RESUMEN
The development of Robert Koch to a scientist with enormous effects to the picture of modern medicine and society is interpreted from the point of view of today. Koch has critically acquired the great scientific progress of his time by reason of his excellent gifts; he has confirmed them and has extended them fundamentally by his discoveries. Koch possessed the prerequisites for it due to his systematic, persevering and comprehensive way of working and his assiduity making him one of the originators of bacteriology, the creator of the control of infectious diseases and above all of tuberculosis. His commitment to helping men and community wherever necessary with all his possibilities, has made him a benefactor to humanity.
Asunto(s)
Bacteriología/historia , Tuberculosis/historia , Alemania , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Tuberculosis/prevención & controlRESUMEN
The fight against tuberculosis in the German Democratic Republic was performed from the very beginning as a task of the state and the society; it was developed according to the progress of economic possibilities and the epidemiological situation. The contribution of the community and of the social-economic development on tuberculosis epidemiology has proved to be decisively important factors in tuberculosis control. The specific methods applied in tuberculosis control in the course of more than 30 years have changed in their importance effectiveness and efficiency with the reduction of the tuberculosis problem and the development of new techniques. Therefore a continuous evaluation of the tuberculosis situation is necessary to recognize the most effective approach. By reducing the estimated annual infection rate to less than 0.05%, the incidence of smear positive pulmonary tuberculosis to less than 5/100,000 and the practical disappearance of tuberculosis among children tuberculosis has become an endemic localized disease among predominantly old citizens. People's mass x-ray examinations have considerably lost their value for finding tuberculosis. Early coverage and examination of persons with respiratory symptoms (21-days-coughers), of contact persons and high risk groups will determine the future activities of the chest clinics. Their integration into the system of outpatient clinics and the system of primary health care were an important step on this way. Successful treatment of each case of tuberculosis is now possible and must be attained. Early case finding + treatment considered as an united activity has become the decisively important measure in the control of tuberculosis. The endemic foci of tuberculosis in some communities have to be surveyed and eliminated with priority. Moreover, the cooperation of all physicians of public health is necessary. Only by this way tuberculosis can be eradicated in GDR in a defined time. (Aim of WHO and IUaT: 1 case of smear positive tuberculosis among 1,000,000 inhabitants.) Up to that time tuberculosis control should remain an obligatory task of public health.
Asunto(s)
Métodos Epidemiológicos , Tuberculosis Pulmonar/prevención & control , Tuberculosis/prevención & control , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Femenino , Alemania Oriental , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Tuberculosis/terapia , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/terapiaRESUMEN
The development of tuberculosis in GDR is analysed upon the different points of view. After assessing the validity of the parameters for evaluating the tuberculosis problem (mortality, incidence and prevalence of disease and infection) some aspects remarkable for tuberculosis control are discussed. Tuberculosis has been vastly reduced in all parameters since 1949. However, the regression of tuberculosis did not occur with the same rate in the various age and finding groups. By this the efficacy of the control measures has changed making necessary a reconsideration of the methods. The Volkskrankheit (common disease in the population) tuberculosis has become a vastly reduced endemic disease in GDR. For future tuberculosis control conclusions are drawn from the analysis.
Asunto(s)
Tuberculosis/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Vacuna BCG , Niño , Preescolar , Reservorios de Enfermedades , Métodos Epidemiológicos , Femenino , Alemania Oriental , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prueba de Tuberculina , Tuberculosis/prevención & control , Tuberculosis Pulmonar/epidemiologíaAsunto(s)
Mycobacterium tuberculosis , Tuberculosis/historia , Animales , Antituberculosos/uso terapéutico , Vacuna BCG , Bacteriología/historia , Bibliografías como Asunto , Bovinos , Alemania , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Tuberculosis/prevención & control , Tuberculosis/transmisiónRESUMEN
The epidemiology of tuberculosis and nonspecific respiratory diseases in GDR is reviewed. For tuberculosis an exact survey on its development in the course of the last 30 years is possible by reason of compulsory registration. The program of tuberculosis control has been pushed on consequently from the very beginning; all indices of tuberculosis epidemiology (annual infection rate, incidence and prevalence of morbidity, mortality) have favourably developed. Till 1982 tuberculosis is expected to be eliminated as a special problem of public health in GDR. The assessment and statistic evaluation of the nonspecific respiratory diseases is much more difficult. There is no compulsory registration or notification; acute respiratory diseases are very common; the chronic pulmonary diseases clinically and prognostically important are insufficiently defined and, therefore, patients can be delimited only badly from the by far greater number of persons with chronic cough and sputum defined on the base of epidemiological aspects. The informative significance of secondary statistics (temporary disabelement, dismissals from hospital, invalidity- social parameters) is analyzed regarding their value for an evaluation of these diseases. Acute respiratory diseases have serious consequences on the sickness absence rate due to the percentage of case and duration of absenteeism (20--35% of all cases) of the considerable portion of hospital dismissals. In periods of epidemics disablement is still by far higher.
Asunto(s)
Enfermedades Respiratorias/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Control de Enfermedades Transmisibles , Métodos Epidemiológicos , Femenino , Alemania Oriental , Humanos , Masculino , Persona de Mediana Edad , Salud Pública , Sistema de Registros , Estadística como AsuntoRESUMEN
After a short review of measures for control and eradication of infectious diseases in general and especially of tuberculosis, the indications of chemoprophylaxis and preventive chemotherapy of tuberculosis are discussed. Using results of a double-blind controlled trial on preventive chemotherapy in a high risk group (persons with fibrotic lung lesions), cost, benefit and side effects of preventive chemotherapy are analysed. Preventive chemotherapy in high risk persons is an effective measure in advanced stage of tuberculosis control. Recommendations to reduce side effects are given.
Asunto(s)
Isoniazida/uso terapéutico , Tuberculosis Pulmonar/prevención & control , Complicaciones de la Diabetes , Economía Médica , HumanosAsunto(s)
Tuberculosis Pulmonar , Vacuna BCG , Epidemiología , Alemania Oriental , Humanos , Organización Mundial de la SaludRESUMEN
The development of the Chest Hospitals and Sanatoria in GDR is discussed and compared with data on the trend of tuberculosis beds in the world given by BULLA (WHO). The density of beds of about 1 per 10 000 of the population for diagnostics and treatment of patients with pulmonary and extrapulmonary tuberculosis is very low. This results from a planned tuberculosis control with a steady decrease of tuberculosis incidence and a continuous diminishing of the duration of hospital treatment in favour of ambulatory therapy. Other indices representing the effectivity of hospital care (beds accomodated, duration of stay, costs and working power per hospital bed and hospitalized patient in the last 5 years are discussed.