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Health-Related Quality of Life (HRQoL) of Patients with Tuberculosis: A Review. Infect Dis Rep 2022; 14:509-524. [PMID: 35893474 PMCID: PMC9326555 DOI: 10.3390/idr14040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis (TB) is a major killer and cause of human suffering worldwide and imposes a substantial reduction in patients’ health-related quality of life (HRQoL). HRQoL indicates the consciousness of patients regarding their physical and mental health. It is, therefore, very relevant in comprehending and measuring the exact impact of the disease state. Therefore, we undertook this review to summarize the available evidence on the impact of TB and its treatment on HRQoL. An in-depth understanding of HRQoL in TB patients can identify the existing management gaps. We undertook a systematic search through PubMed and CENTRAL. Data were extracted and tabulated for study design, targeted population, QoL instrument used, QoL domain assessed, and key findings. We included studies that assessed the effect of TB on the QoL both during and after treatment. There are no specific HRQoL assessment tools for utilization among TB patients. HRQoL is markedly impaired in patients with TB. The factors affecting HRQoL differ with active and latent TB, socio-demographics, socio-economic status, presence of co-infections, etc. This review’s findings can help to frame appropriate policies for tackling HRQoL issues in TB patients.
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Ochanda PN, Lamorde M, Kintu K, Wang D, Chen T, Malaba T, Myer L, Waitt C, Reynolds H, Khoo S. A randomized comparison of health-related quality of life outcomes of dolutegravir versus efavirenz-based antiretroviral treatment initiated in the third trimester of pregnancy. AIDS Res Ther 2022; 19:24. [PMID: 35672853 PMCID: PMC9172107 DOI: 10.1186/s12981-022-00446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Evidence on health-related quality of life (HRQoL) outcomes is limited for new antiretroviral therapies (ART). Dolutegravir-based treatment is being rolled out as the preferred first-line treatment for HIV in many low- and middle-income countries. We compared HRQoL between treatment-naïve pregnant women randomized to dolutegravir- or efavirenz-based ART in a clinical trial in Uganda and South Africa. Methods We gathered HRQoL data from 203 pregnant women of mean age 28 years, randomized to either dolutegravir- or efavirenz-based ART. We used the medical outcomes study-HIV health survey at baseline, 24 and 48 weeks between years 2018 and 2019. Physical health summary (PHS) and mental health summary (MHS) scores were the primary study outcomes, while the 11 MOS-HIV subscales were secondary outcomes. We applied mixed model analysis to estimate differences within and between-treatment groups. Multivariate regression analysis was included to identify associations between primary outcomes and selected variables. Results At 24 weeks postpartum, HRQoL scores increased from baseline in both treatment arms: PHS (10.40, 95% CI 9.24, 11.55) and MHS (9.23, 95% CI 7.35, 11.10) for dolutegravir-based ART; PHS (10.24, 95% CI 9.10, 11.38) and MHS (7.54, 95% CI 5.66, 9.42) for efavirenz-based ART. Increased scores for all secondary outcomes were significant at p < 0.0001. At 48 weeks, improvements remained significant for primary outcomes within group comparison. Estimated difference in PHS were higher in the dolutegravir-based arm, while increases in MHS were more for women in the efavirenz-based armat 24 and 48 weeks. No significant differences were noted for corresponding PHS scores at these time points compared between groups. Differences between arms were observed in two secondary outcomes: role function (1.11, 95% CI 0.08, 2.13), p = 0.034 and physical function outcomes (2.97, 95% CI 1.20, 4.73), p = 0.001. In the multivariate analysis, internet access was associated with higher PHS scores while owning a bank account, using the internet and longer treatment duration were associated with an increase in MHS scores. Conclusion We found no important differences in HRQoL outcomes among HIV-positive women started on dolutegravir relative to efavirenz in late pregnancy. Increases in HRQoL in the first year after delivery provide additional support for the initiation of ART in HIV-positive women presenting late in pregnancy. Trial Registration Clinical Trial Number: NCT03249181
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Affiliation(s)
- Perez Nicholas Ochanda
- Research Department, Infectious Diseases Institute, Makerere University, Hall Lane, P.O Box 22418, Kampala, Uganda.
