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Cupido G, Günther G. Post tuberculosis lung disease and tuberculosis sequelae: A narrative review. Indian J Tuberc 2024; 71:64-72. [PMID: 38296392 DOI: 10.1016/j.ijtb.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 02/08/2024]
Abstract
Post Tuberculosis lung disease (PTLD) and post tuberculosis sequelae is a global and poorly recognized problem, amplified by social factors and immunocompromising conditions, inadequate treatment, lack of effective prevention of tuberculosis (TB) infection and disease. As a disease, it remained until recently poorly defined, with studies heterogenous with regards to regions, population demographics, risk factors, cohort sizes, and methods. Pathophysiologically, even successfully treated pulmonary TB disease has sequelae i.e. involving central and peripheral airways, lung parenchyma and pleura, resulting in airway narrowing and dilatation, fibrocavitation and emphysema, pulmonary vascular changes as well as pleural fibrosis. Functionally patients have airflow limitation, restrictive disease or a mixture of both not rarely associated with respiratory, or even ventilatory failure. Quality of life is often impaired through disability, TB relapse, superinfections and through increased susceptibility to reinfection and persistent inflammation, leading to progressive lung function decline and an increased risk of cardiovascular disease and cancer. Premature mortality due to PTLD is very likely, but poorly described.
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Affiliation(s)
- Gordon Cupido
- Department of Internal Medicine, Katutura State Hospital, Windhoek, Namibia.
| | - Gunar Günther
- Department of Pulmonology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medical Sciences, University of Namibia, School of Medicine, Windhoek, Namibia
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Clark SM, Reeb RN, Born CC, Hurley KE. Benefits of a health advocacy intervention intended to improve self-efficacy for self-care in residents of a homeless shelter. J Prev Interv Community 2024; 52:198-217. [PMID: 38178550 DOI: 10.1080/10852352.2023.2299895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.
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Affiliation(s)
- Sarah M Clark
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Caroline C Born
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
| | - Kathryn E Hurley
- Department of Psychology, University of Dayton, Dayton, Ohio, USA
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Silva Rodrigues OA, Mogaji HO, Alves LC, Flores-Ortiz R, Cremonese C, Nery JS. Factors associated with unsuccessful tuberculosis treatment among homeless persons in Brazil: A retrospective cohort study from 2015 to 2020. PLoS Negl Trop Dis 2023; 17:e0011685. [PMID: 37862375 PMCID: PMC10619819 DOI: 10.1371/journal.pntd.0011685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 11/01/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a preventable and a curable disease. In Brazil, TB treatment outcomes are particularly worse among homeless populations who are either of black race, malnourished or living with HIV/AIDS and other comorbidities. This study therefore evaluated factors associated with unsuccessful TB treatment among homeless population (HP) compared to those with shelter. METHODOLOGY/PRINCIPAL FINDINGS The study population was composed of 284,874 people diagnosed with TB in Brazil between 2015 and 2020 and reported in the Information System for Notifiable Diseases (SINAN), among which 7,749 (2.72%) were homeless and 277,125 (97.28%) were sheltered. Cox regression analysis was performed with both populations to identify factors associated with unsuccessful TB treatment, and significant predictors of TB treatment outcomes. Results show that HP are more susceptible to unfavorable outcomes when compared to sheltered people (Hazard Ratio (HR): 2.04, 95% CI 1.82-2.28). Among the HP, illicit drug use (HR: 1.38, 95% CI 1.09-1.74), mental disorders (HR: 2.12, 95% CI 1.08-4.15) and not receiving directed observed treatment (DOT) (HR: 18.37, 95% CI 12.23-27.58) are significant predictors of poor treatment outcomes. The use of illicit drugs (HR: 1.53, 95% CI 1.21-1.93) and lack of DOT (HR: 17.97, 95% CI 11.71-27.59) are associated with loss to follow-up, while lack of DOT (HR: 15.66, 95% CI 4.79-51.15) was associated with mortality among TB patients. CONCLUSION/SIGNIFICANCE Homeless population living in Brazil are twice at risk of having an unsuccessful treatment, compared to those who are sheltered, with illicit drugs use, mental disorders and lack of DOT as risk factors for unsuccessful TB outcomes. Our findings reinforce the arguments for an intersectoral and integral approach to address these determinants of health among the vulnerable homeless populations.
