Family health team knowledge concerning the health needs of people with tuberculosis

The purposes of the study were to get to know conceptions on tuberculosis and health needs and to describe the care provided to people with tuberculosis, according to health professionals' perspective. Qualitative study developed at family health units in Cap?o Redondo, S?o Paulo. The data were collected through open interviews in January 2010 and submitted to discourse analysis, resulting in three categories: meanings attributed to tuberculosis and health needs and care characteristics. The conceptions regarding the disease are supported by the multi-causal theory of the health-disease process. The care is characterized by interventions that go beyond the biological dimension. The precarious living conditions define the needs of most people with tuberculosis, and can be more important to the ill than the very diagnosis of the disease, influencing treatment adherence, and should gain relevance in care.     

Seeking tuberculosis care in Chiapas, Mexico]

OBJECTIVE: To analyze the process of seeking tuberculosis care and this process's impact on treatment adherence in the Mexican state of Chiapas, given that the two primary factors in successful tuberculosis (TB) control programs are early diagnosis and adherence to TB treatment. METHODS: We conducted a qualitative study using group interviews with 11 groups of patients in three of the nine socioeconomic regions of the state of the Chiapas (Altos, Centro, and Fronteriza). RESULTS: The patients applied a variety of approaches in seeking care. The patients reported considerable delays in diagnosis due to problems that the patients themselves had and because of shortcomings in the care they received from the formal health care system. The treatment options that they followed were the result of their perceptions of the causes of TB and of the variety of traditional medical practices accepted in their communities. CONCLUSIONS: The lack of knowledge about TB encourages people to consider various alternatives for their care. Tuberculosis control in Chiapas requires an optimal utilization of the health services that exist in the state as well as a program of health education. TB control in Chiapas must take into account the social, cultural, and economic reality of the population.     

南宁市基层医疗卫生机构管理的肺结核患者结核病防治核心知识知晓率分析

目的 分析南宁市基层医疗卫生机构管理的肺结核患者对结核病防治核心知识的知晓率水平,探索其影响因素,为完善结核病健康管理提供依据。方法 对311名南宁市基层医疗卫生机构服务的对象（肺结核患者）采用结构化问卷进行面对面调查,了解患者对结核病防治核心知识的知晓情况、认知态度及知识来源情况;统计学分析采用统计软件IBM SPSS Statistics23 进行。结果 311名肺结核患者对结核病核心知识总的知晓率为80.02%（1742/2177）。对结核病归口管理政策的知晓率最高（94.86%）,对结核病治疗转归的知晓率最低（46.95%）,结核病防治7条核心知识的知晓率差异有统计学意义（χ2 = 379.459,P＜0.01）。不同民族和职业分类患者的知晓率差异有统计学意义（χ2值分别为36.613、18.178;P值分别为＜0.001、0.003）。多因素分析显示,年龄和职业是结核病防治核心知识知晓率的影响因素。311名患者中,70%以上患者对结核病的认知态度比较正面,欢迎基层医疗卫生机构人员为其提供健康管理服务。患者获取结核病防治核心知识的途径比较分散,从医生处获得最高（28.63%）,从学校教育中获得最低（1.83%）。结论 南宁市基层医疗卫生机构管理的肺结核患者对结核病防治核心知识的总的知晓率仍未达到结核病防治规划提出的85%的指标要求,今后需要在继续发挥基层医疗卫生机构人员在结核病防治健康促进工作中的作用、联合卫生健康部门和教育部门将结核病健康教育列入学校教学计划中去及探索针对不同人群特点的健康促进方式,最终提高总人群的结核病防治核心知识知晓率。     

Behavioral interventions for the control of tuberculosis among adolescents

OBJECTIVES: Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations. METHODS: The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention. RESULTS: A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics. CONCLUSIONS: Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.     

Health care channels for new cases of respiratory tuberculosis in Seine Saint-Denis in 1984-1986

The purpose of this study was to observe routine practice in the care of tuberculosis cases treated in the Seine Saint-Denis department in 1984, with reference to the recent recommendations of the French Pneumology Society. The pathway of each patient through the care network was established for 336 adult cases being treated for respiratory tuberculosis for the first time. The social and economic cost of each pathway was evaluated. The results show the multiplicity of health services intervening in the care of these patients, the persistence of hospitalization, sanatorium care, and long sick-leaves from work, together with major differences in the care pathways according to the nationality, sex, and socio-economic group of the patients. The cost of tuberculosis treatment is shown to be high for both patients and the community.     

