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Transcript of Tuberculosis
Tuberculosis: a Global Problem Explained within the United States
U.S. Structural Vulnerabilities of TB
Majority of the TB threat resides in urban areas that comprise of 15% of the U.S.’ population (Oren et al., 2011, p. 1256).
Living conditions, population density, lack of available healthcare (Oren et al., 2011).
Jails & Prisons
“...up to 17 times the TB prevalence in the U.S. population; prison inmates have approximately four times the U.S. prevalence” (Roberts et al., 2006, p. 125)
6.5 percent of all cases in the U.S. in 1997 were from the homeless (Curtis et al., 2000, 308).
Ventilation is an issue (Curtis et al., 2000, 311).
Preventative measures: screening upon arrival, chest radiograph testing for those TST (Tuberculin Skin Test) positive and creating separate sections for TB patients. (Curtis et al., 2000, 311).
Medical history and physical examination
Chest radiography and determination of immune response
Skin testing - tuberculin inserted into forearm and swelling/hardened reaction is measured
Interferon gamma release assay - blood test and measure of infected white blood cells
Sputum testing - phlegm test for germs
Depending on where the applicant is from, different tests looked at based on WHO estimated regions of risk
Initial Phase (first 2 months): Main drugs in the form of pills are administered
usually administered for 4 months
administered for 7 months for patients with cavitary pulmonary tuberculosis and other special cases
Directly Observed Therapy (DOT) - health care professional is present for each dose to make sure it is consumed, standards for immigrant applicants
What is Tuberculosis?
One third of the world's population is infected with TB (WHO)
People with HIV are 20-30 times more likely to develop active TB
TB can become multidrug-resistant to standard treatments
This is a particular problem in the United States due to lack of cultural understanding and structural vulnerability.
Primarily caused by
thrive in areas of the body with blood and oxygen
Airborne bacteria known as droplet nuclei spread through sneezing and coughing down into the throat into the alveoli
Bad cough lasting at least 3 weeks
Coughing up blood or sputum
Weight loss and loss of appetite
Sweating at night
Centers for Disease Control and Prevention. (2012). Reported Tuberculosis in the United States, 2011.
Atlanta, GA: U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/tb/statistics/reports/2011/pdf/report2011.pdf
Centers for Disease Control and Prevention. (2008). Promoting Cultural Sensitivity: A Practical Guide for
Tuberculosis Programs That Provide Services to Persons from China. Atlanta, GA: U.S. Department of Health and Human Services, 9-10. Retrieved from http://www.cdc.gov/tb/publications/guidestoolkits/EthnographicGuides/China/chapters/china.pdf
Curtis, B., Novick, F., Driscoll, J., Blair, D., Oxtoby, M., McGarry, M., Hiscox, B., Faulkner, C.,
Taber, H., Valway, S., & Onorato, M. (2000). Analysis of Mycobacterium tuberculosis
transmission patterns in a homeless shelter outbreak. The International Journal of
Tuberculosis and Lung Disease, 4(4), 308-313. Retrieved from
National Research Council. (2000). Ending Neglect: The Elimination of Tuberculosis in the United
States. Retrieved from http://www.nap.edu/openbook.php?record_id=9837&page=1
Oren, E., Winston, C., Pratt, R., Robison, V., & Narita, M. (2011). Epidemiology of Urban
Tuberculosis in the United States, 2000-2007. Am J Public Health, 101(7), 1256-1263. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110232/#__ffn_sectitle
Roberts, C., Lobato, M., Bazerman, L., Kling, R., Reichard, A., & Hammett, T. (2006). Tuberculosis
Prevention and Control in Large Jails: A Challenge to Tuberculosis
Elimination. American Journal of Preventive Medicine, 30(2), 125-130. Retrieved from
“...but also of rising concern was the specter of multidrug-resistant tuberculosis...” (National Research Council, 2000.)
Strong association with HIV: 82 percent of TB patients reported having HIV in 2011 (CDC, 2012, p. 3).
Urban Areas (cont.)
Have qualified interpreters available
Allow patients to be honest and do not discount beliefs that are not held by Western medicine
Do not make assumptions on a race based on stereotypes, turn all supposed “facts” into questions-- open, accepting attitude.
Important to maintain respect between patient and doctor by:
listening to patient and asking questions
blend of traditional and Western medicine
David Pilachowski, Sari Dorn, Dana Parker, Melissa Morella, Cam Rogers & Nathalia Cibotti
Source: CNN News
TB scare on U.S. flight-- overreaction? Centers for Disease Control and Prevention thought so.
Outreach activities are the first step in educating anyone who needs awareness because people who are informed of the significance of TB are more likely to contribute
There are many places from which to gather funds such as federal, state and local government or foundations through thoe Fundation Center.
Donations for organizations such as Project HOPE in Malawi help give professionals a means with which to work towards treatment of patients