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Affiliation(s)
| | | | - Layana Costa Alves
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Renzo Flores-Ortiz
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Cleber Cremonese
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Joilda Silva Nery
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Gomes RS, Passoni LCDL, Sirigatti RDP, Rozin L, Sanches LDC, Cavassin FB. Saúde dos indivíduos em situação de rua. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introdução: A população em situação de rua é vulnerabilizada por diversos fatores que determinam ou condicionam sua saúde e ocasionam aumento dos índices de comorbidades clínicas, entre elas as doenças mentais, crônicas e infectocontagiosas. A marginalização dos indivíduos que se encontram em situação de rua abre uma lacuna na assistência em saúde que, por vezes, é suprida por organizações sem fins lucrativos que exercem um papel social elementar. Objetivo: Mapear o perfil clínico da população em situação de rua de Curitiba (PR) atendida por iniciativa voluntária no período de um ano. Métodos: Trata-se de um estudo observacional descritivo de base documental realizado com fichas clínicas dos 509 pacientes maiores de 18 anos e que tiveram seu primeiro atendimento médico realizado pela Associação Médicos do Mundo, filial Curitiba (PR), no ano de 2019. Resultados: Indivíduos do sexo masculino, de etnia branca, faixa etária entre 36 e 45 anos, que cursaram o ensino fundamental e que se encontravam havia menos de um ano em situação de rua foram as condições sociodemográficas predominantes. As principais queixas motivadoras da procura pelo atendimento foram dor (45,19%), lesões cutâneas (15,71%) e queixas oftalmológicas (6,68%). Parte dos indivíduos mostrou acometimento crônico por hipertensão arterial sistêmica (9,03%), HIV/AIDS (3,53%) e diabetes mellitus (3,53%). Também foi identificada quantidade significativa de relatos de histórico de traumas físicos (59%). Encontrou-se correlação estatística entre hipertensão e medicamentos de uso contínuo (p=0,001). Menos que 10% dos indivíduos procuraram atendimento médico por queixas de saúde mental. Das mulheres que fizerem parte do estudo, 70% relataram fazer uso de substâncias e aproximadamente metade delas, uso regular de medicamentos. Já o uso de anticoncepcionais foi relatado por uma minoria delas (18,57%). Conclusões: As queixas de dor, as lesões cutâneas e as demandas oftalmológicas foram os principais motivadores da procura por ajuda médica pela população em situação de rua, além da prevalência de hipertensão arterial sistêmica como doença crônica. Os achados podem auxiliar e direcionar ações em saúde voltadas para essa população marginalizada.
