Factors determining compliance with tuberculosis treatment in an urban environment, Tamatave, Madagascar

SETTING: Patient compliance remains one of the main obstacles that need to be overcome by tuberculosis control programmes, in the developing world as well as in industrialised countries. A better understanding of the various factors accounting for treatment default could help to achieve better compliance from patients. OBJECTIVES: To increase the understanding of the determining factors of default in an urban environment where medical facilities are accessible. Different kinds of determinants were studied: objective socio-demographic factors, subjective psychological factors, attitudes and behaviour of patients in relation to chemotherapy, quality of relationships with the medical staff, knowledge and attitudes regarding tuberculosis. DESIGN: Risk factors for default were assessed by a retrospective case-control study in a sample of 38 patients who had not completed treatment for pulmonary tuberculosis, compared with 111 controls who had completed treatment under comparable conditions. RESULTS: Default appears to be significantly linked to transportation time, the sex of the patient, patient information and the quality of communication between patients and health workers. False addresses given by patients are both a methodological bias and a risk factor for future default. CONCLUSION: Improved communication skills and attention from the medical staff could encourage more patients to complete their TB treatment.     

Functional evaluation of persons over 60 years of age living in an urban community. ANCO project

OBJECTIVE: To establish the grade of functional deterioration in older people and analyse associated factors. DESIGN: Cross sectional study. SETTING: City of Córdoba. PARTICIPANTS: The population over 60 years old on the Córdoba municipal roll (49,674) and living at home, from which a sample of 1,103 subjects was taken. INTERVENTIONS: The multidimensional OARS-MFAQ questionnaire was filled in. Calculation of the functional deterioration scores enabled five areas to be evaluated: physical health (PH), mental health (MH), economic resources (ER), social resources (SR) and capacity to perform daily activities (DA) autonomously. MEASUREMENTS AND MAIN RESULTS: Reply rate was 86.8%. The prevalence of serious/absolute deterioration in each of the areas was: 9.3% in SR, 8.5% in DA, 8.4% in ER, 6.9% in MH and 5.8% in PH. CONCLUSIONS: Both the prevalence of functional deterioration in the population group under study and the demand for institutional care are similar to other studies performed in our country, but higher than in Anglosaxon countries.     

Tuberculous meningitis in an urban general hospital

We analyzed the clinical and laboratory findings of 19 patients with tuberculous meningitis seen between 1966 and 1974 at the Henry Ford Hospital. Eighteen patients were adults at the time of diagnosis. In eight patients, the history suggested that the infection with the tubercle bacillus had occurred in the remote past. Cerebrospinal fluid analysis was often typical for tuberculous meningitis; stains for Mycobacterium tuberculosis were usually negative. Of 16 patients who were treated, five died and five suffered permanent neurological sequelae. The addition to rifampin to isoniazid therapy did not improve either survival or permanent sequelae. We were not able to analyze the effect of steroids on the disease.     

Sunscreen use in an urban Negev population

The use of sunscreen in the Negev population was assessed. The study population included 1458 subjects, mean age 35.5 +/- 14.2 years, half born in Israel and 25% in East Europe. Two-thirds were exposed to the sun 1-2 hours a day and 13% 4 hours a day or more. Only about 15% used sunscreen while shopping, 69% used it at the beach, and less than half applied it to children being sent to school. Sunscreen use was greater in women (p < 0.000001), especially those with sensitive skin (p < 0.0001) and red hair (p < 0.0001). No significant association was found with age, education or country of birth.     

Law enforcement in an urban society.

