Ohmori Masako, Wada Masako, Mitarai Satoshi, Yanai Hideki, Ito Kunihiko, Yamauchi Yuko, Shishido Shinji
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533, Japan.
Kekkaku. 2006 Feb;81(2):71-7.
To discuss the optimal TB control system in health care facilities for the elderly where the periodic TB screening is currently not obligatory.
A study was conducted in three health care facilities for the elderly in Tokyo during the period from 2002 to 2004, and 212 admitted elderly persons were enrolled in this study. Medical charts were analyzed to identify informations about mental and physical conditions and TB risk factors. Questionnaire-based interviews were conducted in 58 residents who had no dementia or no serious conditions. TB mass screening was carried out with a mobile vehicle equipped with computed radiography, financially supported by the Tokyo Metropolitan Government. Since this mobile vehicle is equipped with a special wheelchair for chest X-ray examination, most elderly persons were able to receive chest X-ray examination. Medical chart review and interview were conducted at around the time of TB mass screening. The screening results of 183 elderly residents who received X-ray examination were reviewed.
Of the 212 persons admitted to the facilities, 73.1% were women. The mean ages of men and women were 80.7 and 84.2 years, respectively. Mental disorders were observed in 42.9% and dysfunction of extremities in 54.7%. At the time of admission, chest X-ray records were submitted by the attending doctors in 73.1% of the residents, but this proportion differed among facilities. From these records, old TB was found in 12.3%; however this proportion was 20.8% according to the TB mass screening results. A history of TB was more prevalent in the group interviewed than in the non-interview group (24.1% vs. 6.5%; p < 0.001). Two facilities had conducted TB screening for three consecutive years and comparative reading of chest X-ray films could be done in 35.8%. The remaining facility conducted TB screening for the first time, and comparative reading was not possible. The proportion of cases requiring further investigations was higher in the facility where TB screening was conducted for the first time (2.8% vs. 13.0%; p = 0.008). No active TB patient was detected in this study.
From the viewpoint of risk management for tuberculosis, it is important to establish a system of early case finding for the aged persons admitted to health care facilities for the elderly. Therefore, the information on risk factors should be collected properly at the time of admission, and careful attention should be paid to the residents with risk factors, for the possible development to active disease. X-ray records submitted by the attending doctors or by screening would provide useful informations for early diagnosis, when abnormal shadows are found on chest X-ray films.
探讨在目前未强制进行定期结核病筛查的老年保健机构中，最佳的结核病控制系统。
2002年至2004年期间，在东京的三家老年保健机构开展了一项研究，212名入院老年人纳入本研究。分析病历以确定有关精神和身体状况以及结核病风险因素的信息。对58名无痴呆或无严重疾病的居民进行了问卷调查访谈。由东京都政府资助，一辆配备计算机放射成像的流动车辆进行了结核病大规模筛查。由于这辆流动车辆配备了用于胸部X光检查的特殊轮椅，大多数老年人能够接受胸部X光检查。在结核病大规模筛查前后进行了病历审查和访谈。对183名接受X光检查的老年居民的筛查结果进行了审查。
在入住这些机构的212人中，73.1%为女性。男性和女性的平均年龄分别为80.7岁和84.2岁。观察到42.9%的人有精神障碍，54.7%的人有肢体功能障碍。入院时，73.1%的居民的主治医生提交了胸部X光记录，但各机构之间这一比例有所不同。从这些记录中，发现陈旧性结核的比例为12.3%；然而，根据结核病大规模筛查结果，这一比例为20.8%。接受访谈的组中结核病病史比未接受访谈的组更普遍（24.1%对6.5%；p<0.001）。两家机构连续三年进行了结核病筛查，35.8%的胸部X光片能够进行对比阅片。其余一家机构首次进行结核病筛查，无法进行对比阅片。首次进行结核病筛查的机构中需要进一步检查的病例比例更高（2.8%对13.0%；p=0.008）。本研究未检测到活动性结核病患者。
从结核病风险管理的角度来看，为入住老年保健机构的老年人建立早期病例发现系统很重要。因此，入院时应妥善收集风险因素信息，对于有风险因素的居民应密切关注，以防发展为活动性疾病。当胸部X光片上发现异常阴影时，主治医生提交的X光记录或筛查提供的信息将有助于早期诊断。
