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Afaq S, Ayub A, Faisal MR, Nisar Z, Zala, Rehman AU, Ahmed A, Todowede O, Siddiqi N. Depression care integration in tuberculosis services: A feasibility assessment in Pakistan. Health Expect 2024; 27:e13985. [PMID: 39102704 PMCID: PMC10849063 DOI: 10.1111/hex.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/30/2023] [Accepted: 01/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses. OBJECTIVE The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan. DESIGN Mixed-method study. SETTING AND PARTICIPANTS Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique. RESULTS A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility. CONCLUSION There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system. PATIENT AND PUBLIC CONTRIBUTION To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.
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Affiliation(s)
- Saima Afaq
- Department of Health SciencesUniversity of YorkYorkUK
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | - Aliya Ayub
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | | | - Zara Nisar
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | - Zala
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | - Ateeq ur Rehman
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | - Afzaal Ahmed
- Institute of Public Health & Social SciencesKhyber Medical UniversityPeshawarPakistan
| | | | - Najma Siddiqi
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical SchoolYorkUK
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Mohd ZW, Ahmad SR, Yaacob NA, Mohd Shariff N, Jaeb MZ, Hussin Z. Innovative Integrated Motivational Interviewing for Dual Management in Tuberculosis Patients with Diabetes (MID-DOT) in Malaysia. Healthcare (Basel) 2023; 11:1929. [PMID: 37444763 DOI: 10.3390/healthcare11131929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Achieving successful tuberculosis (TB) treatment outcomes among diabetic patients is a real challenge as TB complicates control of diabetes. This study aimed to evaluate the effectiveness of an integrated dual management educational module, MID-DOTS, which uses the mmotivational interviewing (MI) technique implemented within directly observed treatment as part of a short course (DOTS) program in TB patients with diabetes (TB/DM). A randomized controlled trial was conducted in the northeastern state of Malaysia. (2) Methods: One hundred and twenty-four TB patients with diabetes received educational intervention using a MID-DOT module that used the MI technique, which was repetitively applied by TB nurses throughout a 6-month DOTS program while another 122 patients were given standard health education. Study outcomes include the proportion of patients with successful TB treatment, and changes in HbA1c and diabetic self-care scores at 6 months. (3) Results: The successful TB treatment outcome was 88% in the intervention group versus 72% in the control group (RR = 1.24; 95%CI 1.16, 1.58). A significant reduction of HbA1c (mean difference 0.82%; 95%CI 0.66, 0.98) and significantly higher diabetes self-care score (mean difference 8.49; 95%CI 7.38, 9.59) were also shown in the intervention group. (4) Conclusions: A dual TB/DM educational strategy which integrates the MI technique applied repetitively within the DOTS program is effective in increasing successful TB treatment as well as improving diabetic outcomes.
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Affiliation(s)
- Zahiruddin Wan Mohd
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | | | - Nor Azwany Yaacob
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | | | - Mat Zuki Jaeb
- Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia
| | - Zalmizy Hussin
- School of Applied Psychology, Social Work and Policy, Universiti Utara Malaysia, Sintok 06010, Malaysia
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Thomas D, Summers RH. Patients' perceptions and experiences of directly observed therapy for TB. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:680-689. [PMID: 35797082 DOI: 10.12968/bjon.2022.31.13.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM To understand patients' perceptions and experiences of directly observed therapy (DOT) for tuberculosis treatment in the UK. METHOD Patients receiving DOT as part of their TB treatment participated in semi-structured and audio-recorded interviews. Data were analysed using a framework approach. RESULTS Non-adherence was driven by socio-cultural, mental health, employment and discrimination factors. Patients valued DOT for its support and social connection but those in employment feared it could lead to disclosure and social discredit. CONCLUSION TB patients experience social isolation and fear discrimination. DOT offers a degree of social connection and support for marginalised patients but fails to tackle fundamental barriers to adherence such as mental health issues, addictions, housing and discrimination. Practice implications: Flexible patient-centred methods of DOT should be offered throughout patients' treatment. Research into multi-agency responsibility for promoting adherence needs to be commissioned, implemented and evaluated. Telemedicine and nurse-led clinics may improve access to care and improve patient experience.
