結核の持続的な不粘性患者の拘禁
T Oscherwitz1, J P Tulsky, S Roger
1Program in Medical Ethics, University of California, San Francisco, USA.
JAMA
|September 18, 1997
まとめ
治療を受けていない結核患者の民事拘禁は公衆衛生上の措置である. 拘留された多くの患者が治療を終えた一方で,治療の完了を確実にするためには,より長い拘留が必要になる可能性があります.
科学分野:
- 公衆衛生は公衆衛生である.
- 感染症のコントロール・コントロール
- 結核の管理について
背景:
- 結核 (TB) 治療の継続的な不服従は,公衆衛生に重大なリスクをもたらします.
- カリフォルニア州は1993年に非感染性だが,持続的に不粘性結核患者のための民事拘置手続きを実施した.
研究 の 目的:
- TB コントローラーによって拘束の対象となる患者の特徴を特定するために.
- 患者の収容の頻度と場所を決定する.
- 拘置中の患者の結核治療の完了率を評価する.
主な方法:
- 他の成人結核患者との横断的な比較を伴うケースシリーズの設計.
- 1994年に結核症例数が多いカリフォルニア州12郡で実施された研究.
- データは公衆衛生記録,結核の公式インタビュー,そして公式の結核症例報告から得られたものです.
主要な成果:
- 結核管理当局は67人の患者 (1.3%の成人) を民事拘禁または逮捕した.
- 拘束された患者はしばしばホームレス (46%),薬物乱用 (81%),精神疾患 (28%) を経験しました.
- 分析された49人の拘束された患者のうち,治療を終えた患者は84%だったが,治療を終えるまで拘束されたのは17人だけであった.拘束された患者は,追跡への損失が高く,拘束されていない患者よりも完了率が低い.
結論:
- 持続的に不粘性結核患者のケアを改善するには,心理社会的サービスの強化が必要になる可能性があります.
- 適切な市民拘置施設は,非加盟者を管理する上で極めて重要です.
- 収容期間は,結核の治療の完了を確保するために十分であるべきです.
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