| | - Mohammed Lamorde
- Research Department, Infectious Diseases Institute, Makerere University, Hall Lane, P.O Box 22418, Kampala, Uganda
| | - Kenneth Kintu
- Research Department, Infectious Diseases Institute, Makerere University, Hall Lane, P.O Box 22418, Kampala, Uganda
| | - Duolao Wang
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thokozile Malaba
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Helen Reynolds
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Yadav RK, Kaphle HP, Yadav DK, Marahatta SB, Shah NP, Baral S, Khatri E, Ojha R. Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal. J Clin Tuberc Other Mycobact Dis 2021; 23:100235. [PMID: 33997309 PMCID: PMC8095181 DOI: 10.1016/j.jctube.2021.100235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province. Methods A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance. Results A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life. Conclusion Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life.
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Affiliation(s)
- Rajesh Kumar Yadav
- School of Health and Allied Sciences, Pokhara University, 33700 Pokhara, Nepal.,Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Hari Prasad Kaphle
- School of Health and Allied Sciences, Pokhara University, 33700 Pokhara, Nepal
| | | | - Sujan Babu Marahatta
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal.,Manmohan Memorial Institute of Health Sciences, Tribhuvan University, 44600 Kathmandu, Nepal.,Nepal Open University, 44700 Lalitpur, Nepal
| | - Naveen Prakash Shah
- National Tuberculosis Centre, Ministry of Health and Population, 44800 Bhaktapur, Nepal
| | - Sushila Baral
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Elina Khatri
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Renuka Ojha
- Australian Catholic University, 3002 Melbourne, Australia
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Jo Y, Gomes I, Shin H, Tucker A, Ngwira LG, Chaisson RE, Corbett EL, Dowdy DW. Health-related quality of life of inpatients and outpatients with TB in rural Malawi. Int J Tuberc Lung Dis 2020; 24:1165-1171. [PMID: 33172524 PMCID: PMC7847550 DOI: 10.5588/ijtld.20.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION: Patients being treated for TB may suffer reductions in health-related quality of life (HRQoL). This study aims to assess the extent of such reductions and the trajectory of HRQoL over the course of treatment in rural Malawi.METHODS: We collected patient demographic and socioeconomic status, TB-related characteristics, and HRQoL data (i.e., EQ-5D and a visual analogue scale VAS) from adults (age ≥18 years) being treated for TB in 12 primary health centers and one hospital in rural Thyolo District, Malawi, from 2014 to 2016. Associations between HRQoL and patient characteristics were estimated using multivariable linear regression.RESULTS: Inpatients (n = 197) consistently showed lower median HRQoL scores and suffered more severe health impairments during hospitalization than outpatients (n = 156) (EQ5D and VAS: 0.79, 55 vs. 0.84, 70). Longer treatment duration was associated with higher HRQoL among outpatients (EQ5D: 0.034 increase per 2 months, 95%CI 0.012-0.057). We found no substantial associations between patients´ demographic and socioeconomic characteristics and HRQoL in this setting.CONCLUSION: HRQoL scores among patients receiving treatment for TB in rural Malawi differ by clinical setting and duration of treatment, with greater impairment among inpatients and those early in their treatment course.