Interventions to improve the health of the homeless: a systematic review

BACKGROUND: Homelessness is a widespread problem in the United States. The primary goal of this systematic review is to provide guidance in the development and organization of programs to improve the health of homeless people. METHODS: MEDLINE, CINAHL, HealthStar, PsycINFO, Sociological Abstracts, and Social Services Abstracts databases were searched from their inception through July 2004 using the following terms: homeless, homeless persons, and homelessness. References of key articles were also searched. 4564 abstracts were screened, and 258 articles underwent full review. Seventy-three studies conducted from 1988 to 2004 met inclusion criteria (use of an intervention, use of a comparison group, and the reporting of health-related outcomes). Two authors independently abstracted data from studies and assigned quality ratings using explicit criteria. RESULTS: Forty-five studies were rated good or fair quality. For homeless people with mental illness, case management linked to other services was effective in improving psychiatric symptoms, and assertive case management was effective in decreasing psychiatric hospitalizations and increasing outpatient contacts. For homeless people with substance abuse problems, case management resulted in greater decreases in substance use than did usual care. For homeless people with latent tuberculosis, monetary incentives improved adherence rates. Although a number of studies comparing an intervention to usual care were positive, studies comparing two interventions frequently found no significant difference in outcomes. CONCLUSIONS: Coordinated treatment programs for homeless adults with mental illness or substance abuse usually result in better health outcomes than usual care. Health care for homeless people should be provided through such programs whenever possible. Research is lacking on interventions for youths, families, and conditions other than mental illness or substance abuse.     

Cost savings from alternative treatments for tuberculosis

The cost effectiveness of short tuberculosis treatment regimes using rifampicin (R) or ethambutol (E) is calculated and compared to long regimes based on thiacetazone and isoniazid (TH). Although rifampicin and ethambutol are more costly per case they are only about one half the cost of the isoniazid based regimes per person effectively treated. This result is primarily derived from higher patient compliance with the short regimes. In addition, ambulatory treatment, where practical, is approximately one third the cost per person effectively treated of regimes using inpatient treatment for the first 2 months. Applied to 1982 data for Botswana, the analysis reveals that treating 80% of patients through ambulatory R and E regimes would have reduced total health expenditures for tuberculosis care by two thirds compared to inpatient regimes based on TH, and the number of people complying and cured would have doubled.     

大学生结核病健康教育效果评价

[目的]评价对大学生实施结核病健康教育的效果。[方法]采用随机整群抽样的方法,从某高校中随机抽取一定数量的学生,随机分为结核病健康教育组(以下简称教育组)和对照组,在教育组实施为期一个学期的结核病健康教育,用自行设计的问卷,分别在健康教育前后对两组进行基线调查和终期调查。[结果]健康教育后教育组对结核病基本知识知晓率显著提高,与结核病相关的态度明显好转,行为意向方面有显著提高,而对照组无变化。[结论]对大学生进行结核病健康教育效果显著,操作方便,值得推广。     

南充市工厂职工结核病防治知识知晓率调查

目的了解南充工厂职工结核病防治知识的知晓现状,为更有效地开展结核病防治健康促进工作提供依据。方法采用横断面整群抽样法抽取调查对象开展问卷调查。结果职工对结核病5条核心信息总知晓率63.0%,知晓率与文化、城乡、年龄等因素有关。文盲组、20～30岁组和农村组知晓率较低,对"连续咳嗽咳痰两周以上或有咯血、痰中带血症状,应该怀疑得了肺结核"知晓率为76.3%,但对国家有免费检查治疗政策知晓率仅为53.0%。结论南充工厂职工结核病防治知识知晓率与国家规划目标要求还有差距,应加大健康教育力度。     

Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection

This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further.     

基层疾控中心对流动人口肺结核的健康教育及护理体会

目的探讨基层疾控中心对流动人口肺结核的健康教育及护理作用,为结核病的防治提供帮助。方法收集我县自2007年至2008年（健康教育前）与2009年至2010年（健康教育后）的流动人口肺结核的就诊及治疗情况,对两阶段流动人口结核病人登记涂阳率,对结核知识的知晓率、治疗依从性及并发症等方面进行系统比较。结果通过将健康教育及护理工作放在首位及加强督导管理,病人治疗依从性明显提高,流动人口肺结核的涂阳登记率及初诊病人的就诊率,对结核知识的知晓率,治疗依从性都有明显提高,并发症逐年下降,差异具有统计意义（p〈0.05）。结论健康教育及护理工作在针对流动人口肺结核病患者的防治中起着积极的作用,提高了结核病的治疗效果及管理效果。     

