Preventive treatment has an essential effect on latent tuberculosis infection(LTBI)[purified protein derivative(PPD)induration≥15 mm].Between2010 and 2013,there were 6 tuberculosis(TB)outbreaks in the universities in...Preventive treatment has an essential effect on latent tuberculosis infection(LTBI)[purified protein derivative(PPD)induration≥15 mm].Between2010 and 2013,there were 6 tuberculosis(TB)outbreaks in the universities in Dalian,China.So far,in Dalian,the directly observed therapy(DOT)and展开更多
Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations...Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.展开更多
MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I...MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I.P. （Institute on Drugs and Drug Addiction）, the PPS （Portuguese Pharmaceutical Society）, and the ANF （National Association of Pharmacies）. In January 2004, the INFARMED （National Authority of Medicine and Health Products） became a partner of the program. The possibility of continuing the treatment at a community pharmacy was restricted to patients receiving a stabilized dose of methadone at IDT, I.P. treatment centers. Pharmacists joining the MMT were given mandatory training. Patients on the MMT program received daily doses of methadone solution under directly observed therapy, and were followed up by trained pharmacists. From January 1998 to January 2013, 3,090 patients underwent MMT in Portuguese community pharmacies. The delivery of MMT at community pharmacy level is feasible. This strategy improves access and adherence to methadone treatment, thus helping to reduce the use of illegal opioids. Community pharmacists fully demonstrated their ability to perform extended roles in public health and harm-reduction strategies. Interaction and close cooperation between the different health professionals and organizations involved were crucial to achieve adequate support to the patients.展开更多
In March 2002,the government of China launched the World Bank Loan/ Department for International Development-supported Tuberculosis （TB） Control Project to reduce the prevalence and mortality of TB. The project gene...In March 2002,the government of China launched the World Bank Loan/ Department for International Development-supported Tuberculosis （TB） Control Project to reduce the prevalence and mortality of TB. The project generated promising results in policy development, strengthening of TB control systems, patient treatment success,funds management, and the introduction of legislation. In light of the global TB epidemic and control environment, it is useful to review the TB control priorities of the project, summarize the achievements and experiences around its implementation.展开更多
Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopi...Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.展开更多
Background:While investment in the development of Tuberculosis(TB)treatment strategies is essential,it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constr...Background:While investment in the development of Tuberculosis(TB)treatment strategies is essential,it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints.This study aimed to determine the economic consequences of directly observed therapy for TB patients.Methods:A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa,Ethiopia.Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients’Costs.Mean and median costs,reduction of productivity,and household expenditure of TB patients were calculated and ways of coping costs captured.Eta(η),Odds ratio and p values were used to measure association between variables.Results:Of the total 576 TB patients enrolled,43%were smear-positive pulmonary TB(PTB),17%smear-negative PTB,37%Extra-PTB and 3%multi-drug resistant TB cases.Direct(Out-of-Pocket)mean and median costs of TB illness to patients were$123.0(SD=58.8)and$125.78(R=338.12),respectively,and indirect(loss income)mean and median costs were$54.26(SD=43.5)and$44.61(R=215.6),respectively.Mean and median total cost of TB illness to patient were$177.3(SD=78.7)and$177.1(R=461.8),respectively.The total cost had significant association with patient’s household income,residence,need for additional food,and primary income(P<0.05).Direct costs were catastrophic for 63%of TB patients,regardless of significant difference between gender(P=0.92)and type of TB cases(P=0.37).TB patients mean productivity and income reduced by 37 and 10%,respectively,compared with pre-treatment level,while mean household expenditure increased by 33%and working hours reduced by 78%due to TB illness.Income quartile categories were directly correlated with catastrophic costs(η=0.684).Conclusion:Despite the availability of free-of-charge anti-TB drugs,TB patients were suffering from out-of-pocket payments with catastrophic consequences,which in turn were hampering the efforts to end TB.TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage,financial incentives,and nutrition support to reduce catastrophic costs and retain them in care.Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities,intensify home treatment of critically-ill patients with impaired mobility,and reduce the spread of TB due to patients traveling to seek care.展开更多
文摘Preventive treatment has an essential effect on latent tuberculosis infection(LTBI)[purified protein derivative(PPD)induration≥15 mm].Between2010 and 2013,there were 6 tuberculosis(TB)outbreaks in the universities in Dalian,China.So far,in Dalian,the directly observed therapy(DOT)and
文摘Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.
文摘MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I.P. （Institute on Drugs and Drug Addiction）, the PPS （Portuguese Pharmaceutical Society）, and the ANF （National Association of Pharmacies）. In January 2004, the INFARMED （National Authority of Medicine and Health Products） became a partner of the program. The possibility of continuing the treatment at a community pharmacy was restricted to patients receiving a stabilized dose of methadone at IDT, I.P. treatment centers. Pharmacists joining the MMT were given mandatory training. Patients on the MMT program received daily doses of methadone solution under directly observed therapy, and were followed up by trained pharmacists. From January 1998 to January 2013, 3,090 patients underwent MMT in Portuguese community pharmacies. The delivery of MMT at community pharmacy level is feasible. This strategy improves access and adherence to methadone treatment, thus helping to reduce the use of illegal opioids. Community pharmacists fully demonstrated their ability to perform extended roles in public health and harm-reduction strategies. Interaction and close cooperation between the different health professionals and organizations involved were crucial to achieve adequate support to the patients.
文摘In March 2002,the government of China launched the World Bank Loan/ Department for International Development-supported Tuberculosis （TB） Control Project to reduce the prevalence and mortality of TB. The project generated promising results in policy development, strengthening of TB control systems, patient treatment success,funds management, and the introduction of legislation. In light of the global TB epidemic and control environment, it is useful to review the TB control priorities of the project, summarize the achievements and experiences around its implementation.
文摘Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.
文摘Background:While investment in the development of Tuberculosis(TB)treatment strategies is essential,it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints.This study aimed to determine the economic consequences of directly observed therapy for TB patients.Methods:A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa,Ethiopia.Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients’Costs.Mean and median costs,reduction of productivity,and household expenditure of TB patients were calculated and ways of coping costs captured.Eta(η),Odds ratio and p values were used to measure association between variables.Results:Of the total 576 TB patients enrolled,43%were smear-positive pulmonary TB(PTB),17%smear-negative PTB,37%Extra-PTB and 3%multi-drug resistant TB cases.Direct(Out-of-Pocket)mean and median costs of TB illness to patients were$123.0(SD=58.8)and$125.78(R=338.12),respectively,and indirect(loss income)mean and median costs were$54.26(SD=43.5)and$44.61(R=215.6),respectively.Mean and median total cost of TB illness to patient were$177.3(SD=78.7)and$177.1(R=461.8),respectively.The total cost had significant association with patient’s household income,residence,need for additional food,and primary income(P<0.05).Direct costs were catastrophic for 63%of TB patients,regardless of significant difference between gender(P=0.92)and type of TB cases(P=0.37).TB patients mean productivity and income reduced by 37 and 10%,respectively,compared with pre-treatment level,while mean household expenditure increased by 33%and working hours reduced by 78%due to TB illness.Income quartile categories were directly correlated with catastrophic costs(η=0.684).Conclusion:Despite the availability of free-of-charge anti-TB drugs,TB patients were suffering from out-of-pocket payments with catastrophic consequences,which in turn were hampering the efforts to end TB.TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage,financial incentives,and nutrition support to reduce catastrophic costs and retain them in care.Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities,intensify home treatment of critically-ill patients with impaired mobility,and reduce the spread of TB due to patients traveling to seek care.
