Isoniazid Completion Rates for Latent Tuberculosis Infection Among College Students Managed by a Community Pharmacist

Objective: The authors' objective was to document 9-month and previously recommended 6-month treatment completion rates for latent tuberculosis infection (LTBI) in a pharmacistmanaged LTBI clinic in a community pharmacy on a college campus, and to describe patient characteristics. Participants: Participants were university students diagnosed with LTBI. Methods: The authors conducted a retrospective review of pharmacy records from 2000 to 2006. Main outcome measures included 6-month and 9-month LTBI treatment completion rates, total isoniazid (INH) tablets taken, characteristics of completers versus noncompleters, average time to treatment completion, and reported adverse drug events. Results: The 9-month completion rate was 59%, and the 6-month completion rate was 67%. Among those not completing treatment, 15.2% experienced fatigue and 2.2% experienced a rash (p = .04 and p = .03, respectively). Conclusion: LTBI clinics are a unique niche for community pharmacies and can provide individualized patient care to ensure LTBI treatment adherence, monitoring for disease progression, and safety of INH.     

肺病隐喻与性别文化象征——中国现代文学中的“肺病”意象探析

肺病是中国现代文学中最典型的疾病意象之一。肺病隐喻的叙事与性别文化象征之间存在着复杂的关联，它有一种性别化倾向，体现为不同的男女两性身体叙事。肺病隐喻的男性叙事在男女两性病患者身上的隐喻变体明显不同，一者主要关注其道德内涵和社会化倾向，一者则主要体现为审美化取向，并从中可以发现性别政治在女性身体上的权力痕迹；肺病隐喻的女性叙事割断了肺病与女性身体之间的审美想象，以丑怪身体呈现了女性在性别政治中的真实处境。     

中国现代文学中的肺病隐喻与性别象征

中国现代文学中的肺病隐喻和性别象征是相互关联的典型意向，既有疾病隐喻的性别化倾向，又有性别象征的疾病叙事，在性别政治的视野下表现出不同的叙事模式。肺病隐喻既有道德化和社会化倾向，又有审美化、意象化取向。男性的性别政治叙事主要关注男性肺病身份的道德内涵和社会化倾向，女性肺病身份则主要体现为审美化取向，凸显其符码化和想象性特征。女性叙事呈现出层次性，萧红、丁玲等人的女性叙事描写肺病，关注爱情，心系女性；张爱玲等人的女性叙事割断了肺病与女性身体之间的审美想轧以丑怪身体呈现了女性在性别政治中的真实处境。     

A probabilistic transmission and population dynamic model to assess tuberculosis infection risk

The purpose of this study was to examine tuberculosis (TB) population dynamics and to assess potential infection risk in Taiwan. A well‐established mathematical model of TB transmission built on previous models was adopted to study the potential impact of TB transmission. A probabilistic risk model was also developed to estimate site‐specific risks of developing disease soon after recent primary infection, exogenous reinfection, or through endogenous reactivation (latently infected TB) among Taiwan regions. Here, we showed that the proportion of endogenous reactivation (53–67%) was larger than that of exogenous reinfection (32–47%). Our simulations showed that as epidemic reaches a steady state, age distribution of cases would finally shift toward older age groups dominated by latently infected TB cases as a result of endogenous reactivation. A comparison of age‐weighted TB incidence data with our model simulation output with 95% credible intervals revealed that the predictions were in an apparent agreement with observed data. The median value of overall basic reproduction number (R₀) in eastern Taiwan ranged from 1.65 to 1.72, whereas northern Taiwan had the lowest R₀ estimate of 1.50. We found that total TB incidences in eastern Taiwan had 25–27% probabilities of total proportion of infected population exceeding 90%, whereas there were 36–66% probabilities having exceeded 20% of total proportion of infected population attributed to latently infected TB. We suggested that our Taiwan‐based analysis can be extended to the context of developing countries, where TB remains a substantial cause of elderly morbidity and mortality.     

