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van Selm L, White TM, Picchio CA, Requena-Méndez A, Busz M, Bakker I, Romero D, Perez Gayo R, Pouille A, Vanderplasschen W, Lazarus JV. Drug use and access to drug dependency services for vulnerable migrants who use drugs in the European Union: Consensus statements and recommendations from civil society experts in Europe. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104087. [PMID: 37307786 DOI: 10.1016/j.drugpo.2023.104087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The number of migrants in the European Union (EU) has been growing, including migrants at risk of using drugs. Little information is available on the actual drug use among first-generation migrants who use drugs in the EU, nor on their access to drug dependency services. This study aims to reach consensus among experts in the EU on the current situation regarding vulnerable migrants who use drugs in the EU and to develop a set of actionable recommendations. METHODS Between April and September 2022, a panel of 57 experts on migration and/or drug use, working in 24 countries, participated in a three-stage Delphi study to develop statements and recommendations about drug use and access to healthcare services for migrants who use drugs in the EU. RESULTS High levels of agreement were reached on the 20 statements (mean=98.0%) and 15 recommendations (mean=99.7%). The recommendations focus on four main topics; 1) increasing data availability and quality, to inform guidelines; 2) increasing the availability of drug dependency services for migrants, including screening for mental health issues and involving migrants who use drugs in the development of services; 3) eliminating country and service level barriers for accessing these services, as well as providing migrants who use drugs with suitable information, and combating stigma and discrimination; 4) the need for increased collaboration among and within EU countries regarding healthcare for migrants who use drugs, at the policy level as well as the service level, including civil society organisations, peer navigation and multilingual cultural mediators. CONCLUSION Policy action and increased collaboration are required by the EU as a whole and by individual EU member states, in addition to collaboration among healthcare providers and social welfare services, to increase access to healthcare services for migrants who use drugs.
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Affiliation(s)
- Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | | | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, New York, United States
| | - Roberto Perez Gayo
- Correlation - European Harm Reduction Network, Amsterdam, the Netherlands
| | - Aline Pouille
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, New York, United States; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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2
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Panin F, Orlandini E, Galli L, De Martino M, Chiappini E. Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018. Travel Med Infect Dis 2021; 44:102185. [PMID: 34715364 DOI: 10.1016/j.tmaid.2021.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians. METHODS All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified. RESULTS In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB). CONCLUSIONS In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.
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Affiliation(s)
- Fiorenza Panin
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elisa Orlandini
- Tuscany Regional Government Department of Right to Health and Solidarity Policies, Information Technology Section, Via T. Alderotti 26/n, 50123, Florence, Italy
| | - Luisa Galli
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Maurizio De Martino
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Elena Chiappini
- Anna Meyer Children's University Hospital, Department of Sciences for Health Sciences, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
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Goscé L, Girardi E, Allel K, Cirillo DM, Barcellini L, Stancanelli G, Matteelli A, Hagphrast-Bidgoli H, Abubakar I. Tackling TB in migrants arriving at Europe's southern border. Int J Infect Dis 2021; 113 Suppl 1:S28-S32. [PMID: 33713814 DOI: 10.1016/j.ijid.2021.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants.
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Affiliation(s)
- Lara Goscé
- Institute for Global Health, University College London, United Kingdom.
| | - Enrico Girardi
- Istituto Nazionale per le Malattie Infettive "L. Spallanzani"- IRCCS, Italy.
| | - Kasim Allel
- Institute for Global Health, University College London, United Kingdom.
| | | | | | | | - Alberto Matteelli
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, Brescia, Italy.
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, United Kingdom.
