Compliance with the treatment by patients with the co-infection HIV/tuberculosis: integrative literature review

This is an integrative review whose objective was to evaluate the evidences available in the literature about the factors associated to the compliance with the treatment by patients with the co-infection HIV/TB. Articles published in the period from 2002 to 2008, in the databases LILACS and MEDLINE were analyzed. The material was categorized according to the year of publication, periodical, study location and factors related to the compliance. The final sample included eight articles. The factors found, associated to the compliance with the treatment of the co-infection HIV/TB, related to: the individual and his lifestyle (previous TB treatment, fear of stigma and discrimination, use of chemical substances, depression, social support); the disease and the medication (type of medication regime, use of other medication, adverse effects, difficulty to diagnose TB in these patients); and the health services (operational problems to follow up the treatment, training of the professionals, supervision, different locations to treat TB and HIV).     

HIV/AIDS stigma among older PLWHA in south rural China

Stigma is a common problem among people living with HIV/AIDS (PLWHA). However, little is known about HIV/AIDS‐related stigma in older PLWHA over the age of 50. This study described the stigma of HIV/AIDS and its factors based on 120 PLWHA aged 50 or older in an area of high HIV prevalence in south rural China. Each participant completed a face‐to‐face questionnaire that collected information on demographic characteristics, AIDS‐related events and experience of HIV/AIDS‐related stigma. Finally, only 18.1% reported experiencing external stigma compared with 64.3% feeling internal stigma. Regression analysis indicated that social support and health status were the two variables that were significantly predictive of both external and internal stigma. Whatever, the more support were received from family members by PLWHA, the less external stigma was perceived. Negative marital situation was also related to external stigma. Reducing HIV/AIDS stigma requires a supportive environment, positive attitude and correct knowledge of AIDS. Health workers and policy makers should take practical approaches to reduce prejudice.     

妇科恶性肿瘤患者病耻感现状及影响因素分析

目的：探讨妇科恶性肿瘤患者病耻感现状及并分析其影响因素。方法：选取天津市某肿瘤医院156例妇科恶性肿瘤患者为研究对象,采用一般资料调查表及社会影响量表进行调查。结果：患者病耻感总分为（60.21±8.06）分,多元线性回归分析结果显示,经济状况、疾病类型、手术史是病耻感的影响因素 （P＜0.05）。结论：妇科恶性肿瘤患者病耻感总体处于中等偏高水平,其中子宫内膜癌患者病耻感得分更高,且病耻感受多种因素影响,因此在临床工作中,护士应该针对具有高危因素的患者提供针对性的干预措施,以降低妇科恶性肿瘤患者病耻感水平,提高患者的生存质量。     

Overcoming mental disorder stigma: A short analysis of patient memoirs

There is controversy concerning the relationship between stigma and the conceptualization of mental illness as a biomedical disease. Proponents of the biomedical model argue that conceptualizing mental illness as a biochemical disease benefits patients, because it not only enables them to receive medical treatments but also helps them avoid the stigmas associated with mental illness. Opposing this position, others suggest that biomedical causal trajectory further contributes to stigma. When considering individuals' sense of well‐being while living with a mental illness, we believe that this debate detracts us from the most important aspects of removing stigma and enabling patients to develop fulfilling lives. Thus, using patient memoirs, we refocus attention on the patient experience itself, searching for how patients' memoirs can illustrate roads to recovery, resilience, and coping. We examine first what facilitates patients to live a fulfilling life and next, what obstacles they identify to a fulfilling life in the face of their encounter with mental illness.     

Negotiating identity: a qualitative analysis of stigma and support seeking for individuals with cerebral palsy

