WordNet

straightforward in means or manner or behavior or language or action; "a direct question"; "a direct response"; "a direct approach"
having no intervening persons, agents, conditions; "in direct sunlight"; "in direct contact with the voters"; "direct exposure to the disease"; "a direct link"; "the direct cause of the accident"; "direct vote" (同)unmediated
in precisely the same words used by a writer or speaker; "a direct quotation"; "repeated their dialog verbatim" (同)verbatim
(of a current) flowing in one direction only; "direct current"
be in charge of
being an immediate result or consequence; "a direct result of the accident"
command with authority; "He directed the children to do their homework"
direct in spatial dimensions; proceeding without deviation or interruption; straight and short; "a direct route"; "a direct flight"; "a direct hit"
give directions to; point somebody into a certain direction; "I directed them towards the town hall"
guide the actors in (plays and films)
lacking compromising or mitigating elements; exact; "the direct opposite"
moving from west to east on the celestial sphere; or--for planets--around the sun in the same direction as the Earth
similar in nature or effect or relation to another quantity; "a term is in direct proportion to another term if it increases (or decreases) as the other increases (or decreases)"
watch attentively; "Please observe the reaction of these two chemicals"
behave as expected during of holidays or rites; "Keep the commandments"; "celebrate Christmas"; "Observe Yom Kippur" (同)celebrate, keep
conform ones action or practice to; "keep appointments"; "she never keeps her promises"; "We kept to the original conditions of the contract" (同)keep
stick to correctly or closely; "The pianist kept time with the metronome"; "keep count"; "I cannot keep track of all my employees" (同)keep, maintain
without anyone or anything intervening; "these two factors are directly related"; "he was directly responsible"; "measured the physical properties directly"
in a forthright manner; candidly or frankly; "he didnt answer directly"; "told me straight out"; "came out flat for less work and more pay" (同)flat, straight
without deviation; "the path leads directly to the lake"; "went direct to the office" (同)straight, direct
(medicine) the act of caring for someone (as by medication or remedial training etc.); "the quarterback is undergoing treatment for a knee injury"; "he tried every treatment the doctors suggested"; "heat therapy gave the best relief"

PrepTutorEJDIC

『まっすぐな』,一直線の(straight),直進する / (列車などが途中駅に寄らずに)直行 / 直系の / 『直接の』,じかの / 『率直な』,単刀直入の / 全くの,絶対の / 原典どおりの / 『まっすぐに』,直行で / 〈事〉‘を'『指揮する』,監督する / 《文》〈人〉‘に'『命令する』,指図する / 〈人〉‘に'(…への)『道を教える』《+『名』〈人〉+『to』+『名』》 / (…に)〈目・注意・努力など〉‘を'『向ける』《+『名』+『to』(『at, toward』)+『名』(do『ing』)》 / 〈音楽・演劇・映画など〉‘を'『指揮する』,演出する,監督する / (…に)〈手紙など〉‘を'あてる《+『名』+『to』+『名』》
…‘を'『観察する』,注意して見る;…‘を'見て気づく / 《『observe』+『that節』》…‘と'『述べる』,言う / 〈法律・慣習・義務など〉‘を'『泉る』 / 〈儀式など〉‘を'『とり行う』,挙行する,〈祭日・祭など〉‘を'祝う(celebrate) / 観察(観測)する / (…について)所見を述べる,論評する《+『on』(『upon』)+『名』》
『まっすぐに』,一直線に / 『直接に』,じかに / 『まさに』,全く(absolutely, exactly) / 『すぐに』,直ちに(at once)《英話》やがて,ほどなく / …するとすぐに(as soon as)
(病気の)治療,療法 / =psychotherapy

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/19 02:29:18」(JST)

wiki en

DOTS redirects here. For the medical mnemonic, see DOTS (mnemonic).

DOTS (directly observed treatment, short-course), is the name given to the tuberculosis control strategy recommended by the World Health Organization.^[1] According to WHO, “The most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The best curative method for TB is known as DOTS.”^[2] DOTS has five main components:

Government commitment (including political will at all levels, and establishment of a centralized and prioritized system of TB monitoring, recording and training).
Case detection by sputum smear microscopy.
Standardized treatment regimen directly of six to nine months observed by a healthcare worker or community health worker for at least the first two months.
A drug supply.
A standardized recording and reporting system that allows assessment of treatment results.

History

The technical strategy for DOTS was developed by Karel Styblo of the International Union Against TB & Lung Disease in the 1970s and 80s, primarily in Tanzania, but also in Malawi, Nicaragua and Mozambique. Styblo refined, “a treatment system of checks and balances that provided high cure rates at a cost affordable for most developing countries.” This increased the proportion of people cured of TB from 40% to nearly 80%, costing up to $10 per life saved and $3 per new infection avoided.^[3]

In 1989, WHO and the World Bank began investigating the potential expansion of this strategy. In July 1990, the World Bank, under Richard Bumgarner's direction, invited Styblo and WHO to design a TB control project for China. By the end of 1991, this pilot project was achieving phenomenal results, more than doubling cure rates among TB patients. China soon extended this project to cover half the country.^[4]

During the early 1990s, WHO determined that of the nearly 700 different tasks involved in Styblo's meticulous system, only 100 of them were essential to run an effective TB control program. From this, WHO's relatively small TB unit at that time, led by Arata Kochi, developed an even more concise "Framework for TB Control" focusing on five main elements and nine key operations. The initial emphasis was on "DOT, or directly observed therapy, using a specific combination of TB medicines known as short-course chemotherapy as one of the five essential elements for controlling TB.^[5] In 1993, the World Bank’s Word Development Report claimed that the TB control strategies used in DOTS were one of the most cost-effective public health investments.^[6]