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Yang N, Chen C, He J, Li J, Zhong Y. Treatment outcome and its associated factors among HIV-MTB co-infected patients in Sichuan, China: A retrospective study. Medicine (Baltimore) 2022; 101:e32006. [PMID: 36482608 PMCID: PMC9726276 DOI: 10.1097/md.0000000000032006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Human immunodeficiency virus (HIV)-Mycobacterium tuberculosis (MTB) co-infection has become a pressing global public health problem. Although tuberculosis (TB) is both treatable and curable, it has been exacerbated by the HIV/acquired immune deficiency syndrome (AIDS) epidemic. HIV-MTB co-infected patients have a variety of disease-specific, and treatment-related factors that can adversely affect their treatment outcomes. This study was conducted to assess the outcomes of TB treatment and its associated factors among HIV-MTB co-infected patients in Sichuan, Southwest China. A retrospective study was performed on HIV-MTB co-infected patients who were diagnosed and registered in TB designated hospitals in Sichuan from January 1, 2016, to December 31, 2020. Data were collected from patients' electronic medical records regarding their demographic, clinical, and social support information, and categorical data, such as sex, were reported using numbers and percentages. χ2 and t-tests were conducted to compare groups in relation to different levels of medical institutions. A binary logistic regression model was used to identify the factors associated with unsuccessful TB treatment outcomes. For logistic regression analysis performed using an α of 0.05, odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for various risk factors. A total of 3677 registered HIV-MTB co-infected patients were enrolled. After adjusting for other variables, male, advanced age, receiving TB treatment at the municipal medical institution, being diagnosed with external pulmonary TB, referral or tracing, being sputum smear positive, not initiating antiretroviral therapy (ART) and not using fixed-dose combinations were the main risk factors for treatment failure of HIV-MTB co-infected patients in Sichuan province. Sex, age, hospital level, patient source, other diagnostic factors (e.g., sputum smear results, anatomical site of TB), and factors of therapeutic schemes (e.g., antiretroviral therapy, fixed-dose combinations) may serve as risk factors to estimate the likely treatment outcome of HIV-TB co-infection.
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Affiliation(s)
- Ni Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Chuang Chen
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
- * Correspondence: Chuang Chen, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China (e-mail: )
| | - Jinge He
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jing Li
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yin Zhong
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
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Nagot N, Hai VV, Dong TTT, Hai OKT, Rapoud D, Hoang GT, Quillet C, Minh KP, Vallo R, Nham TTT, Castellani J, Feelemyer J, Des Jarlais DC, Nguyen LP, Van Le H, Nguyen NV, Vo LNQ, Duong HT, Moles JP, Laureillard D. Alarming Tuberculosis Rate Among People Who Inject Drugs in Vietnam. Open Forum Infect Dis 2022; 9:ofab548. [PMID: 35106311 PMCID: PMC8801226 DOI: 10.1093/ofid/ofab548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The tuberculosis (TB) epidemic is not homogeneous in the general population but presents high-risk groups. People who inject drugs (PWID) are such a group. However, TB among PWID remains largely undocumented. Our goal was to assess the prevalence of TB and the risk factors associated with TB among PWID in Vietnam. METHODS We implemented a cross-sectional survey among 2 community-based cohorts of human immunodeficiency virus (HIV)-positive and HIV-negative PWID in Hai Phong. Participants were screened for TB using questions on TB symptoms. Those who reported any symptom were accompanied by peers to the TB clinic for chest x-ray. If the latter was abnormal, a sputum was collected to perform an Xpert MTB/RIF test. RESULTS A total of 885 PWID were screened for TB. For both cohorts, most PWID were male (>90.0%), with a median age of 42 years. Beside heroin injection, 52.5% of participants reported smoking methamphetamine, and 63.2% were on methadone. Among HIV-positive PWID (N = 451), 90.4% were on antiretroviral therapy and 81.6% had a viral load <1000 copies/mL. Using a complete-case analysis, the estimated TB prevalence was 2.3% (95% confidence interval [CI], 1.0-4.5) and 2.1% (95% CI, 0.8-4.2) among HIV-positive and HIV-negative people, respectively. Living as a couple, arrest over the past 6 months, homelessness, and smoking methamphetamine were independently associated with TB but not HIV infection. CONCLUSIONS In the context of very large antiretroviral therapy coverage, this extremely high rate of TB among PWID requires urgent actions.