Abstract

Purpose: The current research investigates how adults with cerebral palsy construct their personal and social identities in the face of stigma when support seeking, and considers the dilemmas they might face when doing so. Method: Participants were 28 adults with cerebral palsy who completed an online survey reporting on their identity as a person with cerebral palsy and their experiences of stigma when seeking and accessing support. Results: Qualitative analyses indicated that the majority of participants sought support to help manage their cerebral palsy. Of these, half reported experiencing stigma in these environments, although they largely continued seeking support despite this. The majority viewed both their personal identity (i.e. as a unique individual) and their social identity (i.e. as a person with cerebral palsy) as important to their sense of self. However, how participants constructed their identity also appeared to vary according to context. While they appeared to value being seen as an individual to receive support that was unique to their needs (their personal identity), they also reported valuing the group to facilitate coping with stigma (their social identity). Yet, despite their utilities, enacting their identity in each of these ways was associated with costs. In order to access desired support, they had to incorporate their social identity as similar to other disabled people, which led to stigmatization through feelings of difference to the non-disabled. Conversely emphasizing individuality and difference from the disabled stereotype was associated with concerns about the degree to which their suitability for support might be questioned by their care provider. Conclusions: As has been observed in many fields, stigma can complicate identity. In this domain, people with cerebral palsy face a number of threats in how they construe their identity, both in navigating stigma and maintaining access to needed support.

• Implications for Rehabilitation

• Stigma in help and support settings remains a significant problem for adults with cerebral palsy (CP). This creates dilemmas regarding how they view and construct their identity in the contexts of stigma and support-seeking.

• It is important for specialists to recognize that the needs of adults with CP are unique, and so provided services should be tailored to the individual.

• Healthcare providers should also encourage their patients to actively engage with online disability support groups in order to build a meaningful social identity with other people with CP.

     

Tuberculosis care: Olympics 1948 vs 2012

Tuberculosis (TB) is a multi-faceted illness associated with a long and fascinating history. Although much has changed in the diagnosis, treatment and prevention of TB over the past six decades, many of the challenges remain remarkably similar. In developing solutions to these challenges, key stakeholders and politicians would do well to learn from some of the more effective strategies from the pre-chemotherapy era. Despite working with insufficient resources, nurses have historically contributed significantly to the work of the multidisciplinary teams in delivering care to patients and families, as well as in implementing national TB control and prevention programmes. The current resurgence of TB in the UK makes it imperative to achieve consistently and appropriately-funded TB services across the country. Whether NHS commissioners and politicians will engage with nurses and others in the reconfigured NHS to achieve this, however, remains to be seen.     

Delivering happiness: translating positive psychology intervention research for treating major and minor depressive disorders

Despite the availability of many treatment options, depressive disorders remain a global public health problem. Even in affluent nations, 70% of reported cases either do not receive the recommended level of treatment or do not get treated at all, and this percentage does not reflect cases of depression that go unreported due to lack of access to health care, stigma, or other reasons. In developing countries, the World Health Organization estimates that <10% receive proper depression care due to poverty, stigma, and lack of governmental mental health resources and providers. Current treatments do not work for everyone, and even people who achieve remission face a high risk of recurrence and residual disability. The development of low-cost effective interventions that can serve either as initial therapy for mild symptoms or as adjunctive therapy for partial responders to medication is an immense unmet need. Positive activity interventions (PAIs) teach individuals ways to increase their positive thinking, positive affect, and positive behaviors. The majority of such interventions, which have obtained medium-size effect sizes, have been conducted with nondepressed individuals, but two randomized controlled studies in patients with mild clinical depression have reported promising initial findings. In this article, the authors review the relevant literature on the effectiveness of various types of PAIs, draw on social psychology, affective neuroscience and psychophamacology research to propose neural models for how PAIs might relieve depression, and discuss the steps needed to translate the potential promise of PAIs as clinical treatments for individuals with major and minor depressive disorders.     

T-SPOT.TB assay usage in adults and children

The diagnosis and treatment of TB infection is one of the public health priorities. Until recently, diagnosis of TB infection has been based on the tuberculin skin test (TST). However, this is neither 100% sensitive nor specific for the diagnosis of TB infection owing to its many drawbacks. More recently, T-cell-based IFN-γ release assays (IGRAs) have been developed. In this article, we review the clinical performance of one of the IGRAs, T-SPOT.TB assay, for the diagnosis of TB infection in adults and children. We discuss the principle of the assay, its utility in active TB diseases, latent TB infection and the performance of the test in specialized subgroups of patients, such as immunocompromised individuals. When compared with the TST, the T-SPOT.TB assay has better specificity in bacillus Calmette-Guérin-vaccinated individuals, and data suggest that T-SPOT.TB may be more sensitive than the TST. Data in groups at high risk of progression to disease support the idea that T-SPOT.TB performs better than the TST. In addition, application of T-SPOT.TB by using bodily fluids such as cerebrospinal fluid, bronchoalveolar lavage fluid and pleural fluid may offer new diagnostic approaches in extrapulmonary TB disease. Although IGRAs cannot distinguish active TB disease from latent TB infection, these assays perform better than the TST for the detection of TB infection.     

