Tuberculosis (abbreviated to TB) is one of important global health hazards. Since 1993, World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD) have been conducting an all-out global wide campaign of integrated care for TB patients called Directly Observed Treatment Short-course (DOTS). DOTS was found to be most effective by WHO after trials in many countries with high prevalence of TB, and now it is highly recommended by WHO to all countries as a profound TB control strategy. World Bank has also made an assessment of DOTS and hails it a health investment of the highest cost benefit. DOTS is to take advantage of the watchful eyes of a trustworthy bystander to closely observe the process, ascertain that the patient would take each and every dose of prescribed TB medications, and thus make sure the patient would get cured. It is hoped to be able to spot and identify 75% of all smear positive TB patients and cure 85% among them.
For many years, both incidence and mortality rates of TB have stayed number ones among those of all notifiable communicable diseases in Taiwan. Taiwan health authority finally followed the WHO
recommendation and launched a DOTS trial program in certain mountainous rural areas in 1997, and phased into a gradual expansion in 2001 in accordance with the execution of then TB Control Year campaign. In April 2006 after the last batch of counties and cities of Taiwan joined in, a brand new
nationwide ?DOTS program? was born, in which special case carers were officially hired, and hopefully we would reach the DOTS goals set by WHO in the foreseeable future. The purpose of this study was to find out the DOTS program?s cost-effectiveness in two consecutive years, i.e. one year (2005/4/1-2006/3/31) immediately prior to the launch of the new DOTS program, and the one (2006/4/1-2007/3/31) that followed, through the expenditures for the implementation of the DOTS program, indices of therapeutic effectiveness in the two years, and at various stages of its implementation and a cost-benefit analysis of the treatments involved. The figures used in this study were mainly obtained from a Taiwan CDC database for registration of TB case notifications. The individual notified cases studied took place either in. There were 5679 notified TB cases studied. Meanwhile, we also got access to a Department of Health database of death causes and the relevant medical expenditure records from Central Regional Branch, Bureau of National Health Insurance (NHI) for necessary data using the ID number of the patient involved.
Our results indicate that during the specified two years, the age of new TB cases was still getting older, and more males turned out than females, but it seemed the program had but little influence on the
therapeutic outcomes. Fore instance, the accumulated treatment success rate one year after the initiation of the new program turned out to be 97%, somewhat improved from the rate (92.3%) in the previous year of the launch of the new program. In the aspect of mortality, the total mortality of the four counties/cities in the central region of Taiwan that died of TB one year after the implementation of the new program was 20.4%, which is clearly lower than that (22.4%) in the previous year. This indicates that the region?s total mortality did drop considerably due to the enforcing of the DOTS program. Aside from that, about the qualifying rate expressed by successfully changing from smear-positive to smear-negative within three months, there were 91.0% of all cases being successful one year after the activation of the new program, which was, as a whole, better than the 84.2% showing just one year before. Also, among all individual cases that have participated in the DOTS program, the successful changing rates were all better when covered by formal DOTS 95.0%,DOTS program .Overall speaking, to promote DOTS intervening measures turned out to be with a certain degree of positive cost effectiveness. Comparing the accomplishments of the four counties/cities of the central region of Taiwan, we found that Changsha County ranked number one and its success made it a model for the other three to learn from.
The purpose of this study was to understand the health promoting lifestyles on senior high school students in Taichung and to assess the effectiveness of the first of four stage teaching program. Use the Theory of Planned Behavior as a conceptual framework, a quasi-experimental single group design was used in the study. The data were collected from 999 first grade senior high school students using a self-reported questionnaire.
The main findings of the study are as follows:
1? The score of health promoting lifestyles is low, range from 50 to 74. Among them, the highest score was the international relations, followed by spiritual growth, stress management, nutrition, physical activity, and the lowest was health responsibility.
2? The perception of behavior control was the strongest predictor, explained 31.9% of the variance of health promoting lifestyle.
3? After the first stage intervention, students had higher score in physical activity, but not others.
According to the finding of this study, school should continue the teaching program, and focus on
enhancing student?s self-responsibility on health and their sense of control on health lifestyle behavior in order to promote healthy lifestyle effectively.
