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背景:伦敦南区无家可归者收容所。目的:发展一种适宜于在无家可归者中筛检肺结核病人的有效方法。设计:用观察性研究评价筛检方法的可接受性、病例检出率和治疗完成情况。筛检方法包括肺结核病症状问卷、结核菌素试验和在现场冲洗、判读的X线胸片检查。结果:10名受检者(0.5％)被确定为活动性肺结核;其中7人为50岁以上的男性白人。结核病症状问卷调查作用甚小。9名病例是通过X线胸片检查发现,而只有3名病例进行了结核茵素试验。在检出的10名活动性肺结核病例中8人完成了治疗。另外5名结核菌素试验强阳性,但胸片检查正常的受检者开始了预防性药物治疗。结论:X线胸片检查是最有用的筛检方法,如果将之针对于高危人群将是有效的。采取激励方法似乎能提高筛检的接受率。结核菌素试验对于鉴别需要药物预防或BCG免疫接种的受检者有意义。只要对受检者进行正确的管理,病人会有很好的依从性。
Background: South London homeless shelter. OBJECTIVE: To develop an effective method for screenings of tuberculosis among homeless people. DESIGN: Observational studies were used to evaluate the acceptability of screening methods, case detection rates, and treatment completion. Screening methods include a questionnaire on symptoms of tuberculosis, tuberculin test and on-site flushing, interpretation of X-ray examination. Results: Ten subjects (0.5%) were identified as active tuberculosis; seven of them were male whites over the age of 50 years. The Questionnaire on Tuberculosis Syndrome has a small effect. Nine cases were found by X-ray examination, while only three cases were tested for TBR. Eight of the 10 active cases of tuberculosis detected were completed. The other five tuberculin tests were strongly positive, but subjects with normal chest radiographs started prophylactic medical treatment. Conclusions: X-ray examination is the most useful screening method and will be effective if targeted at high-risk populations. It seems that adopting the incentive method can improve the acceptance rate of screening. Tuberculin testing is useful in identifying subjects who require drug prophylaxis or BCG immunization. As long as the subjects under the correct management, the patient will have good compliance.