[Compulsory hospitalization of non-compliant patients with tuberculosis].

The procedure and results of forced treatment per curiam were analyzed in 584 bacteria-discharging persons registered as Group 1 patients to be examined in the tuberculosis facilities of the Kemerovo Region in 2004 to 2007. If a package of measures for forcing the patient to be treated is ineffective, a phthisiatrician draws up documents for court. By the decision of the court, the patient is conveyed by justice officers to a tuberculosis hospital. Judicial practice provides a means of substantially enhancing the efficiency of treatment in this socially compromised group of patients with predominantly destructive processes. Among those who had voluntarily come to the hospital just before or after sentence pronouncement, bacterial discharge cessation and decay cavity closure were achieved in almost 90% of cases; clinical resolution was observed in two thirds. At the same time, there is a group of patients, in whom the existing system of measures has proven to be ineffective. There are serious gaps in the legislation of the Russian Federation, which impede the bringing of patients with tuberculosis, the homeless in particular, to compulsory hospitalization. Legislation should be perfected in this area.

[Impact of procedures for identifying patients on the pattern of a tuberculous process and the efficiency of treatment].

The results of examination and treatment were studied in 3637 new cases of pulmonary tuberculosis. A total of 1879 cases were detected at prophylactic examinations (Group 1) and 1758 cases were identified when they resorted to doctors for complaints (Group 2). Circumscribed and benign existing forms of tuberculosis were prevalent in patients at prophylactic examinations. At the same time tuberculosis was accompanied by destruction in a third of cases and by bacterial excretion in half the cases. On applying to the physicians for complaints, the patients were found to have mainly a process with destructions and bacterial excretion and the proportion of acutely progressive forms of tuberculosis was also considerable. In Group 1, treatment showed a much higher efficiency than in Group 2. Deaths from tuberculosis among the new cases were frequently observed in Group 2 and much less frequently in Group 1. Their cause was generally acute tuberculosis.

[Interdepartmental interaction in the detection and treatment of patients with tuberculosis].

The experience of interdepartmental interaction in solving the problem of tuberculosis in the Kemerovo Region has been analyzed. The region's administration has strengthened the material-and-technical basis of the service. The advisory tuberculosis council has been set up. Territorial interdepartmental commissions have been organized. The level of an intervention with the general medical network (GMN) has been increased. A qualitative sputum test has been carried out for acid-resistant mycobacteria. The Main Board of the Federal Penal Jurisdiction Service (MBFPJS) and the Board of Internal Affairs are attracted to examine social risk-group persons. Strictly uncontrolled chemotherapy for patients with tuberculosis has been introduced on the basis of GMN at the stage of aftercare and by the forces of the Red Cross Committee. Along with the MBFPJS, continuity has been established in the treatment of patients with tuberculosis. Juridical attraction of bacteria-isolating person to treatment has been introduced. The work done has substantially improved the detection and treatment of patients, but there are problems to be solved.