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Affiliation(s)
- David Thomas
- TB Consultant Nurse, University Hospitals Dorset NHS Foundation Trust, Bournemouth
| | - Rachael H Summers
- Visiting Fellow, Faculty of Health Sciences, University of Southampton
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Rouf A, Masoodi MA, Dar MM, Khan SMS, Bilquise R. Depression among Tuberculosis patients and its association with treatment outcomes in district Srinagar. J Clin Tuberc Other Mycobact Dis 2021; 25:100281. [PMID: 34888421 PMCID: PMC8637130 DOI: 10.1016/j.jctube.2021.100281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is among the top 10 causes of death worldwide and there are estimated 10.4 million new (incident) patients, of which about one fourth are in India. There has been calls for rigorous investigations and interventions that may address other factors known to have effect on adherence of treatment like Depression but the amount of research into comorbidity is surprisingly low. The aim of the study was to assess magnitude and impact of depression among TB patients and determine the treatment outcomes of TB in District Srinagar. METHODS In this prospective study the adults with newly diagnosed TB were recruited within one month of initiating treatment and were followed upto the end of treatment. Data collection was done at three time-points: baseline, after 2 months and after 6 months of treatment initiation. The sample size of 200 was calculated using OpenEpi, V3 and identified 202 TB patients were interviewed in their local language and PHQ-9 scale was used to measure Depression. RESULTS The prevalence of Depression at baseline was 50.5% with CI (43.7%-57.3%). After two months of treatment the prevalence reduced to 9.4% with CI (5.9%-14.0%) and at the end of treatment to 2.5% with CI (0.91%-5.4%). Association between Depression in TB patients and treatment failure was found to be small to medium as revealed by Cramer's V test (0.29-0.59). Binary logistic regression estimated that at baseline TB patients with Depression were at 4.46 times at more risk of treatment failure than patients without Depression and those patients who continued Depression even after intensive phase were 34.5 times at higher risk. CONCLUSION Our findings indicate Depression is associated with poor treatment outcome in these patients, despite TB treatment. TB treatment strategies should consider screening and managing the psychologically distressed individuals among TB patients.
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Affiliation(s)
- Abdul Rouf
- Department of Community Medicine, Government Medical College Anantnag
| | - Muneer A Masoodi
- Department of Community Medicine, Government Medical College Anantnag
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Imam F, Sharma M, Obaid Al-Harbi N, Rashid Khan M, Qamar W, Iqbal M, Daud Ali M, Ali N, Khalid Anwar M. The possible impact of socioeconomic, income, and educational status on adverse effects of drug and their therapeutic episodes in patients targeted with a combination of tuberculosis interventions. Saudi J Biol Sci 2021; 28:2041-2048. [PMID: 33911919 PMCID: PMC8071916 DOI: 10.1016/j.sjbs.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Abstract
Socio-economic status is very important in patient receiving DOT therapy. Income influences disease occurrence as well as adverse events. Occupation increases the risk of diseases and results increase risk of adverse events. Low income results mal nutrition and increased risk of drug intolerance or adverse events. DOTS is an effective treatment strategy for MTB patients.
First-line antituberculosis (anti-TB) compounds have been considered as proven components of the Directly Observed Treatment-Short course (DOTS). Drug therapy against tuberculosis has been categorized as I, II, or III following the Revised National Tuberculosis Control Program guidelines. Anti-TB are drugs are quite common and show limited adverse effects. However, first-line anti-TB compounds mediated DOTS therapy and were found with several complications. Thus, those drugs have been discontinued. Therefore, the present study was designed to find out the possible impact of socioeconomic, income, and educational status on the adverse effects of drugs and their therapeutic episodes in patients targeted with a combination of tuberculosis intervention. This study found that an increased incidence of tuberculosis was found in patients who have finished high school, contributing to a high percentage of adverse effects. Notably, adverse events were shown maximally in poor patients compared with rich- or high-income patients. On the contrary, a high prevalence of adverse events was shown to be increased in partially skilled workers compared with full-skilled workers. Consequently, adversely considerable events were implicated to be raised in patients associated with minimal socioeconomic class. Such interesting factors would help in monitoring such events in experimental patients.
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Affiliation(s)
- Faisal Imam
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Corresponding author at: Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Post Box 2455, Riyadh 11451, Saudi Arabia.
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, New Delhi 110062, India
| | - Naif Obaid Al-Harbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad Rashid Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Wajhul Qamar
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Central Laboratory, Research Center, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad Daud Ali
- Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, As Safa, Dammam 34222, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Md. Khalid Anwar
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
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Farooq S, Tunmore J, Comber R. Pharmacological or non-pharmacological interventions for treatment of common mental disorders associated with Tuberculosis: A systematic review. Chron Respir Dis 2021; 18:14799731211003937. [PMID: 33896235 PMCID: PMC8082988 DOI: 10.1177/14799731211003937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We aimed to review the literature on interventions for treating Common Mental Disorders (CMD) in people with Tuberculosis (TB). We followed PRISMA guidelines and the protocol was registered at PROSPERO. The electronic databases (PsycInfo, CINAHL, Medline, Google Scholar, Embase) were searched from 1982 to 2020. 349 relevant records were screened, with 26 examined at full text. 13 studies were included totalling 4326 participants. A meta-analysis was not possible due to nature of data, thus descriptive synthesis was conducted. Eleven studies evaluated psychosocial interventions, which significantly improved adherence or cure rates from TB, anxiety and depression. The elements of effective psychosocial interventions included; combating stigma, socioeconomic disadvantage, managing associated guilt and fear of contagion, and explanatory models of illness in local population. Two articles evaluated pharmacological interventions (antidepressants and Vitamin D). This is the first systematic review of interventions to treat CMD in TB. The studies were mostly low quality and mental health outcomes were not adequately described. However, this review suggests that it is feasible to develop and test interventions for improving mental health outcomes and enhancing treatment adherence in TB.
