1
|
Karat AS, Jones AS, Abubakar I, Campbell CN, Clarke AL, Clarke CS, Darvell M, Hill AT, Horne R, Kunst H, Mandelbaum M, Marshall BG, McSparron C, Rahman A, Stagg HR, White J, Lipman MC, Kielmann K. " You have to change your whole life": A qualitative study of the dynamics of treatment adherence among adults with tuberculosis in the United Kingdom. J Clin Tuberc Other Mycobact Dis 2021; 23:100233. [PMID: 33898764 PMCID: PMC8059079 DOI: 10.1016/j.jctube.2021.100233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Maintaining adherence to treatment for tuberculosis (TB) is essential if the disease is to be eliminated. As part of formative research to develop an intervention to improve adherence, we documented the lived experiences of adults receiving anti-TB treatment (ATT) in three UK cities and examined how personal, social, and structural circumstances interacted to impact on individuals’ adherence to treatment. Using a topic guide that explored social circumstances and experiences of TB care, we conducted in-depth interviews with 18 adults (six women) who were being or had been treated for TB (patients) and four adults (all women) who were caring for a friend, relative, or partner being treated for TB (caregivers). We analysed transcripts using an adapted framework method that classified factors affecting adherence as personal, social, structural, health systems, or treatment-related. Eleven of 18 patients were born outside the UK (in South, Central, and East Asia, and Eastern and Southern Africa); among the seven who were UK-born, four were Black, Asian, or Minority Ethnic and three were White British. TB and its treatment were often disruptive: in addition to debilitating symptoms and side effects of ATT, participants faced job insecurity, unstable housing, stigma, social isolation, worsening mental health, and damaged relationships. Those who had a strong support network, stable employment, a routine that could easily be adapted, a trusting relationship with their TB team, and clear understanding of the need for treatment reported finding it easier to adhere to ATT. Changes in circumstances sometimes had dramatic effects on an individual’s ability to take ATT; participants described how the impact of certain acute events (e.g., the onset of side effects or fatigue, episodes of stigmatisation, loss of income) were amplified by their timing or through their interaction with other elements of the individual’s life. We suggest that the dynamic and fluctuating nature of these factors necessitates comprehensive and regular review of needs and potential problems, conducted before and during ATT; this, coupled with supportive measures that consider (and seek to mitigate) the influence of social and structural factors, may help improve adherence.
Collapse
Affiliation(s)
- Aaron S. Karat
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- TB Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
| | - Annie S.K. Jones
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Colin N.J. Campbell
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
- Respiratory Diseases Department, National Infection Service, Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, United Kingdom
| | - Amy L. Clarke
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Caroline S. Clarke
- Research Department of Primary Care and Population Health, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Priment Clinical Trials Unit, University College London, UCL Medical School, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Marcia Darvell
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Adam T. Hill
- Queen’s Medical Research Institute, University of Edinburgh Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Robert Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London WC1H 9JP, United Kingdom
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, 4 Newark Street, London E1 2AT, United Kingdom
| | | | - Ben G. Marshall
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Ceri McSparron
- NHS Lothian, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Ananna Rahman
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1FR, United Kingdom
| | - Helen R. Stagg
- Usher Institute, University of Edinburgh, MacKenzie House, 30 West Richmond Street, Edinburgh EH8 9DX, United Kingdom
| | - Jacqui White
- Whittington Health NHS Trust, The Whittington Hospital, Magdala Avenue, London N19 5NF, United Kingdom
| | - Marc C.I. Lipman
- UCL Respiratory, Division of Medicine, University College London, UCL Medical School, Level 1, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
- Royal Free London NHS Foundation Trust, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom
- Corresponding authors at: Institute for Global Health and Development, Queen Margaret University, Queen Margaret University Way, Musselburgh, Edinburgh EH21 6UU, United Kingdom (A.S. Karat).
| |
Collapse
|
2
|
Gabler-Schwarz S, Rad-Menendez C, Achilles-Day U, Campbell CN, Day JG. Cryopreservation of Phaeocystis antarctica. Cryo Letters 2013; 34:561-570. [PMID: 24441367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A large number of clonal isolates of the prymnesiophyte Phaeocystis antarctica have been established at the Alfred Wegener Institute in Bremerhaven, Germany, to address questions on the genetic diversity and ecological response patterns to climate change. However, at present the wider scientific community cannot access these strains and their long-term conservation, (currently by serial transfer), cannot be assured. Cryopreservation could provide the solution to these issues, as it would guarantee the long-term security of this genetically and ecological invaluable collection. This study outlines the successful application of conventional approaches and the use of novel, combined non-penetrating and penetrating cryoprotective strategies that have been successfully applied to the different life-stages of this alga.
Collapse
Affiliation(s)
- S Gabler-Schwarz
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
| | - C Rad-Menendez
- Culture Collection of Algae and Protozoa, Scottish Association for Marine Science, Oban, UK
| | - Uem Achilles-Day
- Culture Collection of Algae and Protozoa, Scottish Association for Marine Science, Oban, UK
| | | | - J G Day
- Culture Collection of Algae and Protozoa, Scottish Association for Marine Science, Oban, UK
| |
Collapse
|
4
|
Rieley G, Teece MA, Peakman TM, Raven AM, Greene KJ, Clarke TP, Murray M, Leftley JW, Campbell C, Harris RP, Parkes RJ, Maxwell JR, Campbell CN. Long-chain alkenes of the haptophytes Isochrysis galbana and Emiliania huxleyi. Lipids 1998; 33:617-25. [PMID: 9655378 DOI: 10.1007/s11745-998-0248-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The major alkenes of the haptophytes Isochrysis galbana (strain CCAP 927/14) and Emiliania huxleyi (strains CCAP 920/2 and VAN 556) have been identified by nuclear magnetic resonance spectroscopy and by mass spectrometric analysis of their dimethyl disulfide adducts. The dominant alkene in I. galbana is (22Z)-1 ,22-hentriacontadiene, with 1,24-hentriacontadiene and 1,24-tritriacontadiene present in much lower abundance; (22Z)-1,22-hentriacontadiene also occurs in E. huxleyi (strain CCAP 920/2), together with (2Z,22Z)-2,22-hentriacontadliene (the major hydrocarbon) and (3Z,22Z)-3,22-hentriacontadiene. Minor abundances of 2,24-hentriacontadiene and 2,24-tritriacontadiene are also present in this strain. In contrast, the dominant alkene in E. huxleyi (strain VAN 556) is (15 E,22E)-1,16,23-heptatriacontatriene with the related alkatriene 1,15,22-octatriacontatriene also present and (22Z)-1,22-hentriacontadiene occurring as a minor component. From structural relationships (15E,22E)-1,15,22-heptatriacontatriene is proposed to derive from the same biosynthetic pathway as that of the characteristic C37 alkenones which occur in both E. huxleyi and I. galbana. The C31 and C33 dienes likely derive from chain extension and decarboxylation of (Z)-9-octadecenoic acid or (Z)-7-hexadecenoic acid, using a pathway analogous to that elucidated previously in the chlorophyte Botryococcus braunii. Therefore, long-chain dienes and trienes, which can co-occur in haptophytes, may have distinct biosynthetic pathways.
Collapse
Affiliation(s)
- G Rieley
- School of Chemistry, University of Bristol, Cantock's Close, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|