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Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Vinh Vu Hai
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | | | | | - Delphine Rapoud
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Giang Thi Hoang
- Department of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Khue Pham Minh
- Department of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | | | - Joëlle Castellani
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Jonathan Feelemyer
- School of Global Public Health, New York University, New York, New York, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, New York, New York, USA
| | | | - Hoi Van Le
- National TB control program, Hanoi, Vietnam
| | | | | | - Huong Thi Duong
- Department of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nimes, France
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Nguna J, Okethwangu D, Kabwama SN, Aliddeki DM, Kironde SK, Birungi D, Eurien D, Ario AR, Lukoye D, Kasozi J, Cegielski PJ. Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016-2017. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000152. [PMID: 36962487 PMCID: PMC10022256 DOI: 10.1371/journal.pgph.0000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies including refugee settings. Tuberculosis and HIV/AIDS are increasingly becoming an important cause of morbidity and mortality in refugee settings. We described the treatment outcomes of TB patients and explored factors associated with treatment outcomes among TB patients attending two facilities in Kyangwali Refugee Settlement in Kikuube District, 2016-2017. We abstracted data on laboratory-confirmed patient data from TB registers from 2016 to 2017, in Kikuube Health Centre IV and Rwenyawawa Health Centre II, both located in Kyangwali Refugee Settlement. We abstracted data on socio-demographic variables including age and sex. Other variables were height, weight, final treatment outcomes, demographics, HIV status, TB treatment category, and history of TB. Treatment outcomes were categorized into favorable (including patients who were cured or those who completed treatment) and unfavorable (those in whom treatment failed, those who died, those lost to follow-up, or those not evaluated). We used logistic regression to identify factors associated with unfavorable treatment outcomes. We identified a total of 254 TB patients with a median age of 36 (IQR 26-48) years; 69% (175) were male and 54% (137) were refugees. The median weight was 50.4 kg (range 4-198). Overall, 139 (55%) had favorable outcomes while 115 (45%) had unfavorable outcomes. Refugees formed 53% (71) of those with favorable outcomes and 47% (63) of those with unfavorable outcomes 63(47%). We found that increasing age was statistically associated with unfavorable outcomes, while diagnosis with MDR-TB was associated with decreased odds for unfavorable treatment outcomes. The treatment success rate was lower compared to 85% recommended by WHO. However, the rates are similar to that reported by other studies in Uganda. Innovative approaches to improve treatment success rates with particular focus on persons aged 41-80 years should be devised.
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Affiliation(s)
- Joyce Nguna
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Denis Okethwangu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | | | | | - Doreen Birungi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Eurien
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | - Julius Kasozi
- United Nations High Commission for Refugees, Kampala, Uganda
| | - Peter J Cegielski
- Division of Global HIV and TB, Global TB Branch, US Centers for Diseases Control and Prevention, Atlanta, Georgia, United States of America
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Hino P, Yamamoto TT, Bastos SH, Beraldo AA, Figueiredo TMRMD, Bertolozzi MR. Tuberculosis in the street population: a systematic review. Rev Esc Enferm USP 2021; 55:e03688. [PMID: 33825785 DOI: 10.1590/s1980-220x2019039603688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze evidence of the occurrence of tuberculosis in people living on the streets provided by the literature. METHOD Systematic review conducted in the databases PubMed, EMBASE, LILACS, and SciELO electronic library. Analysis of the empirical material was guided by Hermeneutics. The main themes which give shape to the association between tuberculosis and street population were sought to be understood. RESULTS Initially, 343 articles were identified, but only seven met the eligibility criteria. The literature shows that homeless people with tuberculosis presented unfavorable treatment outcomes when compared to the population with fixed residence. Some of the associated reasons were abusive consumption of alcohol and other drugs and associated diseases, such as human immunodeficiency virus and others. CONCLUSION Despite the importance of this theme, analysis of the scientific production has provided evidence of the need for studies aimed not only at comprehending the occurrence of disease in this vulnerable group, but specially ways of fighting it.