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Affiliation(s)
- Saeed Farooq
- School of Medicine, 4212Keele University, Staffordshire, UK.,7586Midlands Partnership Foundation Trust, St George's Hospital, Stafford, UK
| | - Jessica Tunmore
- 7586Midlands Partnership Foundation Trust, St George's Hospital, Stafford, UK
| | - Rifat Comber
- 7586Midlands Partnership Foundation Trust, St George's Hospital, Stafford, UK
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7
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Wen S, Yin J, Sun Q. Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMJ Open 2020; 10:e036985. [PMID: 33033087 PMCID: PMC7545632 DOI: 10.1136/bmjopen-2020-036985] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB). DESIGN We searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed. SETTING Low-income and middle-income countries. PARTICIPANTS DR-TB patients. OUTCOMES Treatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more. RESULTS Among 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002). CONCLUSION Material support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions. PROSPERO REGISTRATION NUMBER CRD42019140824.
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Affiliation(s)
- Shuqin Wen
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Jia Yin
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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8
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Molebatsi K, Wang Q, Dima M, Ho-Foster A, Modongo C, Zetola N, Shin SS. Depression and delayed tuberculosis treatment initiation among newly diagnosed patients in Botswana. Glob Public Health 2020; 16:1088-1098. [PMID: 32991275 DOI: 10.1080/17441692.2020.1826049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Comorbidity of tuberculosis (TB) and depression may lead to delayed TB treatment initiation. A cross-sectional study was conducted between January and December 2019 to examine the association between depression and delayed TB treatment initiation among newly diagnosed TB patients in Botswana. We used the Patient Health Questionnaire-9 and the ZUNG self-rating anxiety scale to assess depressive and anxiety symptoms, respectively. Delayed TB treatment was defined as experiencing common TB symptoms for more than 2 months before treatment initiation. We used Poisson regression models with robust variance to assess the association between covariates and delayed treatment initiation. Majority of the enrolled 180 study participants were males (n =116, 64.4%). Overall, 99 (55%) were co-infected with HIV; depression and anxiety symptoms were reported by 47.2% and 38.5% of the participants respectively. The prevalence of delayed TB treatment was 42.6% and 18.8% among participants who indicated symptoms of depression and among participants without depression respectively. After adjusting for age, HIV status, gender and anxiety symptoms, depression was still associated with delayed TB treatment (adjusted prevalence ratio [aPR] = 2.09; 95% CI = 1.23-3.57). Integrating management of depressive symptoms during TB treatment may help in improving overall TB treatment outcomes.
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Affiliation(s)
| | - Qiao Wang
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | | | - Ari Ho-Foster
- Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chawangwa Modongo
- Botswana-UPenn Partnership, Gaborone, Botswana.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicola Zetola
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
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Sweetland AC, Galea J, Shin SS, Driver C, Dlodlo RA, Karpati A, Wainberg ML. Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis 2020; 23:600-605. [PMID: 31097069 DOI: 10.5588/ijtld.18.0530] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
<sec id="st1"> <title>SETTING</title> A global survey of National Tuberculosis Program (NTP) directors. </sec> <sec id="st2"> <title>OBJECTIVES</title> To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines. </sec> <sec id="st3"> <title>DESIGN</title> Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire. </sec> <sec id="st4"> <title>RESULTS</title> Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma. </sec> <sec id="st5"> <title>CONCLUSIONS</title> NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide. </sec>.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - J Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, California
| | - C Driver
- Vital Strategies, New York, New York, USA
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - M L Wainberg
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
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Janse Van Rensburg A, Dube A, Curran R, Ambaw F, Murdoch J, Bachmann M, Petersen I, Fairall L. Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries. Infect Dis Poverty 2020; 9:4. [PMID: 31941551 PMCID: PMC6964032 DOI: 10.1186/s40249-019-0619-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies. Main text A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified. Conclusions There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.