健康教育在重症监护室中的应用效果

目的：探讨健康教育在重症监护室中的应用效果。方法：将2011年6月-2012年6月人住重症监护室的36例患者作为观察组，将2010年1月-2011年1月人住重症监护室的32例患者作为对照组。观察组由专门的责任组成员对患者进行系统的、全方位的、动态的、连续的健康教育，包括心理指导、饮食指导、用药指导、作息指导、健康知识传授和技能指导等。对照组应用传统的护理方法进行常规护理及睡眠卫生宣教，常规开展人院介绍，术前、术中、术后健康教育。比较两组患者对疾病相关知识的掌握情况，并发症发生率及患者和家属对护理工作的满意度。结果：观察组患者对疾病掌握情况和治疗效果明显好于对照组，观察组并发症发生率明显低于对照组，观察组患者和家属对护理工作的满意度明显高于对照组，两组比较差异均有统计学意义（P〈O．05）。结论：重症监护室实施系统的、全方位的、动态的、连续的健康教育可以促进患者尽早度过危险期，早日转到普通病房继续治疗，提高患者满意度。     

Perceptions of tuberculosis and health seeking behaviour in rural Inner Mongolia, China

PURPOSE: This study aimed to explore perceptions of TB, and health care seeking pathways, among poor rural communities in Inner Mongolia. METHODOLOGY: Twenty focus group discussions (FGDs) were held and 105 farmers were included. Six hundred and fourteen randomly selected respondents were surveyed through interview questionnaire, in three poor rural counties with a high TB prevalence. MAIN FINDINGS: A substantial proportion of community members were unclear or misinformed as to how TB was transmitted. Sixty percent of respondents identified prolonged cough as a main symptom of TB, while only 40% perceived TB to be caused by 'close interaction with TB patient'. In addition, 70% could not afford TB treatment and fell into debt as a result of having to seek medical care. Social stigma associated with TB influenced marriage prospects and impeded important social interactions within the community. Respondents' perceptions of TB were associated with their socio-economic status. Women, young people, low-income groups and those with less education tended to be less knowledgeable about TB. All farmers in the study reported only seeking health care after they failed to treat themselves; and most of them then sought care from less qualified village level health care providers. Less educated people, low-income groups and old people were identified as less likely to seek care, or more likely to seek care at village level where it is cheaper. Both financial and structural barriers were found to stop farmers seeking health care. CONCLUSIONS AND POLICY IMPLICATIONS: Perceptions of TB and social stigma associated with the disease, together with socio-economic factors, shape the health seeking behaviour of poor farmers. Accessibility and affordability of TB health care issues should be dealt with through a multi-pronged approach, including health promotion in addition to expansion of the DOTS strategy and rural health insurance schemes.     

定远县居民结核病防治知识现状调查

目的分析定远县居民结核病防治知识知晓水平,为制定结核病健康促进计划提供依据。方法采取随机抽样方法,对不同层次目标人群进行问卷调查并统计分析。结果结核病防治知识知晓率为76.41%。最喜爱的健康教育形式是通过电视、医务人员、广播等传播。结论应开展人们喜闻乐见的健康教育活动,提高结核病防治知识水平。     

Analysis & commentary: The Affordable Care Act lays the groundwork for a national diabetes prevention and treatment strategy

The Affordable Care Act includes several provisions that could create a comprehensive approach to preventing and treating diabetes and other chronic health conditions. The current prevention and treatment system is an unconnected, silo-based approach, which reduces the effectiveness and increases the cost of health care. This article presents a three-part proposal: expand the Diabetes Prevention Program nationally; build care coordination through health teams into the traditional Medicare program; and use these teams to connect public health, prevention, and treatment. Enrollment in evidence-based lifestyle modification programs-specifically, those focused on excess weight-should be added as a covered benefit under Medicare with no cost sharing. Funding for the Medicare component could be provided through the budget of the Center for Medicare and Medicaid Innovation. The proposal in its totality has the potential for improving health outcomes and reducing costs.     

Community knowledge, attitudes and practices towards tuberculosis and its treatment in Mpwapwa district, central Tanzania

Tuberculosis (TB) is one of the leading causes of adult mortality with 32% of the global population infected with Mycobacterium tuberculosis. The current control of TB depends mainly on case management using the Direct-Observed Treatment, Short-course (DOTs) regimen. Despite the measures taken, the disease burden is still on increase especially in the developing countries including Tanzania. Correct knowledge and positive perception of the community towards TB and its management is a prerequisite to early treatment seeking. This study was carried out in Mpwapwa district, central Tanzania, to assess the knowledge, attitudes and practice as regards to TB and its treatment. Focus group discussions involving men and women were conducted in six villages. Results show that TB was an important public health problem. However, community knowledge on its cause was poor. Symptoms of TB as mentioned by the community included persistent cough and weight loss. TB was reported to be transmitted mainly through air. Self medication was the first most preferred option, whereas health care facility consultation was the last one. Focus group discussants knew that TB cure requires a 8-month period of treatment. Friends and relatives were the main source of TB information in the community. In conclusion, rural communities of Mpwapwa District have a low knowledge on the causes and the transmission of tuberculosis which is a likely cause of the delay in seeking treatment. An intensive appropriate community health education is required for a positive behavioural change in tuberculosis control.     

