por micobacterias no tuberculosas en la prevalencia de la infección, por lo que se recomienda adoptar, con algunas matizaciones, los criterios de la American Thoracic Society para la interpretación de la prueba de tuberculina (AU)

[Results and epidemiological impact of directly observed treatment of tuberculosis]. / Resultados e impacto epidemiológico de una unidad de tratamiento directamente observado de la tuberculosis.

OBJECTIVES: To analyze the results and epidemiological impact on tuberculosis (TB) of directly observed therapy (DOT) for uncooperative patients. METHOD: Retrospective study of the case histories of patients admitted to the DOT unit in Catalonia (Spain) since its March 1993 inauguration until August 1998. RESULTS: Of a total of 470 patients, 102 were cared for during the unit's first phase, in which funding resources were insufficient. Of the 368 admitted during the second phase beginning January 1996; 176 (47.5%) were cured, 27 (7.3%) died, 72 (19.5%) were still at the unit and 93 (25.2%) left the unit before completing treatment. Of the last group, 25 were cured, 31 died 19 continued DOT and 18 (4.9% of all enrolled in the second phase) were lost to follow-up. Thus, the final outcome distribution for the patients was 201 (54.6%) cured, 58 (15.7% died, 91 (24.7%) still in DOT and 18 (4.9%) lost to follow-up. The compliance rate during the second phase was 91.8%. These results may have contributed significantly to the nearly 30% reduction in the incidence of TB in Catalonia between 1992 and 1997, a period which saw large decreases in the number of cases among 20-to-44-year-olds (33%) and consequently also among under-15-year-olds (55%). Likewise the number of cases of TB in high risk groups decreased, 55% on the average with a minimum decrease of 40.1% among AIDS patients and a maximum decrease of 85.2% among indigents. CONCLUSION: DOT has proven highly effective both for patients and for the community, although many other factors must also be considered when accounting for the current epidemiological trend.

[Tubercular infection and its trend among school children in the population of the Barcelona suburbs]. / La infección tuberculosa y su tendencia en los escolares de una población del extrarradio de Barcelona.

BACKGROUND: Tuberculosis infection is a suitable method to evaluate a community tuberculosis endemic. The calculation of infection indexes (incidence, prevalence, year risk and their decline) have been used to analyze this endemic and ist tendency during 22 years in a suburbial city. METHODS: Practice of the tuberculin test (Mantowx) to almost the totality of schoolchildren during the academic years. 1968-69, 1980-81 and 1981-82; and 1989-90 and 1990-91 as well. During the years 1981-82 and 1990-91, the test was repeated in a sample of schoolchildren to detect the reaction converters (incidence of infection). RESULTS: The prevalence of tuberculosis infection is very high (7.5% in the first primary school year and 15.2% in the 8th primary school year during 1968-69, and decreases to 5.1% and 11.7% during 1980-82 was 2.6% and 1.5% in 1989-91. The decline of the infection risk is very low: about 6% during the whole period, and it is higher: 9%, in its second part. CONCLUSIONS: The high tuberculosis can be related to the population social deficiencies. The favourable tendency observed, during the last ten years, can be attributed to an improvement in the health care and, specifically, in the treatment of patients of tuberculosis.

Retrospective evaluation of the efficacy of the BCG vaccination campaign of newborns in Barcelona, Spain.

The efficacy of the BCG vaccination campaign of neonates in Barcelona, carried out in the period 1966-1974, was evaluated with a study of cases and controls made during the period 1978-1988 in patients between the ages of 4 and 21 years. It shows that the efficacy of this vaccination campaign was 32%, that it was greater in men than women and that it decreased with the passage of time. The number of cases of tuberculosis prevented by this campaign is calculated at 13.4%. Given that the vaccine used offered maximum guarantees, the authors consider that this poor efficacy must be attributed to operational deficiencies in the vaccination campaign itself.

Evaluation of the efficacy of health education on the compliance with antituberculosis chemoprophylaxis in school children. A randomized clinical trial.

Chemoprophylaxis against tuberculosis with isoniazid for 1 year is very useful, but patient compliance is very low. A controlled clinical trial was performed to evaluate the efficacy of three alternative health education strategies and to observe which of them improves compliance with antituberculosis chemoprophylaxis in healthy tuberculin-reactor children. Although all three strategies achieved positive, statistically significant results as compared with the control group, that performed by nursing personnel at the patient's home is the most effective, followed by that performed by the same health professionals by telephone. The least effective strategy by far was that performed by the physician in his surgery.