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4
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Amiri S. Worldwide prevalence of smoking in immigration: A global systematic review and meta-analysis. J Addict Dis 2020; 38:567-579. [PMID: 32780650 DOI: 10.1080/10550887.2020.1800888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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5
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Seminari E, Monzillo V, Lombardi A, Barbarini D, Scudeller L, Schimmenti A, Muzzi A, Marone P. Migrations do not modify Mycobacterium tuberculosis resistance rates: a 20-year retrospective study. Eur J Clin Microbiol Infect Dis 2020; 39:1083-1087. [PMID: 31980988 DOI: 10.1007/s10096-020-03820-z] [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] [Received: 12/03/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Tuberculosis (TB) caused by resistant strains is becoming a public health concern also in high-income countries. In Pavia province, Northern Italy, the prevalence of foreign-born has increased in recent years. Nevertheless, it is unclear if this has modified epidemiology and resistance patterns of Mycobacterium tuberculosis. We retrospectively collected data on all the Mycobacterium tuberculosis strains isolated by culture in the microbiology reference laboratory of the province of Pavia from 01/01/1998 to 31/12/2017. Overall, 919 patients were identified, 320 were foreign-born (34.8%). The proportion of cases due to foreign-born patients increased during the study period as did resistance to isoniazid (INH) (p = 0.01), while resistance to rifampicin (RIF) did not (p = 0.8). INH and RIF resistance were comparable among Italian and foreign-born patients (7.9% vs 9.7% for INH and 4% vs 5% for RIF, respectively). Twenty-height (3.05%) patients harboured MDR strains. Prevalence of MDR strains was not different between Italians and foreign-born patients (2.8% vs 3.4%, p = 0.6). During the study period the proportion of TB cases due to foreign-born patients and INH resistance increased. This increase was equal among Italian and foreign-born patients. Migrants in our area are not a driver of resistance to anti-mycobacterial drugs.
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Affiliation(s)
- Elena Seminari
- UO Malattie Infettive I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 2, 27100, Pavia, Italy.
| | - Vincenza Monzillo
- SC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Lombardi
- UO Malattie Infettive I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 2, 27100, Pavia, Italy
| | - Daniela Barbarini
- SC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigia Scudeller
- SC Biometria e Statistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Schimmenti
- UO Malattie Infettive I, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 2, 27100, Pavia, Italy
| | - Alba Muzzi
- SC Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- SC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Tuberculosis-Related Hospitalizations in a Low-Incidence Country: A Retrospective Analysis in Two Italian Infectious Diseases Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010124. [PMID: 31878009 PMCID: PMC6981912 DOI: 10.3390/ijerph17010124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022]
Abstract
In recent years, a decrease in the incidence of tuberculosis (TB) has been recorded worldwide. However, an increase in TB cases has been reported in foreign people living in low-incidence countries, with an increase in extrapulmonary TB (EPTB) in the western region of the world. In the present work, a retrospective study was conducted in two Italian infectious diseases wards to evaluate the clinical characteristics of TB admission in the time period 2013-2017. A significant increase in TB was shown in the study period: 166 (71% males) patients with TB were enrolled, with ~70% coming from outside Italy (30% from Africa, 25% from Europe, and 13% from Asia and South America). Compared to foreign people, Italians were significantly older (71.5 (interquartile range, IQR: 44.5-80.0) vs. 30 (IQR: 24-40) years; p < 0.0001) more immunocompromised (48% vs. 17%; p < 0.0001), and affected by comorbidities (44% vs. 14%; p < 0.0001). EPTB represented 37% of all forms of the disease, and it was more incident in subjects coming from Africa than in those coming from Europe (39.3% vs. 20%, respectively). In logistic regression analysis, being European was protective (odd ratio, OR (95% CI): 0.2 (0.1-0.6); p = 0.004) against the development of EPTB forms. In conclusion, an increase in the rate of TB diagnosis was documented in two Italian reference centers in the period 2013-2017, with 39% of EPTB diagnosed in patients from outside Europe.