Primary Care Practice for Gender-Diverse Patients Using Gender-Affirming Hormone Therapy

Transgender and gender-diverse individuals face discrimination, bias, stigma, socioeconomic barriers, lack of knowledgeable, and/or supportive gender-affirming health care across the nation. Many primary care providers have not been educated about gender-affirming hormone therapy and the health care considerations using these necessary hormones for patients ≥16 years old. This review highlights basic gender-affirming hormone therapy management with monitoring parameters and some common primary care practice applications for transgender and gender-diverse patients. Evidence-based guidelines, resources, and advocacy links are provided and in alignment with the latest version of the World Professional Association for Transgender Health Standards of Care.     

Clinical evaluation of QuantiFERON TB-2G test in patients with healed pulmonary tuberculosis

We evaluated the response to the QuantiFERON TB-2G (QFT-2G) test in patients with healed pulmonary tuberculosis (TB) compared to the response in those with active pulmonary TB. The subjects were 208 patients with healed pulmonary TB and 155 patients with active pulmonary TB. The QFT-2G test results were analyzed by stratifying them into 5- or 10-year periods after the completion of antituberculosis treatment. Of the 208 patients with healed pulmonary TB, 63% had a positive tuberculin skin test (TST) and 34% had a positive QFT-2G test result. There was no significant difference in the positive response rate for the QFT-2G test, or in the positive test result rate for only the early secretory antigenin target 6-kD protein (ESAT-6) antigen, only the culture filtrate protein 10 (CFP-10) antigen, or both the ESAT-6 and CFP-10 antigens among any subgroups stratified by 5- or 10-year periods after the completion of antituberculosis treatment. The positive rate for the QFT-2G test was significantly higher in patients with active pulmonary TB (83%) than in patients with healed pulmonary TB (34%). Regarding the combined and separate responses to both the ESAT-6 and CFP-10 antigens, the positive response rate for both antigens was significantly lower in patients with healed pulmonary TB than in those with active pulmonary TB. Because many patients continued to show a positive response to the QFT-2G test even when a long period had passed after the completion of the antituberculosis treatment, it is suggested that, in patients with a previous history of TB, particular attention must be paid to the relapse of TB or reinfection with TB.     

Financial challenges to access tuberculosis treatment in Ribeirão Preto - São Paulo

The objective of this study was to analyze the financial challenges that patients have to deal with to access the Tuberculosis (TB) Care Reference Centers in Ribeir?o Preto. Adjustments were made to the Primary Care Assessment (PCAT) and an opinion poll was made with one-hundred patients following treatment and 16 health care professionals working at TB Reference Centers in Ribeir?o Preto. Anova, Kruskall Wallis and chi-square tests were used. Most patients were males and most health care professionals were female. Differences were found between Centers C and A, in that Center C (p=0.028) offers a bus pass, and in A (p=0.010) patients paid for their own transportation. The indicator medical appointment in 24 hours showed a satisfactory level. There were disagreements between the reports from patients and health professionals as to the center offering the bus pass. Patients face challenges in their treatment, such as costs with transportation or being late for work, which result in losses in the family income.     