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Affiliation(s)
- Y Jo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I Gomes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L G Ngwira
- Malawi-Liverpool-Wellcome Trust Clinical Research Center, Blantyre, Malawi
| | - R E Chaisson
- Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - E L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Center, Blantyre, Malawi, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Giummarra MJ, Murgatroyd D, Tran Y, Adie S, Mittal R, Ponsford J, Cameron P, Gabbe B, Harris IA, Cameron ID. Health and return to work in the first two years following road traffic injury: a comparison of outcomes between compensation claimants in Victoria and New South Wales, Australia. Injury 2020; 51:2199-2208. [PMID: 32680598 DOI: 10.1016/j.injury.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND People who sustain road traffic injuries often have poor health outcomes. While outcomes are often worse in people with a compensation claim, especially in fault-based schemes versus no-fault schemes, few studies have directly compared outcomes across scheme types. OBJECTIVE To compare health and work outcomes between people who had no compensation claim, a fault-based claim, or "no-fault" transport or workers compensation claim after hospitalisation for a road traffic injury. METHODS Participants aged >=18 years admitted to hospital in New South Wales or Victoria for >24 hours were recruited in two separate prospective cohort studies (N=1,034). People who died or sustained minor or very severe injuries were excluded. Groups included Compulsory Third Party (fault-based, n=128), no-fault Transport Accident Commission (TAC; n=454) and workers compensation claimants (n=73), or no claim (n=226). Outcomes at six, 12- and 24-months post-injury included health [SF-12 Mental Component Score (MCS) and Physical Component Score (PCS)], and return to work for people working pre-injury. Multivariable mixed effects linear and logistic regressions, adjusting for demographic and injury covariates, examined differences in health and work outcomes between claimant groups, with fixed effects of time and random effects of participant ID. RESULTS Health status was better in people with a no-fault TAC claim (MCS: m=50.62, 95%CI:49.62,51.62; PCS: m=40.49, 95%CI:39.46,41.52) or no claim (MCS: m=49.99, 95%CI:49.62,51.62; PCS: m=44.36, 95%CI:43.00,45.72), than people with a workers compensation (MCS: m=45.73, 95%CI:43.46,48.00; PCS: m=38.94, 95%CI:36.59,41.30) or fault-based CTP claim (MCS: m=41.34, 95%CI:39.54,43.13; PCS: m=35.64, 95%CI:33.78,37.49). Relative to fault-based CTP claimants, the odds of returning to work were higher for people with no claim (AOR=6.84, 95%CI:1.73,27.05) but did not differ for no-fault TAC (AOR=1.21, 95%CI:0.36,4.05) or workers compensation claimants (AOR=0.83,95%CI: 0.17,3.99). While people with a fault-based CTP claim had poorer mental and physical health and return to work after injury, they showed greater improvements in mental health, and similar levels of improvement in physical health and work participation over time to the other groups. CONCLUSION The patterns of health and work across scheme types provide important insights against which we can contrast the effects of future scheme designs on client outcomes.
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia.
| | - Darnel Murgatroyd
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney.
| | - Yvonne Tran
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney; Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University.
| | - Sam Adie
- South West Sydney Clinical School, University of New South Wales, Australia.
| | - Rajat Mittal
- South West Sydney Clinical School, University of New South Wales, Australia.
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton Victoria, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria, Australia.
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, Wales, UK SA2 8PP.
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney.
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney.
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Subrata SA. Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sumarno A. Subrata
- Doctoral Candidate in Doctor of Philosophy Program in NursingInternational and Collaborative Program with Foreign University Program, Mahidol University Nakhon Pathom Thailand
- Department of Nursing and Wound Research Center, Faculty of Health SciencesUniversitas Muhammadiyah Magelang Magelang Indonesia
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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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Qiu L, Tong Y, Lu Z, Gong Y, Yin X. Depressive Symptoms Mediate the Associations of Stigma with Medication Adherence and Quality of Life in Tuberculosis Patients in China. Am J Trop Med Hyg 2019; 100:31-36. [PMID: 30398139 DOI: 10.4269/ajtmh.18-0324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stigma has been associated with health-related outcomes such as medication adherence and quality of life (QOL) in patients with tuberculosis (TB); however, the mechanisms via which TB-related stigma interferes with specific outcomes are unclear. This study aimed to determine whether depressive symptoms were one of the mechanisms that mediated the associations between TB-related stigma and both medication adherence and QOL in patients with TB. A cross-sectional survey was conducted between October 1, 2013, and March 31, 2014, in Hubei Province, central China, and data were collected from 1,342 patients with TB, using a structured questionnaire that measured TB-related stigma, depressive symptoms, medication adherence, and QOL. Multiple imputation was used to account for missing data. Structural equation modeling was performed to assess the mediating effect of depressive symptoms on the associations of TB-related stigma with medication adherence and QOL. Mediation analyses showed that depressive symptoms partially mediated the association between TB-related stigma and medication adherence (standardized indirect effect = -0.16, 95% bias-corrected confidence interval [CI] [-0.19, -0.13], P < 0.01). Moreover, depressive symptoms fully mediated the association between TB-related stigma and QOL (standardized indirect effect = -0.17, 95% bias-corrected CI [-0.21, -0.14], P < 0.01). The results suggest that depressive symptoms played a key role in the relationships among TB-related stigma, medication adherence, and QOL in patients with TB. Therefore, the alleviation of depressive symptoms could be an important strategy for improving medication adherence and QOL in patients with TB.