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Affiliation(s)
- Paula Hino
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | - Thais Tiemi Yamamoto
- Secretaria Municipal de Saúde, Coordenadoria de Vigilância em Saúde, São Paulo, SP, Brazil
| | | | - Aline Ale Beraldo
- Ministério da Saúde, Coordenação Geral do Programa Nacional de Imunizações, Brasília, DF, Brazil
| | | | - Maria Rita Bertolozzi
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brazil
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Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
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Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
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Garfin DR, Morisky D, Shin SS, Salem B, Yadav K, Deguzman R, Harvey G, Adams I, Halas K, Chang A, White K, Wu J, Nyamathi AM. Correlates of depression and anxiety among homeless adults with latent tuberculosis infection. J Health Psychol 2020; 27:494-501. [PMID: 32951464 DOI: 10.1177/1359105320956693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Homeless persons have disproportionate rates of latent tuberculosis infection (LTBI). LTBI treatment can prevent and reduce active tuberculosis spread. We examined associations between mental health, social support, and perceptions of general health in 50 LTBI-positive, homeless adults enrolled in LTBI treatment. Depression and anxiety prevalence were 40% and 48%, respectively. Depression was negatively associated with general health, positive social interaction, and tangible, emotional/informational, and total social support, and positively associated with severe substance use (ps < 0.05). Anxiety was negatively associated with emotional/informational, tangible and total social support, and positively associated with severe substance use (ps < 0.05). Mental health services may help improve LTBI interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alicia Chang
- Los Angeles County Department of Public Health, USA
| | | | - Jesse Wu
- Los Angeles County Department of Public Health, USA
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11
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Ayano G, Shumet S, Tesfaw G, Tsegay L. A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people. BMC Public Health 2020; 20:731. [PMID: 32513264 PMCID: PMC7282102 DOI: 10.1186/s12889-020-08819-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Bipolar disorder (BD) is a common severe mental disorder among homeless people and is associated with an increased risk of disability and mortality from suicide, medical causes (including HIV/AIDS, hepatitis infection, hypertension, and tuberculosis), as well as substance use disorders. However, a systematic synthesis of the existing evidence on the subject is lacking. To fill this gap in the literature, this study aimed to carry out systematic review and meta-analysis to determine the consolidated prevalence of BD among homeless people. Methods In this systematic review and meta-analysis, we searched Embase, PubMed, and Scopus to identify pertinent studies that reported the prevalence of BD among homeless people in March 2019. Random effect meta-analysis was employed to pool data from the eligible studies. Subgroup and sensitivity analysis was conducted and Cochran’s Q- and the I2 test were utilized to quantify heterogeneity. Publication bias was assessed by using Egger’s test and visual inspection of the symmetry in funnel plots. Results Of 3236 studies identified, 10 studies with 4300 homeless individuals were included in the final analysis. Among the 10 studies, five studies used the Diagnostic Statistical Manual of Mental disorders (DSM), three studies used Mini-International Neuropsychiatric Interview (MINI), one study used Schedule for Clinical Assessment of Neuropsychiatry (SCAN), and one study used Composite International Neuropsychiatric Interview (CIDI) to assess BD among homeless individuals. Based on the results of the random effect model, the prevalence of BD among homeless people was 11.4% (95% CI; 7.5–16.9). The prevalence of BD was 10.0% (95% CI; 3.1–27.9) in Europe and it was 13.2% (95% CI; 8.9–19.3) in other countries. Moreover, the prevalence of BD was 11.5% (95% CI; 5.5–22.3) for studies that used DSM to assess BD and it was 11.0% (95% CI; 6.1–19.2) for studies that used other instruments (MINI, SCAN, and CIDI). Conclusion Our meta-analysis demonstrated that BD is highly prevalent among homeless individuals, underlying the importance of early screening and targeted interventions for BD among homeless individuals.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Tesfaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Light Tsegay