General practitioner attitudes to discussing sexual health issues with older people

How health professionals perceive and manage later life sexual problems remains relatively unexplored and, in particular, little is known about the attitudes of GPs, who represent the first point of contact for most older people in the UK who experience sexual health concerns. This paper draws on qualitative data generated from in-depth interviews with 22 GPs working in demographically diverse primary care practices in Sheffield, UK. Analysis identified that GPs do not address sexual health proactively with older people and that, within primary care, sexual health is equated with younger people and not seen as a 'legitimate' topic for discussion with this age group. However, it was apparent that many beliefs held about the sexual attitudes and behaviours of older people were based on stereotyped views of ageing and sexuality, rather than personal experience of individual patients. The discussion considers the implications of these findings for primary care, particularly in relation to education and training.     

Disease-specific health education for COPD: a systematic review of changes in health outcomes

A systematic review was conducted to determine the benefits of disease-specific health education for people with chronic obstructive pulmonary disease (COPD). A search was conducted through Medline, CINAHL, PsycINFO, Embase, Cochrane Library, Physiotherapy Evidence Database and reference lists to obtain publications reporting on educational interventions compared with usual medical care. Two reviewers independently assessed each paper for methodological quality and data extraction. Thirteen publications describing 10 randomized controlled trials were identified for inclusion. The studies reported on a very broad variety of outcomes and follow-up periods, making a meta-analysis not possible for most measures. Didactical educational intervention for the COPD population appeared to have minimal effect on health outcomes including quality of life, health care utilization, exercise capacity or lung function and is therefore not the education delivery method recommended. Education focusing on self-management showed encouraging results with a tendency for improvements in quality of life and health care utilization, but the results did not reach statistical significance as sample sizes were insufficient to detect an effect. Further research is required into self-management education as it is not possible to make generalizations from the current published literature as to the benefits in changing health status in the COPD population.     

社区医护人员PICC健康教育知信行调查分析*

目的调查分析社区医护人员对经外周静脉置中心静脉导管(PICC)健康教育知信行情况。方法选取上海市两家三甲医院医护人员120人(三甲组)与五家社区医院医护人员120人(社区组)进行比较研究,纳入时间2015年1月—2017年1月,对两组医护人员PICC健康教育知信行情况进行调查,比较两组医护人员PICC健康教育知信行各个维度与总分,以及健康知识知晓情况。结果三甲组医护人员在PICC健康教育行为评分、知识评分和信念评分上与社区组比较无明显差异(P0.05),但总分明显高于社区组(P0.05);三甲组医护人员在PICC基本知识、预防知识、带管注意事项和应急处理知识知晓率上均显著高于社区组(P0.05);社区组行为知晓条目的平均分和标准得分略高于社区组。结论社区医护人员PICC健康教育知信行调查结果表明存在不足之处,维度评分与总分不高,而且在PICC基本知识、预防知识、带管注意事项和应急处理知识知晓率上较低,需加大培训与宣教力度。     

The confidence in health care and social services in northern Sweden - a comparison between reindeer-herding Sami and the non-Sami majority population

Aims: To investigate the confidence in primary health care, psychiatry and social services among the reindeer-herding Sami and the non-Sami population of northern Sweden. Methods: A semi-randomized, cross-sectional study design comprising 325 reindeer-herding Sami (171 men, 154 women) and a control population of 1,437 non-Sami (684 men, 753 women). A questionnaire on the confidence in primary health care, psychiatry, social services, and work colleagues was distributed to members of reindeer-herding families through the Sami communities and to the control population through the post. The relative risk for poor confidence was analyzed by calculating odds ratios with 95% confidence intervals adjusted for age and level of education. Results: The confidence in primary health care and psychiatry was significantly lower among the reindeer-herding Sami compared with the control group. No differences were found between men and women in the reindeer-herding Sami population. In both the reindeer-herding Sami and the control population, younger people (≤48 years) reported significantly lower confidence in primary health care than older individuals (>48 years). Conclusions: A conceivable reason for the poor confidence in health care organizations reported by the reindeer-herding Sami is that they experience health care staff as poorly informed about reindeer husbandry and Sami culture, resulting in unsuitable or unrealistic treatment suggestions. The findings suggest that the poor confidence constitutes a significant obstacle of the reindeer-herding Sami to fully benefit from public health care services.