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Takii T, Seki K, Wakabayashi Y, Morishige Y, Sekizuka T, Yamashita A, Kato K, Uchimura K, Ohkado A, Keicho N, Mitarai S, Kuroda M, Kato S. Whole-genome sequencing-based epidemiological analysis of anti-tuberculosis drug resistance genes in Japan in 2007: Application of the Genome Research for Asian Tuberculosis (GReAT) database. Sci Rep 2019; 9:12823. [PMID: 31492902 PMCID: PMC6731343 DOI: 10.1038/s41598-019-49219-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
We investigated the lineages of Mycobacterium tuberculosis (Mtb) isolates from the RYOKEN study in Japan in 2007 and the usefulness of genotypic drug susceptibility testing (DST) using the Genome Research for Asian Tuberculosis (GReAT) database. In total, 667 isolates were classified into lineage 1 (4.6%), lineage 2 (0.8%), lineage 2/Beijing (72.1%), lineage 3 (0.5%), and lineage 4 (22.0%). The nationality, gender, and age groups associated with the isolates assigned to lineage 1 were significantly different from those associated with other lineages. In particular, isolates of lineage 1.2.1 (EAI2) formed sub-clusters and included a 2,316-bp deletion in the genome. The proportion of the isolates resistant to at least one anti-tuberculosis (TB) drug was 10.8%, as determined by either the genotypic or phenotypic method of DST. However, the sensitivities to isoniazid, streptomycin, and ethambutol determined by the genotypic method were low. Thus, unidentified mutations in the genome responsible for drug resistance were explored, revealing previously unreported mutations in the katG, gid, and embB genes. This is the first nationwide report of whole-genome analysis of TB in Japan.
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Affiliation(s)
- Takemasa Takii
- Department of Mycobacteriology, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan.
| | - Kouhei Seki
- Department of Mycobacteriology, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Yasutaka Wakabayashi
- Department of Mycobacteriology, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Yuta Morishige
- Department of Mycobacteriology, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Tsuyoshi Sekizuka
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Akifumi Yamashita
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Kengo Kato
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Kazuhiro Uchimura
- Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Akihiro Ohkado
- Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Naoto Keicho
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Satoshi Mitarai
- Department of Mycobacteriology, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Seiya Kato
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
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Belz M, Rehling N, Schmidt U, Wiltfang J, Kis B, Wolff-Menzler C. Bacterial infections among patients with psychiatric disorders: Relation with hospital stay, age, and psychiatric diagnoses. PLoS One 2018; 13:e0208458. [PMID: 30513128 PMCID: PMC6279031 DOI: 10.1371/journal.pone.0208458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/17/2018] [Indexed: 11/17/2022] Open
Abstract
The prevalence of infections is supposed to be higher in older patients and to extend the length of hospital stays. This study aimed, first, to test this supposition within a large psychiatric population which we divided into four clusters of psychiatric ICD-10 diagnoses: F00-F03 (dementias), F10 (substance disorders), F20-29 (schizophrenia, schizophreniform and other non-mood psychotic disorders), F32-F33 (major depressive disorders). Second, despite the increasing evidence for the role of infections in psychiatric disorders, it is, to the best of our knowledge, largely unknown whether the rates of infections with pathogens of the four most frequent germ families differ between psychiatric diseases. Thus, in a retrospective study, the results of clinical routine examinations (pap smear, analysis of midstream urine, stool) dependent on symptoms in 8545 patients of a German psychiatric clinic were analyzed in a 12-year dataset. Results show that a longer hospital stay was associated with an increased number of microbiological tests, but led to no significant difference between positive vs. negative findings. Consistent with previous studies, patients with infections were older than patients without infections. For the F10 diagnosis cluster we found a significantly reduced (F10: Staphylococcaceae) and for the F20-29 cluster a heightened risk of infections (Staphylococcaceae, Corynebacteriaceae). Furthermore, patients belonging to the F00-F03 cluster exhibited elevated rates of infections with all four germ families. The latter can be ascribed to patients' age as we found higher age to be associated with these infections, independently of the presence of dementia. Our results suggest that different psychiatric diagnoses are associated with a heightened or lowered risk of bacterial infections and, furthermore, that clinical routine infection-screenings for elderly psychiatric patients seems to be reasonable.