Geostatistical analysis of disease data: a case study of tuberculosis incidence in Iran

The main objective of this study is to introduce two advanced statistical methods and to consider geographical distribution of tuberculosis incidence in Iran. With the knowledge that environmental and climatic conditions in each region are affective for the incidence and spread of the disease, the study has been taken into consideration. The disease incidences in different counties are realizations of spatial data, therefore we apply the Poisson kriging and ordinary kriging for prediction of tuberculosis incidence rates map in Iran. To identify high risk areas using statistical map of disease, our results show that tuberculosis incidences are not uniformly distributed in whole of the country and estimated risk is high in the eastern parts. Assessing geographical distribution of a disease is essential for health officials to recognize high-risk areas, and improve case management and resource allocation.     

A simple in-host model for Mycobacterium tuberculosis that captures all infection outcomes

ABSTRACT

Tuberculosis infection can result in clearance, latent infection, or active disease, with slow or fast progression. A four-dimensional model of in-host tuberculosis infection includes macrophages, T lymphocytes, tuberculosis bacteria, and their interactions. Changes in the infection rate, cell-mediated immunity rate, macrophage loss rate, and bacteria killing rate most affect disease outcomes. Simulations show that a periodic solution can occur. When the infected macrophage killing rate is constant, a backward bifurcation exists and the system is globally stable.     

Tuberculosis with relapse: A model

ABSTRACT

In a model of tuberculosis with relapse, the basic reproduction number R₀ includes new and relapse infections. Lyapunov functions help to prove that the global dynamic is completely determined by R₀. Replicated Latin hypercube sampling shows that early diagnosis and treatment are more efficient when relapse cases are considered.     

Efficacy of screening and treatment of latent tuberculosis infection

ABSTRACT

Sixty-three percent of the total active tuberculosis cases in Canada were diagnosed among foreign-born individuals, representing 20% of the total population. The majority of these cases occur from the reactivation of tuberculosis infections acquired prior to immigration. A preventive policy consisting of screening and treating new immigrants for latent tuberculosis infection is evaluated on its efficacy for reducing the total number of tuberculosis cases, using tuberculosis incidence data between 1986 and 1995 from the Canadian tuberculosis reporting system. The most effective intervention is to screen for and treat latent tuberculosis infection among arriving immigrants from countries of birth with a tuberculosis incidence rate greater than 15 cases per 100,000.     

A Probabilistic Transmission Model to Assess Infection Risk from Mycobacterium Tuberculosis in Commercial Passenger Trains

The objective of this article is to characterize the risk of infection from airborne Mycobacterium tuberculosis bacilli exposure in commercial passenger trains based on a risk‐based probabilistic transmission modeling. We investigated the tuberculosis (TB) infection risks among commercial passengers by inhaled aerosol M. tuberculosis bacilli and quantify the patterns of TB transmission in Taiwan High Speed Rail (THSR). A deterministic Wells‐Riley mathematical model was used to account for the probability of infection risk from M. tuberculosis bacilli by linking the cough‐generated aerosol M. tuberculosis bacilli concentration and particle size distribution. We found that (i) the quantum generation rate of TB was estimated with a lognormal distribution of geometric mean (GM) of 54.29 and geometric standard deviation (GSD) of 3.05 quantum/h at particle size ≤ 5 μm and (ii) the basic reproduction numbers (R₀) were estimated to be 0.69 (0.06–6.79), 2.82 (0.32–20.97), and 2.31 (0.25–17.69) for business, standard, and nonreserved cabins, respectively. The results indicate that commercial passengers taking standard and nonreserved cabins had higher transmission risk than those in business cabins based on conservatism. Our results also reveal that even a brief exposure, as in the bronchoscopy cases, can also result in a transmission when the quantum generation rate is high. This study could contribute to a better understanding of the dynamics of TB transmission in commercial passenger trains by assessing the relationship between TB infectiousness, passenger mobility, and key model parameters such as seat occupancy, ventilation rate, and exposure duration.     

酚妥拉明治疗肺结核大咯血的临床观察

目的 :观察酚妥拉明治疗肺结核大咯血的临床疗效。方法 :12 0例肺结核大咯血随机分为 2组 ,治疗组采用酚妥拉明静滴 ,对照组采用垂体后叶素静滴。结果 :治疗组总有效率 88.4 % ,对照组总有效率76 .7%。结论 :酚妥拉明与垂体后叶素均为治疗肺结核大咯血有效药物 ,但酚妥拉明副作用少 ,应用范围更广 ,更应受到临床重视。