わが国の結核医療の現状と問題点 : 平成12年厚生労働省「結核緊急実態調査」の分析  [in Japanese] The Current state of tuberculosis treatment in Japan and attendant problems : An analysis of the "survey on the tuberculosis state of emergency" conducted by the Ministry of Health, Labor and Welfare in 2000  [in Japanese]

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Author(s)

    • 藤井 紀男 FUJII Norio
    • 厚生労働省健康局結核感染症課 Infectious Disease Control Division, Health Bureau Ministry of Health, Labour and Welfare Government of Japan
    • 中谷 比呂樹 NAKATANI Hiroki
    • 厚生労働省健康局結核感染症課 Infectious Disease Control Division, Health Bureau Ministry of Health, Labour and Welfare Government of Japan
    • 森 亨 MORI Tohru
    • 財団法人結核予防会結核研究所 The Research Institute of Tuberculosis Japan Anti-Tuberculosis Association

Abstract

平成12年に厚生労働省が実施した「結核緊急実態調査」の結果に基づき,現在,わが国における結核を取り巻く問題点を医療現場を中心に解説した。わが国の結核対策は結核予防法に基づき届出が行われ,行政が患者登録,医療の基準の提示等の患者管理を行い,適切な治療を確保する体制となっている。しかし,今回の調査から,届出については,結核予防法に基づく届出からみた死亡数と人口動態統計による結核死亡数に乖離があること,登録者の病名精査により結核以外の疾患が約1割混入していることが明らかとなった。これは届出の正確さ,わが国の結核の状況の評価に関する問題点を示唆するものである。また医療の提供おいては,短期化学療法の選択や結核菌の薬剤感受性検査等が適切に行われていないことを示唆する例があり,治療期間の短縮の推進や薬剤耐性化防止の観点から問題があった。また,結核患者の発病には,医学的な問題以外にも社会的・経済的な背景が大きく影響していることが示唆され,とくに高齢者や基礎疾患を有する者,住所不定者については,医療提供の側面からも早期発見および治療完了率の向上の観点からも十分な留意が必要である。今後,これらの問題を踏まえた対応の重要さが明らかになった。

Problems involving tuberculosis in Japan, primarily in its actual treatment, have been brought to light through the results of the “Survey on the Tuberculosis State of Emergency” in 2000 by the Ministry of Health, Labor and Welfare of Japan. Measures that Japan is taking against tuberculosis include issuing notification as required by the Tuberculosis Prevention Law, the registration of patients by the government, the implementation of patient management including the setting of treatment standards, and the set up of a system to ensure proper medical treatment. The survey showed a discrepancy in the number of tuberculosis deaths according to vital statistics and the number of deaths according to notification made as required by the Tuberculosis Prevention Law. Upon close examination of diseases listed by registered patients, it was found that disorders other than tuberculosis make up about 10% of the total. This suggests a problem with the accuracy of notifications and the overall evaluation of tuberculosis in Japan. In treatment provided, certain cases suggest that diagnoses for the option of short-term chemical treatment or sensitivity to drugs that fight the bacteria responsible for tuberculosis are not conducted properly. This presents problems in the promotion of reducing treatment period or preventing drug-resistant bacterium. The survey results also suggested that nonmedical issues greatly influenced the contraction of tuberculosis, including social and economic factors. In particular, when providing medical treatment to the elderly and to those with underlying disease or those with no fixed address, full consideration must be given to early detection and improvement of the completion of treatment.

Journal

  • Nihon Kyukyu Igakukai Zasshi

    Nihon Kyukyu Igakukai Zasshi 13(3), 123-132, 2002-03-10

    Japanese Association for Acute Medicine

References:  10

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008386585
  • NII NACSIS-CAT ID (NCID)
    AN10284604
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0915924X
  • Data Source
    CJP  CJPref  J-STAGE 
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