- Department of Psychiatric Nursing, College of Health Sciences, Axum University, Axum, Ethiopia
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12
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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13
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Ayano G, Tesfaw G, Shumet S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:370. [PMID: 31775786 PMCID: PMC6880407 DOI: 10.1186/s12888-019-2361-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Schizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. This systematic review and meta-analysis aimed to estimate the pooled prevalence of schizophrenia and other psychotic disorders among homeless people. METHODS PubMed, Embase, and Scopus were searched to identify pertinent studies. We used a fixed- or random-effect meta-analysis to pool data from the included studies depending on the anticipated heterogeneity. A predesigned search strategy, as well as inclusion and exclusion criteria, were used. We also performed subgroup and sensitivity analysis and Cochran's Q- and the I2 test was employed to compute heterogeneity. Egger's test and visual inspection of the symmetry in funnel plots were used to assess publication bias. RESULTS Thirty-one studies involving 51,925 homeless people were included in the final analysis. The meta-analysis showed a remarkably higher prevalence of psychosis [21.21% (95% CI:13.73, 31.29), I2 = 99.43%], schizophrenia [10.29% (95%, CI: 6.44, 16.02), I2 = 98.76%], schizophreniform disorder [2.48% (95% CI: 6.16, 28.11), I2 = 88.84%] schizoaffective disorder [3.53% (95% CI: 1.33, 9.05), I2 = 31.63%,] as well as psychotic disorders not otherwise specified [9% (95% CI: 6.92, 11.62), I2 = 33.38%] among homeless people. The prevalence estimate of psychosis was higher in developing (29.16%) as compared to developed (18.80%) countries. Similarly, the prevalence of schizophrenia was highest in developing (22.15%) than developed (8.83%) countries. CONCLUSION This systematic review and meta-analysis revealed that schizophrenia and other psychotic disorders are highly prevalent among homeless people, indicating an urgent need for studies to help develop better mechanisms of prevention, detection as well as treatment of those disorders among homeless people.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Getachew Tesfaw
- 0000 0000 8539 4635grid.59547.3aDepartment of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- 0000 0000 8539 4635grid.59547.3aDepartment of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Tuberculosis incidence rate among the homeless population: The impact of socio-demographic and health-related variables. Pulmonology 2018; 24:309-311. [PMID: 29884446 DOI: 10.1016/j.pulmoe.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/02/2018] [Accepted: 05/03/2018] [Indexed: 11/22/2022] Open
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15
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Duarte R, Migliori G, Zumla A, Cordeiro C. Strengthening tuberculosis control to advance towards elimination: The 2018 Rev. Port. Pneumol. (RPP) TB Series. Pulmonology 2018. [DOI: 10.1016/j.pulmoe.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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16
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Rito T, Matos C, Carvalho C, Machado H, Rodrigues G, Oliveira O, Ferreira E, Gonçalves J, Maio L, Morais C, Ramos H, Guimarães JT, Santos CL, Duarte R, Correia-Neves M. A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto. BMC Infect Dis 2018; 18:53. [PMID: 29370774 PMCID: PMC5785791 DOI: 10.1186/s12879-018-2968-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/17/2018] [Indexed: 01/30/2023] Open
Abstract
Background Tuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases. Methods We genotyped the M. tuberculosis strains using the MIRU-VNTR system. We performed an evolutionary reconstruction of the genotypes with median networks, used in this context for the first time. TB cases from a period of two years were evaluated combining genetic, epidemiological and georeferencing information. Results The data reveal a unique complex scenario in Porto where the autochthonous population acts as a genetic reservoir of M. tuberculosis diversity with discreet episodes of transmission, mostly undetected using classical epidemiology alone. Conclusions Although control policies have been successful in decreasing incidence in Porto, the discerned complexity suggests that, for elimination to be a realistic goal, strategies need to be adjusted and coupled with a continuous genetic characterization of strains and detailed epidemiological evaluation, in order to successfully identify and interrupt transmission chains.