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Affiliation(s)
- Lei Qiu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.,School of management, Hainan Medical University, Haikou, P. R. China
| | - Yeqing Tong
- Center for Disease Control and Prevention of Hubei Province, Wuhan, P. R. China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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Yan S, Zhang S, Tong Y, Yin X, Lu Z, Gong Y. Nonadherence to Antituberculosis Medications: The Impact of Stigma and Depressive Symptoms. Am J Trop Med Hyg 2018; 98:262-265. [PMID: 29141744 DOI: 10.4269/ajtmh.17-0383] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Medication nonadherence is common among tuberculosis (TB) patients in China and is of great concern. Herein, we determined the incidence of nonadherence in TB patients in central China and the impact of stigma and depressive symptoms on adherence; these issues are relatively unexplored. A cross-sectional survey was performed, and 1,342 TB patients were recruited from TB dispensaries in three counties in Hubei province using a multistage sampling method. The patients completed structured questionnaires that addressed medication adherence, TB-related stigma, and depressive symptoms. The independent effects of stigma and depressive symptoms on adherence were determined via multinomial logistic regression analysis. The mean medication adherence score was 6.03 ± 1.99. The percentage of TB patients with high, medium, and low medication adherence was 32.12%, 34.58%, and 33.31%, respectively. The impact of stigma and depressive symptoms on medication adherence was significant. TB patients with medium (odds ratios [OR]: 1.54, 95% confidence interval [CI]: 1.08-2.21) or high (OR: 5.32, 95% CI: 3.34-8.46) stigma or patients with mild (OR: 1.92, 95% CI: 1.34-2.75) or severe (OR: 3.67, 95% CI: 2.04-6.61) depressive symptoms showed a higher likelihood of having low adherence than those with low stigma or without depressive symptoms. TB-related stigma and depressive symptoms were common among TB patients in China, as was nonadherence, and independently associated with their adherence behavior. Social and psychological interventions that combat stigmatization and depression in TB patients should be adopted and optimized to improve medication adherence.
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Affiliation(s)
- Shijiao Yan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | | | - Yeqing Tong
- Center for Disease Control and Prevention, Wuhan, P.R. China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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Zhang S, Meng L, Qiu F, Yang JD, Sun S. Medication-related risk factors associated with health-related quality of life among community-dwelling elderly in China. Patient Prefer Adherence 2018; 12:529-537. [PMID: 29692604 PMCID: PMC5903496 DOI: 10.2147/ppa.s156713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated that medication adherence has an impact on health-related quality of life (HRQoL). However, other medication-related factors that may influence HRQoL have not been extensively studied, especially factors based on the Medication-Risk Questionnaire (MRQ), and such studies are mostly done in Western countries. Our objective was to explore risk factors associated with HRQoL among community-dwelling elderly with chronic diseases in mainland China, especially the medication-related risk factors regarding MRQ. METHODS The study was conducted in a community health service center through surveys to eligible patients. The main outcomes of HRQoL were assessed by the EuroQol-5D (EQ-5D) scale and EQ-visual analog scale (EQ-VAS). Medication-related risk factors according to MRQ associated with HRQoL were identified using a multiple linear regression. RESULTS A total of 311 patients were analyzed, averaging 71.19±5.33 years, and 68.8% were female. The mean EQ-5D index was 0.72±0.09, and the mean EQ-VAS score was 71.37±11.97. The most prevalent problem was pain/discomfort, and 90.0% believed that they could take care of themselves without any problems. Sex, age, educational level, frailty, function status, and certain medication-related factors regarding MRQ were found to be significant factors impacting the HRQoL. A multivariate analysis showed that MRQ factors of polypharmacy, multimorbidity, feeling difficultly with taking medicines as prescribed, and taking medicines with narrow therapeutic index had negative impacts on the quality of life. CONCLUSION Patient's internal characteristics and medication-related risk factors according to MRQ were associated with quality of life. The results of the MRQ is an indicator of quality of life that can identify patients who need interventions.
