| 摘要: | 俄羅斯總體結核病流行病的惡化是在通貨膨脹、經濟改革環境及社會變遷為背景之下發生的。價格自由化加劇通貨膨脹；總經穩定化緊縮衛生預算、醫療投入減少；私有化及長期薪資欠款則進一步擴大所得差距。社會變遷產生許多社會經濟地位較低落的群體易於受到傳染病的感染。總體生活水準的下降導致俄羅斯結核病流行病情況的惡化。
結核病為與社會情況相當有關聯的疾病。俄羅斯結核病惡化的因素可以歸結於總體經濟瓦解、生活水準惡化、失業率及無家可歸人數上升，而這些危險因子又是政治、經濟及社會不穩定下的產物。經費不足及失業率上升導致X光受檢率下降、結核病部門人員老化及監獄受刑人出獄後之後續追蹤治療問題都是俄羅斯保健部結核病部門面臨的考驗。
俄羅斯結核病問題42%來自監獄，多重抗藥性問題亟待解決。此外，同時感染HIV及結核菌加速結核病的嚴重化。結核病採用不同統計方式〈例如將監獄受刑人、軍人、無家可歸者及移民納入八號統計〉對於俄羅斯結核病發生率及死亡率的上升也有重大的影響。
歐洲國家在過去十年間通報的結核病案例數在增加當中，尤其以中東歐國家及前蘇聯國家惡化情形較為嚴重。結核病在此地區增加的基本原因為：
一、管理不佳或過時的治療使得控管不當，導致抗藥性結核病例增加。
二、經濟衰退、貧窮、營養不良、酗酒及吸毒、擁擠的監獄、缺乏健康照顧的取得。
三、來自結核病盛行國家移民影響〈西歐〉。
四、HIV/AIDS感染加速結核病的傳播，感染HIV同時感染結核病導致高死亡率。
俄羅斯的情形又以第一、二、四項為主。
The deterioration of general TB epidemiological situation in Russia took place against a background of inflation, economic reform environment and a time of social change. Price liberalization deteriorated the situation of inflation. Macroeconomic stabilization tightened health budget and diminished medical inputs. Privatization and pro-longed wage arrears enlarged the income gap. Social environment change had caused a number of groups with low social-economic status to be easily affected by infectious diseases. The deterioration of standard of living made the TB situation even worse.
When it comes to tuberculosis, it is a disease that is bound to social conditions. Factors that affected the TB situation in Russia were macroeconomic destruction, worsening of standard of living, increasing number of unemployment and homeless, and these factors were due to political, economic, and social instability. Insufficient financing and the increase of unemployment rate, which caused the decline of X-ray coverage, aging of TB department medical member, and the follow-up treatment of patients from prisons are main tasks for the TB department (ministry of Public Health, RF) to face.
42% of the Russian TB problem is in prisons. The problem of MDR-TB is yet to be settled. Besides, HIV/TB coinfection speeds the deterioration of TB. The acceptance of different kind of statistics of TB epidemiology (for example, the inclusion of prisoners, armed forces, homeless, immigrants, in the list of form № 8) had a great influence on the raise of TB incidence and mortality rate in Russia.
European countries have registered rising tuberculosis (TB) over the last decade, and the situation in the countries of central and eastern Europe and the former Soviet countries is particularly serious. The principal reasons for the increase in TB in the region are:
1.poorly managed and outdated practices, which cause the increase in MDR-TB.
2.economic recession, poverty, malnutrition, alcohol/drug abuse, overcrowded prisons, lack of access to health care.
3.immigration from TB high-burden countries(to western Europe countries).
4.increasing rates of HIV infection, HIV/TB coinfection leads to high mortality rate.
Reasons 1,2,4 discussed above are the case in Russia. |