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Affiliation(s)
- Michael Belz
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany
| | - Nico Rehling
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany
| | - Ulrike Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Lower-Saxony, Germany.,Institute for Biomedicine (iBiMED), Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Lower-Saxony, Germany
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Shokri M, Najafi R, Niromand J, Babazadeh A, Javanian M, Bayani M, Afra ZG, Ebrahimpour S. The frequency of risk factors for pulmonary tuberculosis in tuberculosis patients in Babol, Northern Iran, during 2008-2015. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In the current study, we investigated the risk factors for tuberculosis in patients admitted to the Ayatollah Rouhani Hospital in Babol, north of Iran. This cross-sectional study was conducted on 207 patients with proven tuberculosis during the years 2008-2015. Demographic data such as age and sex, smoking, history of underlying illness, illness symptoms, and laboratory results were collected and analyzed at a significant level of less than 0.05. From 207 patients, 136 were male (65.7%), 71 were female (34.3%), and 76 of them (37.3%) were smokers. It is notable that most patients (29.5%) were over the age of 71. The relation between age profile and being tuberculosis has been studied, but the co-relation was found to be not significant. The most common complaint has been coughing (60.9%).
While investigating underling diseases, the most common illness has found to be Diabetes (11.3%). Based our finding, there was a significant relationship between gender and smoking with tuberculosis. Accordingly, as smoking is one of the risk factors for tuberculosis, smokers and non-smokers should be informed that smoking carries the risk for tuberculosis. Such a program should be particularly addressed to males.
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Affiliation(s)
- Mehran Shokri
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Rahmatollah Najafi
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Jalal Niromand
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Masomeh Bayani
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
| | - Zahra Geraili Afra
- Department of Statistic and Epidmiology, School of Medicine , Babol University of Medical Sciences , Babol , I.R Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , I.R. Iran
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Quattrocchi A, Barchitta M, Nobile CGA, Prato R, Sotgiu G, Casuccio A, Vitale F, Agodi A. Determinants of patient and health system delay among Italian and foreign-born patients with pulmonary tuberculosis: a multicentre cross-sectional study. BMJ Open 2018; 8:e019673. [PMID: 30082341 PMCID: PMC6078265 DOI: 10.1136/bmjopen-2017-019673] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this cross-sectional study was to identify key factors associated with patient delay (PD), health system delay (HSD) and total delay (TOTD) in patients with tuberculosis (TB) to inform control programmes. SETTING The study was conducted in four Italian regions in 2014-2016. Data were obtained using a questionnaire including: sociodemographic and lifestyle data, TB comorbidities, patient knowledge and attitudes towards TB, stigma, access to TB care and health-seeking behaviours. PARTICIPANTS Patients' inclusion criteria were being diagnosed as a new smear positive pulmonary TB case and living in one of the participating Italian regions. Overall, 344 patients from 30 healthcare centres were invited to participate and 253 patients were included in the analysis (26.5% non-response rate); 63.6% were males and 55.7% were non-Italian born. OUTCOME MEASURES Risk factors for PD, HSD and TOTD in patients with TB were assessed by multivariable analysis. Adjusted ORs (aOR) and 95% CIs were calculated. RESULTS Median PD, HSD and TOTD were 30, 11 and 45 days, respectively. Factors associated with longer PD were: stigma (aOR 2.30; 95% CI 1.06 to 4.98), chest pain (aOR 2.67; 95% CI 1.24 to 6.49), weight loss (aOR 4.66; 95% CI 2.16 to 10.05), paying for transportation (aOR 2.66; 95% CI 1.24 to 5.74) and distance to the health centre (aOR 2.46; 95% CI 1.05 to 5.74) (the latter three were also associated with TOTD). Shorter HSD was associated with foreign-born and female status (aOR 0.50; 95% CI 0.27 to 0.91; aOR 0.28; 95% CI 0.15 to 0.53, respectively), dizziness (aOR 0.18, 95% CI 0.04 to 0.78) and seeking care at hospital (aOR 0.35; 95% CI 0.18 to 0.66). Prior unspecific treatment was associated with longer HSD (aOR 2.25; 95% CI 1.19 to 4.25) and TOTD (aOR 2.55; 95% CI 1.18 to 5.82). Haemoptysis (aOR 0.12; 95% CI 0.03 to 0.43) and repeated visits with the same provider (aOR 0.29; 95% CI 0.11 to 0.76) showed shorter TOTD. CONCLUSIONS This study identifies several determinants of delays associated with patient's behaviours and healthcare qualities. Tackling TB effectively requires addressing key risk factors that make individuals more vulnerable by the means of public health policy, cooperation and advocacy to ensure that all patients have easy access to care and receive high-quality healthcare.