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Affiliation(s)
- André Janse Van Rensburg
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa.
| | - Audry Dube
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jamie Murdoch
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Max Bachmann
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa.,King's Global Health Institute, King's College London, Stamford Street, London, UK
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11
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Zhang K, Wang X, Tu J, Rong H, Werz O, Chen X. The interplay between depression and tuberculosis. J Leukoc Biol 2019; 106:749-757. [PMID: 31254317 DOI: 10.1002/jlb.mr0119-023r] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
Depression is a major mental health condition and is expected be the most debilitating and widespread health disorder by 2030. Tuberculosis (TB) is also a leading cause of morbidity and mortality worldwide and interestingly, is a common comorbidity of depression. As such, much attention has been paid to the association between these 2 pathologies. Based on clinical reports, the association between TB and depression seems to be bidirectional, with a substantial overlap in symptoms between the 2 conditions. TB infection or reactivation may precipitate depression, likely as a consequence of the host's inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Nevertheless, few studies have considered whether patients with depression are at a higher risk for TB. In this review, we discuss the hypotheses on the association between depression and TB, highlighting the immuno-inflammatory response and lipid metabolism as potential mechanisms. Improving our understanding of the interplay between these 2 disorders should help guide TB clinical care and prevention both in patients with comorbid depression and in the general population.
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Affiliation(s)
- Kehong Zhang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China.,Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Xin Wang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
| | - Jie Tu
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institutes of Advanced Technology, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, Chinese Academy of Sciences, Shenzhen, China
| | - Han Rong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Oliver Werz
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Xinchun Chen
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
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12
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A systematic review of non-pharmacological interventions to improve therapeutic adherence in tuberculosis. Heart Lung 2019; 48:452-461. [PMID: 31084923 DOI: 10.1016/j.hrtlng.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reviews examining non-pharmacological interventions to improve therapeutic adherence in tuberculosis have several limitations (design, quality assessment…). Consequently, for clinical practice, it is important to generate a review containing all the information to improve patient adherence, solving the previous issues. OBJECTIVES To examine non-pharmacological interventions to improve therapeutic adherence in tuberculosis through clinical trials. METHODS A systematic review in MEDLINE/EMBASE was performed. RESULTS Thirty seven papers were analysed. The disease treatment interventions were disparate, grouped into: education, psychological interventions, new technologies, directly observed treatment, incentives and improved access to health services. In the treatment of latent infection, the majority of studies were conducted in the marginal population (drug addicts, homeless individuals and prisoners) and were based mainly on the provision of incentives. Study quality was generally low. CONCLUSIONS Great variability exists in the studies comparing strategies for identifying interventions, objectives and effects. The designs carried out generally have methodological deficits.
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Li X, Wang B, Xu Y, Chen Y, Zhang Y, Huang J, Yang J, Tan D, Li M, Zhang D, Tang C, Cai X, Yan Y. Comprehensive Intervention for Anxiety and Depression among the Community Elderly with Tuberculosis. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1080/01973533.2019.1600519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Xuhui Li
- Tongji Medical College, Huazhong University of Science and Technology
| | - Bin Wang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Yihua Xu
- Tongji Medical College, Huazhong University of Science and Technology
| | - Yanshu Chen
- Tongji Medical College, Huazhong University of Science and Technology
| | - Ying Zhang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Jiayu Huang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Jie Yang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Dixin Tan
- Tongji Medical College, Huazhong University of Science and Technology
| | - Mengyu Li
- Tongji Medical College, Huazhong University of Science and Technology
| | - Dandan Zhang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Cong Tang
- Tongji Medical College, Huazhong University of Science and Technology
| | - Xiaonan Cai
- Tongji Medical College, Huazhong University of Science and Technology
| | - Yaqiong Yan
- Wuhan Municipal Center for Disease Control and Prevention
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14
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Alipanah N, Jarlsberg L, Miller C, Linh NN, Falzon D, Jaramillo E, Nahid P. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS Med 2018; 15:e1002595. [PMID: 29969463 PMCID: PMC6029765 DOI: 10.1371/journal.pmed.1002595] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/29/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Incomplete adherence to tuberculosis (TB) treatment increases the risk of delayed culture conversion with continued transmission in the community, as well as treatment failure, relapse, and development or amplification of drug resistance. We conducted a systematic review and meta-analysis of adherence interventions, including directly observed therapy (DOT), to determine which approaches lead to improved TB treatment outcomes. METHODS AND FINDINGS We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retrospective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions. When compared with DOT alone, self-administered therapy (SAT) was associated with lower rates of treatment success (CS: risk ratio [RR] 0.81, 95% CI 0.73-0.89; RCT: RR 0.94, 95% CI 0.89-0.98), adherence (CS: RR 0.83, 95% CI 0.75-0.93), and sputum smear conversion (RCT: RR 0.92, 95% CI 0.87-0.98) as well as higher rates of development of drug resistance (CS: RR 4.19, 95% CI 2.34-7.49). When compared to DOT provided by healthcare providers, DOT provided by family members was associated with a lower rate of adherence (CS: RR 0.86, 95% CI 0.79-0.94). DOT delivery in the community versus at the clinic was associated with a higher rate of treatment success (CS: RR 1.08, 95% CI 1.01-1.15) and sputum conversion at the end of two months (CS: RR 1.05, 95% CI 1.02-1.08) as well as lower rates of treatment failure (CS: RR 0.56, 95% CI 0.33-0.95) and loss to follow-up (CS: RR 0.63, 95% CI 0.40-0.98). Medication monitors improved adherence and treatment success and VOT was comparable with DOT. SMS reminders led to a higher treatment completion rate in one RCT and were associated with higher rates of cure and sputum conversion when used in combination with medication monitors. TB treatment outcomes improved when patient education, healthcare provider education, incentives and enablers, psychological interventions, reminders and tracers, or mobile digital technologies were employed. Our findings are limited by the heterogeneity of the included studies and lack of standardized research methodology on adherence interventions. CONCLUSION TB treatment outcomes are improved with the use of adherence interventions, such as patient education and counseling, incentives and enablers, psychological interventions, reminders and tracers, and digital health technologies. Trained healthcare providers as well as community delivery provides patient-centered DOT options that both enhance adherence and improve treatment outcomes as compared to unsupervised, SAT alone.
