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[Mass radiography. The "pros and cons" of a classic method of preventive medicine (author's transl)].

The relation of expense to benefit of mass radiography (RRU) can no longer be referred to the tuberculosis discovery rate. Far more frequently other thoracic diseases are detected, e.g. tumors, cardiovascular diseases, pneumoconiosis, sarcoidosis, etc. The prerequisite and therefore the immediate objective is the limitation to the defined and detectable group of risks so as to increase the detection rate. In combination with other prophylactic investigations the benefit of RRU can still be increased -- it provides a valuable insight into the epidemiology of different social diseases.

Heart Diseases↗

[The risk of reactivation of post-tuberculosis changes in patients with severe somatic diseases].

To establish the risk of tuberculosis reactivation in subjects who had severe somatic conditions, 103 patients were observed in a multiprofile general hospital and followed-up for 1-3 years after their discharge. A potential and actual risk (estimated to be 78.0 +/- 6.5 and 7.3 +/- 4.0% of the cases, respectively) for recurrent tuberculosis was recorded as a result of the excretion of conditionally stable and unstable M. tuberculosis L-forms. The importance of the nature and the degree of residual tuberculous changes in view of a specific process reactivation risk for the patients was confirmed. It was indicated that the persons with severe somatic conditions and residual tuberculous changes in respiratory organs made up a tuberculosis risk group to be observed by a phthisiologist.

Adult↗

Adult mortality in slums of Karachi, Pakistan.

OBJECTIVE: Cause-specific death rates are rarely available to guide health interventions for adults in South Asia. We report mortality patterns among Karachi's urban poor. METHODS: We conducted verbal autopsies for adult deaths under active surveillance during 1990-1993 in five urban slums of Karachi. Two physicians assigned underlying cause of death by consensus. Analysis included cause- and category-specific rates, 45Q15s and comparison with 1991 Japanese national statistics. RESULTS: All 345 adult deaths (15-59 years) in the 5 slums (total population 45,389) were included. Male mortality exceeded female (4.4 vs 3.3/1000, p = .02). Noncommunicable diseases claimed 59% of deaths, communicable and reproductive 27% and injuries, 15%. The leading identified death rates (/100,000) among women were: circulatory disorders (66), maternal causes (33), tuberculosis (30), and burns (23); and among men they were: circulatory disorders (124) tuberculosis (30) and road traffic accidents (30). Overall Karachi adult mortality was 3.7 times Japanese rate. Compared to Japan, adults in Karachi had one to two orders of magnitude excess mortality due to maternal causes, tuberculosis and burns. Circulatory disorders and tuberculosis accounted for 47% of excess male mortality; these plus maternal causes and burns accounted for 55% of excess female mortality. CONCLUSION: These mortality levels and patterns compel interventions and research for poor urban adults beyond maternal health. Women's health would equally benefit from tuberculosis control or burn prevention. Men need safer travel. Both need improved cardiovascular health.

Adolescent↗