HIV感染者/AIDS病人相关羞辱和歧视的调查研究

[目的]了解HIV感染者/AIDS病人相关羞辱和歧视现状,为寻求降低其相关羞辱和歧视的干预对策提供依据。[方法]应用HIV感染者/AIDS病人相关羞辱和歧视量表对100例HIV感染者/AIDS病人进行调查和评定。[结果]HIV感染者/AIDS病人相关羞辱和歧视总分为132.96分±21.49分,处于较高水平,性传播病人与吸毒病人的羞辱和歧视差异比较有统计学意义(P<0.05)。[结论]HIV感染者/AIDS病人有较严重的羞辱和歧视感,应采取积极有效的干预措施降低病人的羞辱和歧视。     

British HIV Association national audit on the management of patients co-infected with tuberculosis and HIV

This audit aims to compare UK management of tuberculosis (TB)/HIV co-infection with recommended practice and to describe local care arrangements. Services providing HIV care were invited to complete a survey of care arrangements and to review case notes of HIV positive patients aged over 16 who started therapy for active TB between October 2007 and April 2008. Corresponding TB services, if separate, were invited to complete a similar survey. Responses were received from 124 of 170 HIV services, and 18 corresponding TB services. Data were obtained for 236 coinfected patients. Despite some incomplete data, this audit yielded useful findings. Many positive smear results were unacceptably delayed. The TB therapy completion rate fell short of the chief medical officer's (CMO's) 85% target. Culture confirmation of pulmonary TB met the CMO's 65% target. A high number of patients were diagnosed with HIV during investigation of TB. Contrary to current guidelines, many services do not routinely test TB patients for HIV.     

服刑人员129例肺结核平片分析

目的 :探讨服刑人员肺结核影像特点及临床类型。材料与方法 :对普查发现的 12 9例肺结核病例拍摄后前位胸片 ,部分病例加拍侧位片 ,分析其影像形成的病理机制 ,病变特点和临床类型。结果 :原发性肺结核 10例 ,占 7 8% ;血行播散性肺结核 2例 ,占 1 5 % ;继发性肺结核 70例 ,占 5 4 3% ;结核性胸膜炎 4 7例 ,占 36 4 %。结论 :服刑人员肺结核以继发性多见 ,其次为结核性胸膜炎。病变呈多种病理性质 ,慢性化过程 ,形态多样 ,范围广 ,新老病灶同时存在 ,空洞率高 ,并发症多     

Experiences of a community-based tuberculosis treatment programme in Namibia: a comparative cohort study

Background

Tuberculosis (TB) remains a widespread healthcare problem in Africa, although it can be cured within 6-8 months’ effective treatment. However, many patients fail to adhere to TB treatment, resulting in failure to get cured and the possible development of multi-drug resistant TB (MDR TB). A community-based TB treatment programme, was started in the Omaheke region of Namibia during 2002. The efficacy of this community-based TB programme, compared to the standard hospital- and clinic-based TB treatment, was unknown.

Objectives

The major objectives were to compare TB treatment outcomes for patients who used the community-based TB with those who chose the clinic/self-administered TB treatment option; and to identify advantages and disadvantages of community-based TB care as experienced by patients who had completed their community-based TB treatment.

Design

A quasi-experimental study design was used to compare TB patients’ treatment outcomes using checklists and exit interviews.

Setting

The study was conducted in the Omaheke region of Namibia.

Participants

TB patients (n = 332) who were hospitalised during the study period participated in the study.

Methods

An analytic cohort prospective design was used to do follow-up visits, and complete checklists, of 332 TB patients. Structured exit interviews were conducted with 101 TB patients who had completed their community-based TB treatment.

Results

Enhanced knowledge of TB patients improved their participation in community-based TB care. A family member was the most convenient, acceptable and accessible directly observed treatment (DOT) supervisor for 72.8% of the participants. A statistically significant difference in cure rates between community-based and the clinic/self-administered groups was found (χ² 11.78; p ≤ 0.05; and RR = 1.35; p = 0.05). The major advantages of community-based TB treatment included the ability to continue with one's daily activities during treatment and the saving of time and money. The major disadvantages included that the clinics ran out of TB drug supplies, patients did not always have food to eat after taking their pills and they could not get sufficient rest because they had to continue doing their daily chores.

Conclusions

TB patients on the community-based TB treatment option had better cure rates than those on clinic/self-administered TB treatment (although it cannot be inferred that the community-based treatment caused the improved cure rates, because the TB patients who did not select the community-based treatment option might have been different). The advantages experienced by patients who completed their community-based TB treatment outweighed the disadvantages.     

Tuberculosis of the genitourinary system

Tuberculosis (TB) is a deadly infectious disease. Pulmonary TB cases have decreased; yet, extrapulmonary cases such as genitourinary TB have not (Centers for Disease Control and Prevention, 2005). Health care awareness of the clinical features of genitourinary TB is necessary to effectively treat patients with this disease.     