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Affiliation(s)
- Narges Alipanah
- University of California San Francisco, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, San Francisco, California, United States of America
- Santa Clara Valley Medical Center, Department of Internal Medicine, San Jose, California, United States of America
| | - Leah Jarlsberg
- University of California San Francisco, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, San Francisco, California, United States of America
| | - Cecily Miller
- University of California San Francisco, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, San Francisco, California, United States of America
| | - Nguyen Nhat Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | - Payam Nahid
- University of California San Francisco, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, San Francisco, California, United States of America
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15
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Sweetland AC, Kritski A, Oquendo MA, Sublette ME, Norcini Pala A, Silva LRB, Karpati A, Silva EC, Moraes MO, Silva JRLE, Wainberg ML. Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 2018; 21:852-861. [PMID: 28786792 DOI: 10.5588/ijtld.16.0584] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Kritski
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil TB Research Network (REDE-TB), Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M E Sublette
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Norcini Pala
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - L R Batista Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - E C Silva
- State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M O Moraes
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lapa E Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M L Wainberg
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
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16
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Li X, Wang B, Tan D, Li M, Zhang D, Tang C, Cai X, Yan Y, Zhang S, Jin B, Yu S, Liang X, Chu Q, Xu Y. Effectiveness of comprehensive social support interventions among elderly patients with tuberculosis in communities in China: a community-based trial. J Epidemiol Community Health 2018; 72:369-375. [PMID: 29352014 PMCID: PMC5909740 DOI: 10.1136/jech-2017-209458] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 11/28/2017] [Accepted: 01/06/2018] [Indexed: 01/25/2023]
Abstract
Background With the increasing of ageing population, tuberculosis in the elderly brings a challenge for the tuberculosis (TB) control in China. Enough social support can promote the treatment adherence and outcome of the elderly patients with TB. Exploring effective interventions to improve the social support of patients is of great significance for TB management and control. Methods A community-based, repeated measurement trial was conducted. Patients with TB >65 years of age were allocated into the intervention or control group. Patients in the intervention group received comprehensive social support interventions, while those in the control group received health education alone. The social support level of patients was measured at baseline and at the first, third and sixth months during the intervention to assess the effectiveness of comprehensive social support interventions. Results A total of 201 patients were recruited into the study. Compared with the control group, social support for patients in the intervention group increased significantly over time (βgroup*time=0.61, P<0.01) in the following three dimensions: objective support (βgroup*time=0.15, P<0.05), subjective support (βgroup*time=0.32, P<0.05) and support utilisation (βgroup*time=0.16, P<0.05). The change in the scores in the control group was not statistically significant. Conclusions The intervention programme in communities, including health education, psychotherapy and family and community support interventions, can improve the social support for elderly patients with TB compared with single health education. Trial registration number ChiCTR-IOR-16009232
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Affiliation(s)
- Xuhui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dixin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dandan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaonan Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqiong Yan
- Wuhan Municipal Center for Disease Control and Prevention, Wuhan, China
| | - Sheng Zhang
- Gutian Community Health Service, Wuhan, China
| | - Bo Jin
- Xincun Street Community Health Service, Wuhan, China
