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Statistics for the last 6 years show a trend to growing number of new cases with tuberculosis of the lungs with drug-resistant pathogen. In recurrent tuberculosis multiple drug resistance (MDR) was three times higher than in new cases. Treatment efficacy depended on MDR and patients' compliance. The results of the basic treatment course were unstable: many patients had exacerbation within 3-4 years after therapy, many patients died, especially those with M. tuberculosis resistant to many drugs.

The present clinical and social characteristics of new cases with pulmonary tuberculosis show some features. The clinical characteristics of patients in 1995 to 1997 indicate an increased number of patients with disseminated, frequently bilateral processes and acute tuberculosis which is largely associated with the decline in preventive fluorographic surveys of the population including those who have contacted bacteria-isolating patients. There were 61.3% with pulmonary symptoms among those who visit physicians and 62.1% among those from the foci of tuberculous infection. Social aspects of the study demonstrate that there is a great number of young patients (56.4% of those under 39-49 years) and a high proportion (81.1%) of able-bodied patients among both males and females. There was an increase in the proportion of patients having higher education (43.7%) and a decrease in laboring patients (21.4%). This is most likely to be associated with the fact that many patients did not work by the profession they had been trained. There was a higher proportion (43.0%) of the patients having different poor working conditions and patterns. In these years, the patients' financial position deteriorated. It was slightly better in the employed than in the unemployed. However, in both groups the bulk of the patients had income per head in the family at the subsistence level or lower (56.2 and 21.6% in the unemployed and employed, respectively. These data were assessed by the guidelines made by the State Statistics Committee of the Russian Federation and the RF Ministry of Labour. It should be noted that the nutritional quality did not correspond to the optimal composition ratio of dietary foods and it was characterized by the high content of less valuable foods, carbohydrates, low levels of protein and vitamins. Poor social aspects in characteristics of patients were undoubtedly to be associated with a greater number of patients with severe, frequently progressive forms of tuberculosis although they had received specific chemotherapy.

Three hundred and eighty new cases of pulmonary tuberculosis were examined and the characteristics of a tuberculous process studied in different social groups (industrial and office workers, unemployed) in relation to methods of detection of the disease: on referrals or prophylactic examinations. There was a considerable reduction in the proportion of patients whose disease was detected on prophylactic examinations, and in the families of patients with tuberculosis. The tuberculous process detected on referrals was characterized by its higher prevalence and a qualitatively more severe form (caseous pneumonia, fibrinous-cavernous, and cavernous processes). A decay phase and bacterial isolation were more frequently noted.

Disability was analyzed in 270 patients with pulmonary tuberculosis detected in 1995-1997. Today the level of disability and its associated expenses on payment of allowances due to the working incapacity of patients with pulmonary tuberculosis are more and more determined by different poor social factors, such as the specific features of the labour market, unemployment, lower living conditions of most patients with this disease.

The paper analyzes the examination of 240 patients with alleviating pulmonary tuberculosis (follow-up group 2) and provides clinical and social characteristics of this group of patients who had poor social factors, such as a social behaviour, alcoholism, unemployment, etc. Ninety one patients had various concomitant visceral diseases. During treatment of pulmonary tuberculosis, most patients developed profound residual changes. This all requires more thorough follow-up while performing seasonal drug regimens and other prophylactic measures in Group 2 patients.

As shown by medical disability expert commission which followed up 142 tuberculous patients throughout chemotherapy, the disability in new-onset tuberculosis cases is related both to medical and social factors. The jobs of 1/2 of the examinees were not fit for such patients. More than half of them had concomitant visceral lesions. The duration of temporary disability was consequent to many factors, the principal of which were dissemination and destruction: subjects with local infection without destruction were incapable 192 days, on the average, while those with tuberculosis dissemination and destruction 266 days. 14.1% became invalids. Only a small group of the patients were not in need of social support.

A group of new-onset pulmonary tuberculosis patients has been studied and its social characterization is provided in the paper. Comparison of the 1991-1992 findings with those obtained in 1970-1980 has indicated that social aspects are topical as before and have some specific features in recent years. The most important issues are now living conditions, financial status of the patients, their social lifestyle, refugees and rational employment of tuberculosis patients and disabled persons.

Sickness certificates for prolonged recovery terms (by 2.5 months, on the average) were given to 330 tuberculous patients. It is shown that when the disability expert commission fixed prolonged terms for convalescence (10 months and longer) for tuberculous patients, this led to the disease stabilization in 90% of the patients who were able to resume their previous work. Only 10% of them became invalids.

The present status of disability problem due to tuberculosis is presented. Its characteristic features typical of tuberculosis are identified: a considerable contribution of social factors to permanent disability in tuberculosis patients, an epidemiologic factor and disability establishment in subjects who have been recovered of tuberculosis and develop severe dysfunctions in the presence of post-tuberculous changes. Ways for reducing tuberculosis-caused disability rates are outlined.

A specially developed screening was used to examine 652 workers of an assembly shop of a watch plant whose work is characterized by their being in a constrained position for hours which leads of general inactivity and hypoventilation. Disturbances of external respiratory function were found in 180 (27.6%) subjects, which is associated with their working conditions rather than with smoking. These subjects deserve special care since the pre-clinical obstructive bronchial changes can be the precursors of broncho-pulmonary diseases and later of tuberculosis.

A combination of factors conducive to disability development due to tuberculosis infection was established in 1004 newly diagnosed cases. Stable loss of their working capacity was promoted by a combination of social and medical factors. Among the social factors, the unfavourable working conditions (70%) were most significant, while among the medical ones, the process progression (44.5%) and serious functional disturbances (61.6%) were predominant.

The role of the highest tuberculosis risk groups in the enlargement of dispensary contingents increases under conditions of endemic tuberculosis decline while it is less manifest in the epidemiologically unfavourable regions. Risk contingents of polyclinics should be supplemented by a socially unfavourable group of subjects who together with patients having several risk factors and those with severe diabetes mellitus are the most vulnerable with respect to tuberculosis.

For the purpose of BCG revaccination of the young people (aged 13-30 years) having a negative tuberculin response, 3 methods of vaccination were practised, including working as a team, launching an expedition and functioning within a residential area. The choice of the method required is dictated by the local conditions and the given task. A high level of tuberculosis infection was recorded, especially among the risk groups in relation to this disease. The circumstances to be taken into account when planning the tuberculosis prevention measures, i. e. BCG revaccination, are defined.