Public health interventions to encourage TB class A/B1/B2 immigrants to present for TB screening.

From 1985 to 1995 the proportion of all Santa Clara County, California (SCC), tuberculosis (TB) cases among recent immigrants climbed 73% (137 to 237). In SCC the efficient and cost-effective means encouraging TB Class A/B1/B2 immigrants (TBIMs) to present for TB screening and the prevalence of active TB among them were never investigated. We studied all TBIMs entering SCC from October 1, 1995 to June 30, 1996, notified to SCC by the CDC's Division of Quarantine (DQ). Encouraging TBIMs to seek TB screening, we sent letters to them promptly on the DQ notification, followed sequentially by phone calls and home visits. We determined the outcome of screening and its cost. We screened 314 of 323 (97.2%) TBIMs including 79 of 323 TBIMs who presented prior to interventions, 213 of 314 (87.3%) who responded to letters, 17 (7%) to phone calls, and 5 (2%) to home visits. Of 283 TBIMs screened 16 (5.7%) had active TB. To locate one TBIM cost $9.90 by letter, $43.25 by phone, and $129.88 by home visit. Locating one TB case cost $175.88 by letter, $696.26 by phone call. The prevalence of active TB in TBIMs is high. Our interventions resulted in low-cost TB screening and high-yield identification of active TB cases. We recommended that health departments develop a system for encouraging TBIMs to present for prompt TB screening.

A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia.

OBJECTIVE: This study was designed to establish whether a ratio of three units of Dysport is equivalent to one unit of Botox for the treatment of cervical dystonia. METHODS: Patients with predominantly rotational cervical dystonia, and a minimum of four previous Botox treatments, were randomised to receive either the clinically indicated dose of Botox or three times that dose in Dysport units. Study botulinum toxin was administered in a double blind fashion, to one or more clinically indicated muscles, at one or more sites per muscle. Patients returned for assessment two, four, eight, and 12 weeks after treatment. RESULTS: A total of 73 patients (Dysport, 38; Botox, 35) were entered. The Dysport group received a mean (SD) dose of 477 (131) (range 240-720) Dysport units, and the Botox group received a mean (SD) dose of 152 (45) (range 70-240) Botox units. The mean (SEM) post-treatment Tsui scores for the Dysport group (4.8 (0.3)) and the Botox group (5.0 (0.3)) were not statistically different (p=0.66). The study had 91% power to detect a clinically significant difference of two points. Both groups showed substantial improvement in Tsui score by week 2 (mean (SD); Dysport, 46 (28)%; Botox, 37 (28)%), with a peak effect at week 4 (mean (SD); Dysport, 49 (29)%; Botox, 44 (28)%). A similar response profile was seen for other assessments of efficacy. The duration of effect, assessed by time to retreatment, was also similar (mean (SD); Dysport, 83.9 (13.6) days; Botox, 80.7 (14.4) days; p=0.85). During the study 22 of 38 (58%) Dysport patients reported 39 adverse events, and 24 of 35 (69%) Botox patients reported 56 adverse events (p=0.35). A global assessment of efficacy and safety considered that 29 of 38 (76%) Dysport patients and 23 of 35 (66%) Botox patients were treatment successes (p=0.32). CONCLUSION: Patients with predominantly rotational cervical dystonia treated with the clinically indicated dose of Botox or three times that dose in Dysport units show similar improvements and do not have significantly different safety profiles.