| | - Songlin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xunchang Liang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihua Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Koyanagi A, Vancampfort D, Carvalho AF, DeVylder JE, Haro JM, Pizzol D, Veronese N, Stubbs B. Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries. BMC Med 2017; 15:209. [PMID: 29179720 PMCID: PMC5704363 DOI: 10.1186/s12916-017-0975-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/09/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Depression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries. METHODS Cross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations. RESULTS The prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P < 0.001). Tuberculosis was associated with a 1.98 (95% CI 1.47-2.67), 1.75 (95% CI 1.26-2.42), and 3.68 (95% CI 3.01-4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains. CONCLUSIONS Depression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain. .,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Jordan E DeVylder
- Fordham University, Graduate School of Social Service, New York, NY, USA
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Damiano Pizzol
- Operation Research Unit, Doctors with Africa, Maputo, Mozambique
| | - Nicola Veronese
- Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy.,National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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18
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Mason PH, Sweetland AC, Fox GJ, Halovic S, Nguyen TA, Marks GB. Tuberculosis and mental health in the Asia-Pacific. Australas Psychiatry 2016; 24:553-555. [PMID: 27206468 PMCID: PMC5332205 DOI: 10.1177/1039856216649770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This opinion piece encourages mental health researchers and clinicians to engage with mental health issues among tuberculosis patients in the Asia-Pacific region in a culturally appropriate and ethical manner. The diversity of cultural contexts and the high burden of tuberculosis throughout the Asia-Pacific presents significant challenges. Research into tuberculosis and mental illness in this region is an opportunity to develop more nuanced models of mental illness and treatment, while simultaneously contributing meaningfully to regional tuberculosis care and prevention. CONCLUSIONS We overview key issues in tuberculosis and mental illness co-morbidity, highlight ethical concerns and advocate for a regional approach to tuberculosis and mental health that is consistent with the transnational challenges presented by this airborne infectious disease. Integrating tuberculosis and mental health services will go a long way to addressing the needs of vulnerable populations and stopping the transmission of one of the world's biggest infectious killers.
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Affiliation(s)
- Paul H Mason
- Research Fellow, Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, and; Honorary Fellow, Woolcock Institute of Medical Research, Glebe, NSW, and; Scholarly Teaching Fellow, Department of Anthropology, Macquarie University, Sydney, NSW, Australia
| | - Annika C Sweetland
- Assistant Professor, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Greg J Fox
- Clinical Lecturer, Medicine, Central Clinical School, University of Sydney, Sydney, NSW, and; Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Shaun Halovic
- Clinical Project Officer, Westmead Psychotherapy Program, Westmead, NSW, Clinical Lecturer, Sydney University, Sydney, NSW, Australia
| | - Thu Anh Nguyen
- Country Director, Woolcock Institute of Medical Research, Ha Noi, Vietnam
| | - Guy B Marks
- Clinical Professor, Woolcock Institute of Medical Research, Glebe, NSW, and; Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, and; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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19
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Peddireddy V. Quality of Life, Psychological Interventions and Treatment Outcome in Tuberculosis Patients: The Indian Scenario. Front Psychol 2016; 7:1664. [PMID: 27833578 PMCID: PMC5081393 DOI: 10.3389/fpsyg.2016.01664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
Objective: Psychological distress is being recognized in individuals affected with many diseases since it affects quality of life (QOF) and has gained importance in the clinical settings. Psychological interventions and their effect on the treatment outcome have yielded encouraging results in many diseased conditions. Tuberculosis (TB) ranks as a deadly disease resulting in millions of deaths worldwide. However, the effect of TB on the psychological status of patients and interventions to improve treatment outcome is neglected, especially in underdeveloped and developing countries. Methods: Systematic review of research papers that published on the QOF in TB and the effect of psychological interventions on treatment outcome were conducted. Results: Tuberculosis patients experience high levels of stress and decreased QOF. In the Indian scenario, TB patients undergo immense psychological stress similar to what is reported in other locations. Psychological interventions renewed hope on life and adherence to medication and treatment outcomes. Such psychological interventions are not practiced in Indian clinical settings. Conclusion: There is an urgent need for both governmental and non-governmental organizations to devise strategies to include psychological interventions mandatory during TB treatments. In the absence of such interventions, the fight against TB in India will remain incomplete.