Discusses 4 conditions which affect the capability of the judicial and law enforcement systems to cope with crime and presents several recommendations that may ease the workload and mitigate the potential ineffectiveness of the legal establishment. The law explosion (i.e., the quantitative and qualitative problems associated with social conflicts that are settled by law); the malaise in criminal law (e.g., incomplete and misunderstood crime statistics and reports and the uneven distribution of resources in the legal system); organizational fragmentation within the judicial, police, and law networks; and the overload of the courts are considered to be the major problems which face legal authorities concerned with the reduction in crime. Attention is focused on the discrepancies in role expectations of the police and the various systems of control which affect police behavior. Suggested remedies include additional resources, a redistribution and reorganization of present resources, and new means of judging social crimes, possibly decriminalization. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acetaminophen toxicity in an urban county hospital

BACKGROUND: The prevalence and characteristics of acetaminophen-associated liver injury in hospitalized patients are not well defined. METHODS: We identified patients hospitalized for excessive acetaminophen ingestion at an urban county hospital over a 40-month period (1992 to 1995) and reviewed their medical records to determine the incidence and clinical features of the ingestions and their outcomes. RESULTS: Of the 71 patients studied, 50 were classified as having taken acetaminophen during suicide attempts and 21 as having accidentally poisoned themselves while attempting to relieve pain. The suicidal patients had ingested almost twice as much acetaminophen as those in the accidental-overdose group (median, 20 vs. 12 g; P=0.009). Among the patients for whom data were available, 63 percent of those in the accidental-overdose group and 25 percent of those in the suicidal group had chronic alcohol abuse (P=0.009). The patients in the accidental-overdose group more often had severe liver necrosis (aminotransferase levels, >3500 IU per liter; 52 percent vs. 14 percent; P=0.002), and were more likely to have hepatic coma (33 percent vs. 6 percent, P=0.006). There were four deaths (19 percent) in the accidental-overdose group and one (2 percent) in the suicidal group (P=0.04). Five patients -- three in the accidental-overdose group and two in the suicidal group -- had ingested 4 g of acetaminophen or less. Acetaminophen ingestion accounted for 12 percent of all patients hospitalized with overdoses (71 of 589) and 40 percent of patients with acute liver failure (10 of 25) during the study period. CONCLUSIONS: In an urban county hospital, patients hospitalized with acetaminophen toxicity related to accidental misuse had higher rates of morbidity and mortality than those who attempted suicide, even though the latter had taken more acetaminophen. A higher frequency of chronic alcohol abuse among the patients with accidental overdoses may be one explanation.     

Suboptimal compliance with periconceptual folic acid in an Irish hospital population

A time-series study of homicide and suicide rates by each method in England and Wales from 1950 to 1985 showed that the sociological correlates of these rates depended upon the method used for killing. This raises the possibility that murder and suicide may not be unitary phenomena, but rather that murder and suicide by particular methods are distinct deviant acts and should be studied separately.     

Drinking and driving in an urban setting in Kenya

A roadside alcohol prevalence survey of drivers randomly selected from the general traffic was conducted in Eldoret, Kenya. Blood alcohol concentration (BAC) data obtained by a breath test in 90% of the sample (n = 479) was analysed by demographic and travel characteristics. 19.9% had a positive breath test (BAC > or = 5 mg%), 8.4% had BACs greater than 50 mg%, and 4% exceeded 80 mg%. A greater proportion of males (20%) had been drinking compared to females (12.5%): all drivers with high BACs (> or = 50 mg%) were males. The likelihood of having consumed alcohol was greater in motorists aged 25 years and above (20.4%) than in younger drivers aged 16-24 years (15.4%), their mean BACs were also more elevated (57 mg% versus 31 mg%). In comparison to operators of public service vehicles (PSV), people driving personal cars were more than twice as likely to have been drinking: with 21.9% being BAC positive against 10.8% (OR = 2.3; 95% CI, 1.0 to 6.3, p = 0.05). Educated individuals with skilled careers tended to indulge in drink-driving to a greater extent than professional drivers (operators of public transport, taxi and heavy goods vehicles), with BAC prevalence rates of 23.7% and 15.5%, respectively. Other circumstances influencing the probability of drink-driving were number of vehicle occupants, distance to destination, road location, time of the night and whether it was a weekend or weekday. These findings are discussed in relation to the potential for promotion of relevant deterrent measures, including the establishment of an appropriate BAC legal limit for drivers in Kenya.     