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Affiliation(s)
- Sha Zhang
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Long Meng
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Feng Qiu
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Feng Qiu, Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, No. 1 Medical College Road, Yuzhong District, Chongqing 400016, People’s Republic of China, Tel +86 23 8901 2401, Fax +86 23 6881 1793, Email
| | - Jia-Dan Yang
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shusen Sun
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA
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Kastien-Hilka T, Rosenkranz B, Schwenkglenks M, Bennett BM, Sinanovic E. Association between Health-Related Quality of Life and Medication Adherence in Pulmonary Tuberculosis in South Africa. Front Pharmacol 2017; 8:919. [PMID: 29326591 PMCID: PMC5741974 DOI: 10.3389/fphar.2017.00919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background: Health-related quality of life (HRQOL) and adherence to treatment are two often inter-related concepts that have implications for patient management and care. Tuberculosis (TB) and its treatment present a major public health concern in South Africa. The study aimed to evaluate the association between HRQOL and adherence in TB patients in South Africa. Methods: Four self-reported HRQOL and one self-reported adherence measures were used in an observational longitudinal multicentre study during 6-month standard TB treatment. These included the generic Short-Form 12 items (SF-12) and European Quality of Life 5 dimensions 5 levels (EQ-5D-5L), the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS) for HRQOL. Adherence was measured by the Morisky Medication Adherence Scale 8 items (MMAS-8). The relationship between both concepts was examined in 131 patients using Spearman's rho correlations, and linear regression models. Results: HRQOL improved over 6-month TB treatment, whereas adherence mean scores stayed constant with participants attaining a medium average level. Around 76% of patients reported to be high adherers and 24% were reporting a medium or low adherence. Associations between HRQOL and adherence were mainly weak. High adherence at treatment start was positively related to improvements in anxiety and depression after 6-month treatment. The overall improvement in pain and discomfort, and psychosocial health aspects over treatment time was positively, but weakly associated with adherence at 6 months of treatment. Conclusion: A positive relationship exists between adherence and HRQOL in TB in a South African setting, but this relationship was very weak, most likely because HRQOL is affected by a number of different factors and not limited to effects of adherence. Therefore, management of TB patients should, besides adequate drug treatment, address the specific mental and psychosocial needs.
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Affiliation(s)
- Tanja Kastien-Hilka
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Fundisa African Academy of Medicines Development, Cape Town, South Africa
| | - Matthias Schwenkglenks
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Bryan M. Bennett
- Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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12
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Conversion of standard retrospective patient-reported outcomes to momentary versions: cognitive interviewing reveals varying degrees of momentary compatibility. Qual Life Res 2017; 27:1065-1076. [DOI: 10.1007/s11136-017-1762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 01/23/2023]
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13
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Wang X, Guo G, Zhou L, Zheng J, Liang X, Li Z, Luo H, Yang Y, Yang L, Tan T, Yu J, Lu L. Health-related quality of life in pregnant women living with HIV: a comparison of EQ-5D and SF-12. Health Qual Life Outcomes 2017; 15:158. [PMID: 28851384 PMCID: PMC5575929 DOI: 10.1186/s12955-017-0731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/28/2017] [Indexed: 11/16/2022] Open
Abstract
Background This paper investigates the properties and performance of the two generic measures, EQ-5D and SF-12, for Health-Related Quality of Life (HRQoL) assessments of pregnant women living with HIV in Kunming City, Yiliang County, Daguan County, Longchuan County, Tengchong County, Longling County and Fengqing County in Yunnan Province, China. Methods As part of a screening programme for the prevention of mother-to-child transmission of HIV (PMTCT), a retrospective cross-sectional survey was conducted in the seven Maternal and Infant Health Care centers in Yunnan Province, China, between April and June of 2016. The demographic and HIV infection-related information used in the study was collected through questionnaires designed by the study’s staff. HRQoL information was collected using two generic scales: EQ-5D and SF-12. Results A total sample of one hundred and one pregnant women with a mean age of 30.4 ± 5.1 years was investigated. Average time elapsed since infection diagnoses was 5.8 ± 3.4 years. Only one infant (1.0%) was HIV positive, and 56 (55.4%) infants were HIV negative. The HIV status of 44 (43.6%) infants was unknown. The relationship between the EQ-5D functional dimensions and the PCS-12 and the relationship between the EQ-5D anxiety/depression dimension and the MCS-12 were stronger. Those whose PCS-12 and MCS-12 scores were at the median or lower were classified as being in worse health, while those over the median were classified as being in better health. Respondents who reported no problem on each of the EQ-5D dimensions was divided according to the median SF-12 component scores. Those who scored at the median or lower than the median were classified as being in worse health, while those higher than the median were classified as being in better health. The VAS scores were also significantly different than the median split of the SF-12 scores for these subjects. Conclusion EQ-5D and SF-12 showed a discrimination ability in measuring the HRQoL of pregnant women living with HIV. The construct validity was identified for EQ-5D and SF-12 in the study. The respective constructs of EQ-5D and EQ-VAS may not overlap. Pregnant women living with HIV in the study gave more weight to their mental health when they provided a total health rating in EQ-VAS. EQ-VAS could explain the limitations of the EQ-5D dimension scores with ceiling effects in the survey. The results of our study could help to determine the suitable HRQoL instruments for pregnant women living with HIV and provide evidence for the proper comparison of EQ-5D and SF-12.