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Affiliation(s)
- Annalisa Quattrocchi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
- LaPoSS, Laboratory of Policies and Social Services, University of Catania, Catania, Italy
| | - Carmelo G A Nobile
- Department of Health Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Sciences for Health Promotion and Mother-Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
- LaPoSS, Laboratory of Policies and Social Services, University of Catania, Catania, Italy
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Mustazzolu A, Borroni E, Cirillo DM, Giannoni F, Iacobino A, Fattorini L. Trend in rifampicin-, multidrug- and extensively drug-resistant tuberculosis in Italy, 2009-2016. Eur Respir J 2018; 52:13993003.00070-2018. [PMID: 29724919 DOI: 10.1183/13993003.00070-2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Emanuele Borroni
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Federico Giannoni
- Dept of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Iacobino
- Dept of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Dias A, Gaio R, Sousa P, Gomes M, Oliveira O, Duarte R. Migration Flow and Its Impact on Tuberculosis Notification in Portugal. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2017.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Dias A, Gaio R, Sousa P, Gomes M, Oliveira O, Duarte R. Migration Flow and Its Impact on Tuberculosis Notification in Portugal. Arch Bronconeumol 2018; 54:18-23. [DOI: 10.1016/j.arbres.2017.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
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Conners E, Garfein RS, Rodwell TC, Udwadia ZF, Catanzaro DG. Mobility patterns of persons at risk for drug-resistant tuberculosis in Mumbai, India. Int J Tuberc Lung Dis 2016; 20:1633-1638. [PMID: 27931339 PMCID: PMC10424886 DOI: 10.5588/ijtld.16.0187] [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] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) hospital in Mumbai, India. OBJECTIVE To describe the mobility patterns of persons with suspected drug-resistant tuberculosis (DR-TB) and to assess whether there were significant differences in demographic or risk characteristics based on mobility. DESIGN Observational cohort study of TB clinic patients at risk for DR-TB. RESULTS Among 602 participants, 37% had ever moved from their place of birth; 14% were local movers (within state), and 23% were distant movers, between states or countries. Univariate multinomial logistic regression models showed that distant movers were more likely than non-movers to have lower income, less education, a greater number of previous TB episodes, and to have ever smoked. Compared to non-movers, local movers were more likely to have lower income and were more likely to have seen a doctor in the past 2 years. Clinical outcomes, including DR-TB, diabetes, and human immunodeficiency virus (HIV), did not differ between the three mobility groups. CONCLUSION Mobility was common among patients at risk for DR-TB in Mumbai. TB programs should consider the implications of mobility on the protracted treatment for DR-TB in India.