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Affiliation(s)
- Vidyullatha Peddireddy
- Department of Biotechnology and Bioinformatics, University of Hyderabad Hyderabad, India
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20
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van Hoorn R, Jaramillo E, Collins D, Gebhard A, van den Hof S. The Effects of Psycho-Emotional and Socio-Economic Support for Tuberculosis Patients on Treatment Adherence and Treatment Outcomes - A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0154095. [PMID: 27123848 PMCID: PMC4849661 DOI: 10.1371/journal.pone.0154095] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is uncertainty about the contribution that social support interventions (SSI) can have in mitigating the personal, social and economic costs of tuberculosis (TB) treatment on patients, and improving treatment outcomes. OBJECTIVE To identify psycho-emotional (PE) and socio-economic (SE) interventions provided to TB patients and to assess the effects of these interventions on treatment adherence and treatment outcomes. SEARCH STRATEGY We searched PubMed and Embase from 1 January 1990-15 March 2015 and abstracts of the Union World Conference on Lung Health from 2010-2014 for studies reporting TB treatment adherence and treatment outcomes following SSI. SELECTION CRITERIA Studies measuring the effects of PE or SE interventions on TB treatment adherence, treatment outcomes, and/or financial burden. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed titles and abstracts for inclusion of articles. One reviewer reviewed full text articles and the reference list of selected studies. A second reviewer double checked all extracted information against the articles. MAIN RESULTS Twenty-five studies were included in the qualitative analysis; of which eighteen were included in the meta-analysis. Effects were pooled from 11 Randomized Controlled Trials (RCTs), including 9,655 participants with active TB. Meta-analysis showed that PE support (RR 1.37; CI 1.08-1.73), SE support (RR 1.08; CI 1.03-1.13) and combined PE and SE support (RR 1.17; CI 1.12-1.22) were associated with a significant improvement of successful treatment outcomes. Also PE support, SE support and a combination of these types of support were associated with reductions in unsuccessful treatment outcomes (PE: RR 0.46; CI 0.22-0.96, SE: RR 0.78; CI 0.69-0.88 and Combined PE and SE: RR 0.42; CI 0.23-0.75). Evidence on the effect of PE and SE interventions on treatment adherence were not meta-analysed because the interventions were too heterogeneous to pool. No evidence was found to show whether SE reduced the financial burden for TB patients. DISCUSSION AND CONCLUSIONS Our review and meta-analysis concluded that PE and SE interventions are associated with beneficial effects on TB treatment outcomes. However, the quality of evidence is very low and future well-designed evaluation studies are needed.
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Affiliation(s)
- Rosa van Hoorn
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | | | - David Collins
- Management Sciences for Health, Boston, United States of America
| | - Agnes Gebhard
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Department of Global Health, Academic Medical Center and Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
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Pradhan A, Dholakia Y. Profile of NGOs involved in management of MDR TB in Mumbai before rollout of DOTS Plus. Indian J Tuberc 2015; 62:124-127. [PMID: 26117485 DOI: 10.1016/j.ijtb.2015.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Anagha Pradhan
- Independent Researcher, The Maharashtra State Anti-Tuberculosis Association, 2B Saurabh, 24E Sarojini Road, Santacruz West, Mumbai 400054, India
| | - Yatin Dholakia
- Hon. Secretary & Technical Adviser, The Maharashtra State Anti-Tuberculosis Association, 2B Saurabh, 24E Sarojini Road, Santacruz West, Mumbai 400054, India.
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22
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Sweetland A, Oquendo M, Wickramaratne P, Weissman M, Wainberg M. Depression: a silent driver of the global tuberculosis epidemic. World Psychiatry 2014; 13:325-6. [PMID: 25273311 PMCID: PMC4219079 DOI: 10.1002/wps.20134] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Annika Sweetland
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Maria Oquendo
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Priya Wickramaratne
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Myrna Weissman
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
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23
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Pachi A, Bratis D, Moussas G, Tselebis A. Psychiatric morbidity and other factors affecting treatment adherence in pulmonary tuberculosis patients. Tuberc Res Treat 2013; 2013:489865. [PMID: 23691305 PMCID: PMC3649695 DOI: 10.1155/2013/489865] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 01/03/2013] [Accepted: 02/07/2013] [Indexed: 12/11/2022] Open
Abstract
As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients.
