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In Russia, social tuberculosis-controlling organization have been existing and actively functioning just for about 120 years. In the organizational context, they have gone a long way--from single interim and standing commissions by setting up local societies of phthisiologists in large centers of Russia (Petersburg, Moscow, Voronezh, Kharkov, etc.), the All-Russian Tuberculosis-Controlling League before the establishment of All-Union and All-Russian research medical societies of phthisiologists. At present, the All-Union Research Medical Society of Phthisiologists was reorganized as the International Research Medical Society of Phthisiologists and the All-Russian Research Medical Society of Phthisiologists functions as the Russian social organization. "The Russian Society of Phthisiologists". Throughout their history, social tuberculosis-controlling organizations have been playing an important role in forming and developing phthisiological science, in improving the tuberculosis-controlling care system for Russia's population. At present, social tuberculosis-controlling organizations hold great promise for their multi-faceted activities for the welfare of the population of Russia.

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The paper proposes a principle of following up patients from tuberculosis facilities, which is based on the patients' need for treatment rather than on the duration of monitoring of cure stability. The proposed scheme of dispensary registration may focus phthisiologists' attention on the patients who really need a follow-up. The use of the scheme in tuberculosis facilities will enhance the efficiency of treatment in patients and reduce the rate of tuberculosis reactivation in patients registered as risk group ones.

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A new technology of medical service of those followed up at tuberculosis control dispensaries (TCD) was developed on the basis of analysis of the data available in the literature. In doing so, the author took into account the specific features of clinical manifestations of ROT, the pattern and rates of involution of a tuberculous process with current therapeutical and diagnostic capacities borne in mind. This made it possible to define the optimum duration of a basic course of combined treatment in patients with ROT, new principles of evaluation of the outcomes of treatment, criteria for clinical recovery, as well as the procedure and duration of a follow-up. Testing this technology indicated that the latter enhanced the efficiency and profitability of TCD activities by reducing the duration of the basic course of treatment (by an average of 9-11 months), by accelerating the time of statement of ROT recovery (by 1-2 years), by decreasing follow-up periods in control TCD groups (by an average of 3 years), by drastically reducing the number of persons to receive drug therapy for preventive purposes (by 58-70%). Moreover, it may be used extensively in all regions of Russia and requires no additional logistic means and resources.

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The paper summarizes experience in using a new technology of health care provided to patients from antituberculous dispensaries (ATD), which has been developed by the Russian Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation. The new procedure was used at the ATD of 114 districts, towns, and cities of 6 Russian administrative regions over 5 years. The areas under study covered more than 7 million adults. The procedure enhances the efficiency of ATD patient service and health care mainly by fixing the optimum time of basic complex therapy of patients with pulmonary tuberculosis (PT), by decreasing the time of recovery by 1-2 years and the follow-up duration for control outpatient groups (III, VII ATD groups), by drastically reducing the number of persons to be medically treated for preventive purposes by 58-70%. The proposed procedure for ATD follow-up care may be useful in the areas of the Russian Federation and requires no material and technical means and resources.

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The paper deals with the results of analysis of the clinical types of pulmonary tuberculosis by the examination findings of new cases in 1990 (n = 1623), 1993 (n = 6686), 1994 (n = 7460), and 1995 (n = 9748). The analysis was made by the diagnoses established in patients identified in 12 areas of the Russian Federation. The proportion of clinical types of tuberculosis, the rate of detection of destructive changes in the lung and bacterial isolation were taken into account. Moreover, tuberculosis complications on detection, the dissemination of the process and concurrent diseases were borne in mind in patients with infiltrative tuberculosis. It was found that new cases of pulmonary tuberculosis increased, but the proportion of its clinical forms and patients with destructive changes in the lung and isolated strains remained unchanged in the past 3 years (1993-1995). The vast majority of new cases of tuberculosis (91.9-91.4%) includes patients with treatable diseases in whom a good clinical outcome can be expected.

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Data on the incidence of recurrent respiratory tuberculosis in the Russian Federation from 1978 to 1993 were analysed in 1165 adult patients with recurrence and 2017 tuberculosis-cured patients. In the vast majority of patients (97-98%), steady-state clinical healing of tuberculosis can be achieved with its favourable clinical course and adequate treatment. This is evidenced by comparatively few relapses (6-7 per 100,000 adult persons). Among all varieties of relapses, late recurrences make up 74.7-81.2% and occur on the average 9.7-13.1 years after the completion of complex treatment. Comparison of the incidence of clinical types of pulmonary tuberculosis, used treatment regimens and methods has demonstrated that the clinical course of a late recurrence did not differ from that of the first diagnosed tuberculosis. It is expedient to recognize late recurrence to be essentially a new case of pulmonary tuberculosis. This suggests that the concept of recurrence, the pathogenesis of late recurrence, the form and content of work with registered outpatients should be reviewed.

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The relapse-free interval after the primary treatment has been studied in 1165 adults with respiratory tuberculosis (RT) who has developed the recurrent disease. Early recurrences (in follow-up group III) were recorded within 2-3 years since the treatment completion. Late recurrences occurred in group VII-A 9.7 years, in patients crossed off the register 13.1 years after the treatment. New principles of antituberculosis service at specialized dispensaries proposed by the authors promote more efficient regimens of treatment, more rapid cure. It secures a stable rate of recurrences which does not exceed 1.2% from those treated.

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New methodologic approaches have been developed to the outpatient care of patients with respiratory tuberculosis, which accelerates their cure and shorten the terms of their follow-up in dispensary registry groups. These methods were tested in antituberculosis institutions of 26 regions and cities of the RSFSR during 10 years. At present they have been introduced into the antituberculosis establishments of some RSFSR administrative areas. The use of the new method of outpatient care of tuberculosis patients enables the number of the contingents requiring specialized phthisiatric care to be defined more accurately and specified. Introduction of the method requires no additional material and technical expenses and resources. On the contrary, it provides their more effective use in order to improve the quality of diagnostic and therapeutic care to tuberculosis patients.

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