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Affiliation(s)
- Xiaowen Wang
- Department of Public Health, Kunming Medical University, Yunnan, China.,Yunnan Centers for Disease Control and Prevention, Yunnan, China
| | - Guangping Guo
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Ling Zhou
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Jiarui Zheng
- Yunnan Maternal and Child Health Care hospital, Yunnan, China
| | - Xiumin Liang
- Yiliang County Centers for Disease Control and Prevention, Yunnan, China
| | - Zhanqin Li
- Longling County Centers for Disease Control and Prevention, Yunnan, China
| | - Hongzhuan Luo
- Fengqing County Centers for Disease Control and Prevention, Yunnan, China
| | - Yuyan Yang
- Longchuan County Maternal and Child Health Care hospital, Yunnan, China
| | - Liyuan Yang
- Longling County Maternal and Child Health Care hospital, Yunnan, China
| | - Ting Tan
- Department of Public Health, Kunming Medical University, Yunnan, China
| | - Jun Yu
- Department of Public Health, Kunming Medical University, Yunnan, China
| | - Lin Lu
- Department of Public Health, Kunming Medical University, Yunnan, China. .,Health and Family Planning Commission of Yunnan Province, No. 309, Guomao Street, Kunming, Yunnan Province, China.
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14
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Kastien-Hilka T, Rosenkranz B, Sinanovic E, Bennett B, Schwenkglenks M. Health-related quality of life in South African patients with pulmonary tuberculosis. PLoS One 2017; 12:e0174605. [PMID: 28426759 PMCID: PMC5398494 DOI: 10.1371/journal.pone.0174605] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background The evaluation of patient-reported health-related quality of life (HRQOL) in pulmonary tuberculosis (TB) contributes to a comprehensive understanding of the burden associated with this disease. The aim of this study was to assess the overall impact of TB on the health status and on single health domains identified in the WHO definition of health, including physical, mental and social health aspects. Methods Four instruments for HRQOL evaluation were applied in a longitudinal multicentre study during six-month standard TB treatment in South Africa. These included the generic SF-12 and EQ-5D-5L, the disease-specific St. George´s Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS). Statistical analysis included significance testing, univariable and multivariable analysis, and repeated measures ANOVA. Change over time in the physical component score (PCS) of SF-12 was defined as primary endpoint. A target sample size of 96 patients was estimated. Results HRQOL of the study participants was impaired in all physical, mental and psycho-social health domains at treatment start. HRQOL improved significantly and in a clinically meaningful manner during the course of standard TB treatment, over the period of the study. The greatest improvement (95%) was observed in mental health. Younger patients with higher education and who were employed had a better HRQOL. Discussion This study demonstrates the need for an integrative understanding of TB with HRQOL as core element to inform gaps in current TB management. Improvements in the management of TB following an integrative patient-centred approach will contribute towards meeting the United Nations Sustainable Development Goal 3 (SDG3) target and will support the End TB strategy of the WHO.
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Affiliation(s)
- Tanja Kastien-Hilka
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland.,Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Fundisa African Academy of Medicines Development, Cape Town, South Africa
| | - Edina Sinanovic
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bryan Bennett
- Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Matthias Schwenkglenks
- University of Basel, Basel, Switzerland.,Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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