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Affiliation(s)
- E Conners
- Department of Medicine, University of California, San Diego, San Diego State University, San Diego, California, USA
| | - R S Garfein
- Department of Medicine, University of California, San Diego
| | - T C Rodwell
- Department of Medicine, University of California, San Diego
| | | | - D G Catanzaro
- University of Arkansas, Department of Biological Sciences, Fayetteville, Arkansas, USA
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15
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Hanway A, Comiskey CM, Tobin K, O'Toole RF. Relating annual migration from high tuberculosis burden country of origin to changes in foreign-born tuberculosis notification rates in low-medium incidence European countries. Tuberculosis (Edinb) 2016; 101:67-74. [PMID: 27865401 DOI: 10.1016/j.tube.2016.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/22/2016] [Accepted: 07/31/2016] [Indexed: 11/19/2022]
Abstract
The level of immigration from high tuberculosis (TB) burden countries (HBCs) which impacts on the foreign-born TB notification rate is largely unknown. In this work, we performed a cross-sectional analysis of epidemiological data from 2000 to 2013 from nine European countries: Austria, Denmark, Finland, Hungary, Netherlands, Norway, Spain, Sweden, and the United Kingdom. Crude notification rates were calculated for foreign- and native-born populations and a multiple-linear regression model predicting notification rates with HBC population data was generated. From 2000 to 2013, the population percentage with a foreign birthplace increased on average each year in all nine countries, ranging from +0.11%/year in the Netherlands to +0.66%/year in Spain. An annual increase in HBC migrants above +0.43% per year (95% Confidence Interval: 0.24%-0.63%) corresponded with higher TB notification rates in the foreign-born population of the countries analyzed. This indicates that migration from HBCs can exert a measurable effect on the foreign-born TB notification rate. However, an increase in the foreign-born TB notification rate coincided with an average annual rise in national TB notification rates only in countries, Norway (+3.85%/year) and Sweden (+2.64%/year), which have a high proportion (>80%) of TB cases that are foreign-born.
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Affiliation(s)
- Aidan Hanway
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | - Katy Tobin
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Ronan F O'Toole
- Breathe Well Centre, School of Medicine, University of Tasmania, Hobart, Australia.
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Fattorini L, Mustazzolu A, Borroni E, Piccaro G, Giannoni F, Cirillo DM. Tuberculosis in migrants from 106 countries to Italy, 2008–2014. Eur Respir J 2016; 47:1273-6. [DOI: 10.1183/13993003.01844-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/15/2015] [Indexed: 11/05/2022]
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Stoesslé P, González-Salazar F, Santos-Guzmán J, Sánchez-González N. Risk Factors and Current Health-Seeking Patterns of Migrants in Northeastern Mexico: Healthcare Needs for a Socially Vulnerable Population. Front Public Health 2015; 3:191. [PMID: 26301213 PMCID: PMC4526788 DOI: 10.3389/fpubh.2015.00191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/22/2015] [Indexed: 11/13/2022] Open
Abstract
This study identified risk factors for health and access to healthcare services of migrants during their journey across Mexico to the United States. Data were collected in shelters located in Monterrey, the largest city of northeastern Mexico, through a basic clinical examination and a survey completed by 75 migrants; 92% of them were undocumented Central Americans. During their transit, they are at a high risk of contracting, developing, and transmitting diseases. The need of working to survive affects health-seeking behavior and a constant fear of being traced keeps migrants away from public health services, which delays diagnosis and treatment of diseases. Negligent lifestyles, such as smoking, drinking (31.8% of men and 11.1% of women), and drug abuse (13% of men and 11% of women), were found. Regarding tuberculosis (TB), undocumented migrants are usually not screened, even though they come from countries with a high TB burden. Besides, they might be overexposed to TB because of their living conditions in overcrowded places with deficient hygiene, protection, and malnutrition (54.7% of the sample). Possible comorbidities like acquired immune deficiency syndrome (AIDS; 4%) and diabetes (2.7%, but probably under-diagnosed) were referred. Migrants have little TB knowledge, which is independent of their level of education or a previous experience of deportation. About one-third of the migrants were totally unfamiliar with TB-related symptoms, while 36% had correct knowledge of basic TB symptoms. We conclude that a shortage of information on the highly vulnerable migratory population combined with a lack of social support and health education among migrants may play a significant role in the spread of communicable diseases. We recommend that health authorities address this urgent, binational, public health concern in order to prevent outbreaks of emerging infections.
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Affiliation(s)
- Philippe Stoesslé
- Department of Social Sciences, University of Monterrey , Monterrey , Mexico
| | - Francisco González-Salazar
- Mexican Social Security Institute (IMSS) , Monterrey , Mexico ; Department of Basic Sciences, University of Monterrey , Monterrey , Mexico
| | | | - Nydia Sánchez-González
- School of Medicine, Monterrey Institute of Technology and Higher Education , Monterrey , Mexico
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