都道府県別の結核まん延の消長とこれに関与した要因の分析,今後の展望 : (2)現在の結核死亡率および結核死亡減少傾向と結核対策要因,生活環境要因との関係
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The areal difference in the mortality from tuberculosis among prefectures in Japan is still a matter of importance in spite of the achievement in reducing the mortality since 1947. The authors pointed out in the previous report that the present areal difference in the mortality from tuberculosis is conceivably caused by the effects of the treatment and preventive measure after the War, intensity of the epidemic before the introduction of chemotherapeutics and socioenvironmental conditions.<BR>The present study was undertaken in an attempt to determine the effects of each individual factors of the countermeasures of tuberculosis (case-finding, medical treatment, patient care and vaccination programmes) and socio-environmental conditions on the areal difference of the mortality in Japan. The results were summarized as follows.<BR>1. The response rate of the case finding X-ray screening, particularly for general inhabitants and for families of the registered tuberculosis cases and proportion of cases detected by X-ray screening among total newly registered cases were negatively correlated to the mortality from tuberculosis and its decrease.<BR>2. Percents of SM-1-PAS+INH regimen and surgical treatment among total accepted therapies in 1950 s were inversely correlated to the mortality rate from tuberculosis and its decrease at present, and it is conceivable that the powerful countermeasure conducted soon after the introduction of chemotherapeutics into the field of tuberculosis in Japan is closely connected to the areal difference in the mortality from tuberculosis among prefectures now<BR>3. In the area where the mortality rate is higher, there were likelihood th a t the percentage of the cases not under medical treatment were also high and number of follow-up X-ray examination for patients and number of PHN visit as the indices of patient care are small. It seems desirable, therefore, to make effort to place as many cases as possible under medical care and treatment.<BR>4. The study did not provide an answer to the question on the effect of BCG vaccination.<BR>5. The areal difference in the mortality from tuberculosis at present is attribut e d in part to the level of the improvement in the socio environmental condition. The factors most significant among all are nutrition, living standard and environment of the place of residence (urban or country area).<BR>6. From the fi nding obtained above, it was required to put the emphasis in making extensive case finding and patient care for the area providing the highest yield of the mortality from tuberculosis.
- 日本結核病学会の論文
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