阿尔茨海默病患者挑战性行为与病耻感的关系研究

目的调查阿尔茨海默病患者挑战性行为与病耻感的关系。方法采用便利抽样法选取122例阿尔茨海默病患者为研究对象,使用中文版阿尔茨海默病患者挑战性行为量表和病耻感自我评定量表进行问卷调查。结果阿尔茨海默病患者发生挑战性行为有104例,发生率为85.2%,挑战行为总分为(26.01±12.04)分。病耻感总分为(28.10±4.61)分,社交、治疗及能力维度的得分分别为(15.04±6.33)分、(9.52±4.91)分、(10.27±4.09)分。Pearson相关分析显示,患者挑战性行为与病耻感总分及社交、治疗及能力维度均呈正相关(P<0.05)。多元回归分析结果显示,文化程度、伴随疾病、自理能力和病耻感是阿尔茨海默病发生挑战性行为的影响因素。结论阿尔茨海默病患者病耻感对挑战性行为具有正向预测作用,病耻感高的患者更容易发生挑战性行为。     

湖北省石首市和巴东县肺结核患者就诊和卫生系统延迟情况及影响因素分析

  目的  对湖北省2个县（市）的肺结核病患者的就诊和卫生系统延迟情况进行调查,分析其影响因素,为结核病患者早发现,早治疗提供依据。  方法  采用横断面调查,通过现场面对面的询问和收集患者的病案信息、医院门诊记录和住院记录的方式调查患者的就诊和诊疗信息,应用单因素分析和多因素logistic回归分析进行影响因素分析。  结果  肺结核患者的就诊延迟中位数为7（P₂₅～P₇₅∶0～30）d,咳嗽或咳痰（OR=1.97,95%CI: 1.04～3.75）,到达首次就诊医疗机构的距离>20 km （OR=2.35,95%CI: 1.36～4.06）为就诊延迟的危险因素,胸痛（OR=0.47,95%CI: 0.25～0.89）为就诊延迟的保护因素。 肺结核患者卫生系统延迟的中位数为24（P₂₅～P₇₅: 13～54）d,就诊次数和就诊的不同医疗机构数为患者卫生系统延迟的危险因素（P<0.05）,且就诊次数和就诊的不同医疗机构数越多,结核病患者发生卫生系统延迟的风险越大。 肺结核患者总延迟的中位数为56（P₂₅～P₇₅: 26～138）d,咳嗽或咳痰（OR=2.37, 95%CI: 1.14～4.95）,痰涂片阳性（OR=2.07, 95%CI: 1.16～3.68）,到达最近结核病定点医疗机构距离>30 km（OR=1.92,95%CI: 1.04～3.55）,就诊次数3～4次（OR=2.50,95%CI: 1.25～4.97）和就诊次数>4次（OR=25.42,95%CI: 5.19～124.44）均为患者总延迟的危险因素（P<0.05）。  结论  本研究中肺结核患者总延迟主要由卫生系统延迟造成,在采取有效措施减少患者就诊延迟的同时,还需要改善患者的就医行为,优化患者就医路径,提高非结核病定点医疗机构对结核病的警觉性和诊疗水平,发挥分子生物学检查等手段在患者筛查中作用,提高结核病诊断水平,减少患者卫生系统延迟。     

教育管理体系对佛山市结核病医院公众结核病防治知识的影响

目的探讨我市结核病医院内部人群对大众结核病防治知识知晓率情况,为我市有效开展结核病防控健康工作提供科学依据。方法对研究人群进行分类(医技人员、院内非医技人员、外聘公司人员、患者及家属),采用结核病防治知识调查问卷,分析比较不同人群对结核病防治知识的差异,并分析其影响因素。结果调查人群结核病防治知识的总知晓率为95.34%,其中性别与户籍类型人员对知晓率无统计学意义,不同人群类别特征中总知晓率差异有统计学意义(Z=38.74,P0.05)。结论我市结核病医院内的人群对结核病防治知识知晓率较高,但需进一步提高公众结核病防治知识的知晓率。