Attendance versus compliance with tuberculosis treatment in an occupational setting--a pilot study

AIM: To determine the prevalence of non-compliance with tuberculosis treatment at Freegold Mines. OBJECTIVES: 1. To establish the rates of attendance and collection of anti-tuberculosis drugs. 2. To determine prevalence of non-compliance by means of urine tests. DESIGN: A cross-sectional study conducted over 2 weeks at mine medical stations. METHOD: Urine samples were collected from tuberculosis patients 3 hours after drug ingestion. Non-compliance was established by testing these samples for rifampicin and/or isoniazid (INH) metabolites. Non-compliance was defined as a negative urine test result for these drugs in participants whose treatment regimens included one or both. Daily attendance and collection of drugs statistics are recorded in the medical station tuberculosis register. The patient rate of adherence was calculated as the observed number of days on which medication had been collected over the expected treatment days in a given period. RESULTS: Urine test results showed an overall prevalence of non-compliance of 14.6 +/- 3.3%. The study showed that non-compliance with tuberculosis treatment was underestimated by the surveillance data. The rate of non-adherence with treatment established from the formal surveillance procedure was 0.2%. The poor response rate of patients was found to be a major problem and fewer than 40% per day returned to bring urine specimens. The mean prevalences of non-compliance established by rifampicin and INH tests were 19.5 +/- 5.3% and 9.8 +/- 3.9%, respectively, and these were significantly different (Chi 2 = 7.44; P < 0.05). The proportion of false-positive results for INH and rifampicin urine tests were 21% (11/53) and 35% (17/48), respectively, showing that some patients were taking the wrong treatment. CONCLUSIONS: It is clear that attendance at the clinics does not accurately reflect compliance. Both programme compliance (dispensing of the correct treatment) and patient compliance need to be improved. This has important implications for the new national tuberculosis control policy adopted by the South African government that stresses the importance of directly observed therapy, short-course (DOTS) and a patient-centred approach.     

Experiences of injectable contraceptive users in an urban setting

Anti-invasive and anti-metastatic effects of anti-integrin antibodies (against VLA-alpha 2, alpha 4, beta 1) were examined on human fibrosarcoma cells using in vitro invasion assay in a reconstituted basement membrane (Matrigel) and experimental metastatic assay in a chick embryo. The effects of anti-integrin antibodies were compared with those of RGD-containing peptides (GRGDS), which have been known as effective inhibitors of tumor cell metastasis. Although slight differences in effective concentration among antibodies were observed, invasion and metastasis were significantly inhibited by anti-integrin antibodies. The results also showed partial inhibitory effect of GRGDS on the invasion and metastasis of human fibrosarcoma cells. These results indicate that integrin receptors mediating cell-cell/cell-extracellular matrix components interactions play a key role in the invasion and metastasis of human fibrosarcoma cells.     

Prospective assessment of triage in an urban emergency department

BACKGROUND: This study examined the effectiveness of a triage system based on patient complaints, medical history, vital signs, and triage nurse impression. Measurements included recognizing patients needing admission, in correlating with disposition, and its effectiveness in all age groups. METHODS: Data were collected prospectively on all patients coming to a general emergency department (ED) of an urban teaching hospital from October 1, 1992, through November 30, 1992. Data included assigned triage acuity, disposition waiting time to physician examination, and disposition, as well as return to the ED within 2 weeks. The patients were divided into age groups: 0 to 16 years, 17 years to 25 years, 25 years to 50 years, 50 years to 65 years, and >65 years of age. RESULTS: There were five patients (n = 4,993, 0.4%) who were triaged nonemergently and subsequently admitted. The sensitivity and specificity of an assigned triage 3 acuity assignment in correlating with lack of admission were 99% and 56%, respectively. Mean waiting time to physician examination was 61 +/- 14 minutes for triage 1, 129 +/- 19 for triage 2, and 182 +/- 22 for triage 3. Mean time to admission from sign-in was 246 +/- 10 minutes for triage 1 and 372 +/- 16 minutes for triage 2. CONCLUSIONS: This triage system accurately correlated with disposition and determined waiting time to examination.