In the Fall of 1994, Kraig Klaudt, WHO's TB Advocacy Officer, developed the name and concept for a marketing strategy to brand this complex public health intervention. To help market "DOTS" to global and national decision makers, turning the word "dots" upside down to spell "stop," proved a memorable shorthand that promoted "Stop TB. Use Dots!"^[7]^[8]

According to POZ Magazine, “You know the worldwide epidemic of TB is entering a critical stage when the cash-strapped World Health Organization spends a fortune on glossy paper, morbid photos and an interactive, spinning (!) cover for its 1995 TB report.”^[9] India's Joint Effort to Eradicate TB NGO observated that, ”DOTS became a clarion call for TB control programmes around the world. Because of its novelty, this health intervention quickly captured the attention of even those outside of the international health community."^[7]

The DOTS report was released to the public on March 20, 1995, at New York City’s Health Department. At the news conference, Tom Frieden, head of the city’s Bureau of TB Control captured the essence of DOTS, "TB control is basically a management problem.” Frieden had been credited for using the strategy to turn around New York City’s TB outbreak a few years earlier.^[10]^[11]

On March 19, 1997, at the Robert Koch Institute in Berlin, Germany, WHO announced that "DOTS was the biggest health breakthrough of the decade." According to WHO Director-General Hiroshi Nakajima, “We anticipate that at least 10 million deaths from TB will be prevented in the next ten years with the introduction and extensive use of the DOTS strategy.” ^[12]^[13] Upon Nakajima's death in 2013, WHO recognized that the promotion of DOTS was one of WHO's most successful programs developed during his ten-year administration.^[14]

Impact

There has been a steady global uptake of DOTS TB control services over the subsequent decades. Whereas less than 2% of infectious TB patients were being detected and cured, with DOTS treatment services in 1990 approximately 60% have been benefitted from this care. Since 1995, 41 million people have been successfully treated and up to 6 million lives saved through DOTS and the Stop TB Strategy. 5.8 million TB cases were notified through DOTS programs in 2009.^[15]

A systematic review of randomized clinical trials found no difference for cure rates as well as the treatment completion rates between directly observed therapy (DOT) and self-administered drug therapy.^[16] A 2013 meta-analysis of both clinical trials and observational studies too did not find any difference between DOTS and self-administered therapy.^[17] However, the WHO and all other TB programs continue to use DOTS as an important strategy for TB delivery for fear of drug resistance.

DOTS-Plus is for multi-drug-resistant tuberculosis (MDR-TB).

Systemic review does not show that DOTS is more efficacious than self administered treatment.( Volmik J, et al. Cochrane library . Issue 1, 2005 . oxford)

References

^ As of 1997, in its revised guidelines for national TB control programs, WHO increasingly stopped spelling out the DOTS acronym. This was due to the perceived overemphasis on the directly observed therapy component (DOT), which is only one of the five essential components of DOTS. See Treatment of TB: Guidelines for National Programmes. World Health Organization. WHO/TB/97.220. 1997
^ "Tuberculosis." WHO factsheet (revised). No. 104. March 1996.
^ "TB: Join the DOTS." The Economist. May 20, 1995. P. 89.
^ "Controlling Tuberculosis in China." In Millions Saved: Proven Successes in Global Health, edited by Ruth Levine, 31–37. Washington, D.C.: Center for Global Development, 2004.
^ "Framework for Effective Tuberculosis Control." World Health Organization. Document WHO/TB/94.179.
^ World Bank. 1993. World Development Report 1993: Investing in Health. Oxford University Press: New York.
^ ^a ^b "Creation of DOTS" JEET (Joint Effort to Eradicate Tuberculosis) http://archive.is/85fS5
^ Ogden, J., et al (2003). "The politics of ‘branding’ in policy transfer: the case of DOTS for tuberculosis control." In Social Science & Medicine. 57 (pp, 179-188).
^ "Lives in Turnaround: WHO knows how to address TB." POZ Magazine. Aug./Sept. 1995. P. 16.
^ "WHO Calls for Action Against TB." Science. Vol. 267. March 24, 1995. (https://www.sciencemag.org/content/267/5205/1763.1.citation?related-urls=yes&legid=sci;267/5205/1763).
^ Klaudt, K. (2000). "The Political Causes and Solutions of the Current Tuberculosis Epidemic." In J. Whitman (Ed.), The Politics of Emerging and Resurgent Infectious Diseases (pp. 86—109). London: MacMillan Press.
^ "Breakthrough in TB Control Announced by WHO." WHO press release. WHO/23, March 19, 1997
^ "Is DOTS the Health Breakthrough of the 1990s?" World Health Form. Vol. 18, No. 3/4, 1997. World Health Organization. Geneva.
^ "Former Director-General of WHO dies: health contributions remembered." WHO note for the media. January 28, 2013. (http://www.who.int/mediacentre/news/notes/2013/nakajima_death_20130128/en/),
^ United Nations Millennium Development Goals Report 2011. 2011, p. 51.
^ Volmink, J; Garner P (2007). "Directly observed therapy for treating tuberculosis". The Cochrane database of systematic reviews (1): CD003343. doi:10.1002/14651858.CD003343. PMID 12535470.
^ Pasipondya, JG; Gumbo T (2013). "A meta-analysis of self-administered vs directly observed therapy effect on microbiologic failure, relapse, and acquired drug resistance in tuberculosis patients." 57 (1). pp. 21–31. doi:10.1093/cid/cit167. PMID 23487389.

External links

DOTS program WHO - DOTS
ACTION Advocacy to Control TB Internationally

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