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Affiliation(s)
- Teresa Rito
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal. .,ICVS/3B's, PT Government Associate Laboratory, Braga/4805-017, 4710-057, Guimarães, Portugal.
| | - Carlos Matos
- Eastern Porto Public Health Unit, (ACES Porto Oriental), 4200-510, Porto, Portugal
| | - Carlos Carvalho
- Northern Health Regional Administration, Department of Public Health, 4000-078, Porto, Portugal.,Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-013, Porto, Portugal
| | - Henrique Machado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/4805-017, 4710-057, Guimarães, Portugal
| | - Gabriela Rodrigues
- Northern Health Regional Administration, Department of Public Health, 4000-078, Porto, Portugal
| | - Olena Oliveira
- EPI Unit, Institute of Public Health, University of Porto, 4050-600, Porto, Portugal
| | - Eduarda Ferreira
- Eastern Porto Public Health Unit, (ACES Porto Oriental), 4200-510, Porto, Portugal
| | - Jorge Gonçalves
- Western Porto Public Health Unit, (ACES Porto Ocidental), 4100-503, Porto, Portugal
| | - Lurdes Maio
- Eastern Porto Public Health Unit, (ACES Porto Oriental), 4200-510, Porto, Portugal
| | - Clara Morais
- Porto TB Outpatient Centre, Centro Diagnóstico pneumológico, 4250-162, Porto, Portugal
| | - Helena Ramos
- Porto Hospital Centre, Hospital Santo António, 4099-001, Porto, Portugal
| | - João Tiago Guimarães
- EPI Unit, Institute of Public Health, University of Porto, 4050-600, Porto, Portugal.,Clinical Pathology, São João Hospital Centre, 4200-319, Porto, Portugal.,Biomedicine Department, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Catarina L Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/4805-017, 4710-057, Guimarães, Portugal
| | - Raquel Duarte
- EPI Unit, Institute of Public Health, University of Porto, 4050-600, Porto, Portugal.,Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, 4400-129, Vila Nova de Gaia, Portugal.,Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Margarida Correia-Neves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Gualtar Campus, 4710-057, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/4805-017, 4710-057, Guimarães, Portugal
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17
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Duarte R, Lönnroth K, Carvalho C, Lima F, Carvalho ACC, Muñoz-Torrico M, Centis R. Tuberculosis, social determinants and co-morbidities (including HIV). Pulmonology 2017; 24:115-119. [PMID: 29275968 DOI: 10.1016/j.rppnen.2017.11.003] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/12/2017] [Indexed: 11/26/2022] Open
Abstract
The risk of exposure, progression to active tuberculosis (TB) and then to cure is a process affected by several risk factors. Along with well known risk factors such as human immunodeficiency virus (HIV), use of immunosuppressive drugs and being of young age, emerging risk factors such socio-economic and behavioral aspects play a significant role in increasing the susceptibility to infection, and unsuccessful treatment outcomes. This paper summarizes the effects of these socio-economic determinants and co-morbidities (including HIV) on TB infection and disease.
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Affiliation(s)
- R Duarte
- Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Pneumologia, Vila Nova de Gaia, Portugal; ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - K Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County, Sweden
| | - C Carvalho
- Serviço de Doenças Infecciosas, Centro Hospitalar São João, Porto, Portugal
| | - F Lima
- Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Pneumologia, Vila Nova de Gaia, Portugal
| | - A C C Carvalho
- Laboratory of Innovations in Therapies, Education and Bioproducts (LITEB), Oswaldo Cruz Institute (IOC), FioCruz, Rio de Janeiro, Brazil
| | - M Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Mexico
| | - R Centis
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS Tradate, Italy
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18
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Santos-Silva AF, Migliori GB, Duarte R. Tuberculosis, alcohol and tobacco: Dangerous liaisons. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:177-178. [PMID: 28579223 DOI: 10.1016/j.rppnen.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- A F Santos-Silva
- Serviço de Doenças Infecciosas, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal.
| | - G B Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy
| | - R Duarte
- Faculdade de Medicina da Universidade do Porto, Portugal; Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia-Espinho, Portugal; Instituto de Saúde Pública da Universidade do Porto, Portugal
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