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Affiliation(s)
- Argiro Pachi
- Psychiatric Department, Sotiria General Hospital of Chest Disease, Athens, Greece
| | - Dionisios Bratis
- Psychiatric Department, Sotiria General Hospital of Chest Disease, Athens, Greece
| | - Georgios Moussas
- Psychiatric Department, Sotiria General Hospital of Chest Disease, Athens, Greece
| | - Athanasios Tselebis
- Psychiatric Department, Sotiria General Hospital of Chest Disease, Athens, Greece
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M'imunya JM, Kredo T, Volmink J. Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane Database Syst Rev 2012; 2012:CD006591. [PMID: 22592714 PMCID: PMC6532681 DOI: 10.1002/14651858.cd006591.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Non-adherence to tuberculosis treatment can lead to prolonged periods of infectiousness, relapse, emergence of drug-resistance, and increased morbidity and mortality. In this review, we assess whether patient education or counselling, or both, promotes adherence to tuberculosis treatment. OBJECTIVES To evaluate the effects of patient education or counselling, or both, on treatment completion and cure in people requiring treatment for active or latent tuberculosis. SEARCH METHODS Without language restriction, we searched for eligible studies in the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS; checked reference lists of relevant articles; and contacted relevant researchers and organizations up to 24 November 2011. SELECTION CRITERIA Randomized controlled trials examining the effects of education or counselling, or both, on treatment completion and cure in people with clinical tuberculosis; and treatment completion and clinical tuberculosis in people with latent disease. DATA COLLECTION AND ANALYSIS We independently screened identified studies for eligibility, assessed methodological quality, and extracted data; with differences resolved by consensus. We expressed study results as risk ratios (RRs) with 95% confidence intervals (CI). MAIN RESULTS We found three trials, with a total of 1437 participants, which examined the effects of different educational and counselling interventions on adherence to treatment for latent tuberculosis.All three trials reported the proportion of people who successfully completed treatment for latent tuberculosis. Overall, education or counselling interventions may increase successful treatment completion but the magnitude of benefit is likely to vary depending on the nature of the intervention, and the setting (data not pooled, 923 participants, three trials, low quality evidence).In a four-arm trial in children from Spain, counselling by nurses via telephone increased the proportion of children completing treatment from 65% to 94% (RR 1.44, 95% CI 1.21 to 1.72; 157 participants, one trial), and counselling by nurses through home visits increased completion to 95% (RR 1.46, 95% CI 1.23 to 1.74; 156 participants, one trial). Both of these interventions were superior to counselling by physicians at the tuberculosis clinic (RR 1.20, 95% CI 0.98 to 1.47; 159 participants, one trial).In the USA, a programme of peer counselling for adolescents failed to show an effect on treatment completion rates at six months (RR 1.01, 95% CI 0.90 to 1.13; 394 participants, one trial). In this trial treatment completion was around 75% even in the control group.In the third study, in prisoners from the USA, treatment completion was very low in the control group (12%), and although counselling significantly improved this, completion in the intervention group remained low at 24% (RR 1.94, 95% CI 1.03 to 3.68; 211 participants, one trial).None of these trials aimed to assess the effect of these interventions on the subsequent development of active tuberculosis, and we found no trials that assessed the effects of patient education or counselling on adherence to treatment for active tuberculosis. AUTHORS' CONCLUSIONS Educational or counselling interventions may improve completion of treatment for latent tuberculosis. As would be expected, the magnitude of the benefit is likely to depend on the nature of the intervention, and the reasons for low completion rates in the specific setting.
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Affiliation(s)
- James Machoki M'imunya
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, Kenya.
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Acha J, Sweetland A, Guerra D, Chalco K, Castillo H, Palacios E. Psychosocial support groups for patients with multidrug-resistant tuberculosis: Five years of experience. Glob Public Health 2007; 2:404-17. [DOI: 10.1080/17441690701191610] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.
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Affiliation(s)
- Martin Prince
- King's College London, Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, London, UK.
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Hasegawa T, Suzuki E, Fujimori K, Sakagami T, Toyabe S, Akazawa K, Kawano K, Haraguchi M, Toyama J, Arakawa M, Satoh H, Gejyo F. Comparison between compliance of fluticasone propionate diskhaler and of fluticasone propionate diskus in adult bronchial asthma patients. Respiration 2007; 73:680-4. [PMID: 17008787 DOI: 10.1159/000095313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 05/15/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because inhaled corticosteroids (ICS) play a central role in the management of asthma, new drug delivery systems for fluticasone propionate, Diskhaler (FPdh) and Diskus (FPdk), were developed. However, few studies have focused on compliance with these drug delivery systems, which can influence drug efficacy. Hence, we compared compliance with FPdk versus that with FPdh. METHODS Data were obtained from a survey of pharmacists dispensing anti-asthmatic drugs to adult asthma patients who visited participating pharmacies between October 2002 and November 2003. Patients were limited to regular users of FPdh or FPdk whose medication had not been changed for >6 months before the survey. Compliance and daily administration frequency of ICS were evaluated on the basis of pharmaceutical records. Data on asthma status and various other factors affecting ICS compliance were obtained by questionnaire. RESULTS Data were acquired on 337 patients. There were no significant differences in gender, age, and duration between the FPdk and FPdh groups. Although FPdk compliance was significantly higher than that of FPdh, conversely there was no significant difference in daily dose and administration frequency between the 2 groups. Furthermore, there was no significant difference in the rate of concomitant drug and in various influencing factors associated with drug compliance. Regarding compliance of concomitant drug, that of oral sustained-released theophylline was significantly lower in FPdk versus FPdh users. CONCLUSION In the area of drug compliance, FPdk is superior to FPdh. Although the reason for this is unclear, it is probably due to the characteristics of FPdk itself.
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Affiliation(s)
- Takashi Hasegawa
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
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