2494 research outputs found
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Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province
No full textAbstract
Background
Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.
Methods
A retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with \u2018died\u2019 as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.
Results
Of the 190,472\ua0TB cases included in the analysis, 30,991 (16.3%) had \u2018died\u2019 as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8\u201317 years (AOR: 2.0; CI: 1.5\u20132.7), 18\u201349 years (AOR: 5.8; CI: 4.0\u20138.4), 50\u201364 years (AOR: 7.7; CI: 4.6\u201312.7), and \u226565\ua0years (AOR: 14.4; CI: 10.3\u201320.2). Other factors associated with increased odds of mortality included: HIV co-infection (males \u2013 AOR: 2.4; CI: 2.1\u20132.8; females \u2013 AOR: 1.9; CI: 1.7\u20132.1) or unknown HIV status (males \u2013 AOR: 2.8; CI: 2.5\u20133.1; females \u2013 AOR: 2.4; CI: 2.2\u20132.6), having a negative (AOR: 1.4; CI: 1.3\u20131.6) or a missing (AOR: 2.1; CI: 1.4\u20133.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2\u20131.4).
Conclusions
Although mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered
Computerized alcohol screening identified more at-risk drinkers in a level 2 than a level 1 trauma center
No full textAbstract
Background
Alcohol abuse is recognized as a significant contributor to injury. It is therefore essential that trauma centers implement screening and brief intervention (SBI) to identify patients who are problem drinkers. Although, the utility of SBI in identifying at-risk drinkers have been widely studied in level 1 trauma centers, few studies have been done in level 2 centers. This study evaluates the usefulness of SBI in identifying at-risk drinkers and to investigate the pattern of alcohol drinking among level 2 trauma patients.
Methods
This is a retrospective study of a convenience sample of trauma patients participating in computerized alcohol screening, brief intervention, and referral to treatment (CASI) in an academic level 1 trauma center and a nearby suburban community hospital level 2 trauma center. CASI utilized Alcohol Use Disorders Identification Test (AUDIT) to screen patients. We compared the pattern of alcohol drinking, demographic factors, and readiness-to-change scores between those screened in a level 2 and 1 trauma center.
Results
A total of 3,850 and 1,933 admitted trauma patients were screened in level 1 and 2 trauma centers respectively. There was no difference in mean age, gender, and language between the two centers. Of those screened, 10.2% of the level 1 and 14.4% of the level 2 trauma patients scored at-risk (AUDIT 8\u201319) ( p \u2009<\u20090.005). Overall, 3.7% of the level 1 and 7.2% of the\ua0level 2 trauma patients had an AUDIT score consistent with dependency (AUDIT\u2009>\u2009=20) ( p \u2009<\u20090.005). After adjusting for age, sex, education, and language, the odds of being a drinker at the level 2 center was two times of those at the level 1 center ( p \u2009<\u20090.005). The odds of being an at-risk or dependent drinker at level 2 trauma center were 1.72 times of those at\ua0the level 1 center ( p \u2009<\u20090.005).
Conclusions
Findings suggest that SBI is effective in identifying at-risk drinkers in level 2 trauma center. SBI was able to identify all drinkers, including at-risk and dependent drinkers at higher rates in level 2 versus level 1 trauma centers. Further studies to evaluate the effectiveness of SBI in altering drinking patterns among level 2 trauma patients are ..
Alcohol management plans in Aboriginal and Torres Strait Islander (Indigenous) Australian communities in Queensland: community residents have experienced favourable impacts but also suffered unfavourable ones
No full textAbstract
Background
In Australia, \u2018Alcohol Management Plans\u2019 (AMPs) provide the policy infrastructure for State and Commonwealth Governments to address problematic alcohol use among Aboriginal and Torres Strait Islanders. We report community residents\u2019 experiences of AMPs in 10 of Queensland\u2019s 15 remote Indigenous communities.
Methods
This cross-sectional study used a two-stage sampling strategy: N \u2009=\u20091211; 588 (48%) males, 623 (52%) females aged \u226518\ua0years in 10 communities. Seven propositions about \u2018favourable\u2019 impacts and seven about \u2018unfavourable\u2019 impacts were developed from semi-structured interviews. For each proposition, one-sample tests of proportions examined participant agreement and multivariable binary logistic regressions assessed influences of gender, age (18\u201324, 25\u201344, 45\u201364, \u226565\ua0years), residence (\u22656\ua0years), current drinking and Indigenous status. Confirmatory factor analyses estimated scale reliability ( \u3c1 ), item loadings and covariances.
Results
Slim majorities agreed that: AMPs reduced violence (53%, p \u2009=\u20090.024); community a better place to live (54%, 0.012); and children were safer (56%, p \u2009<\u20090.001). More agreed that: school attendance improved (66%, p \u2009<\u20090.001); and awareness of alcohol\u2019s harms increased (71%, p \u2009<\u20090.001). Participants were equivocal about improved personal safety (53%, p \u2009=\u20090.097) and reduced violence against women (49%, p \u2009=\u20090.362). The seven \u2018favourable\u2019 items reliably summarized participants\u2019 experiences of reduced violence and improved community amenity ( \u3c1 \u2009=\u20090.90).
Stronger agreement was found for six \u2018unfavourable\u2019 items: alcohol availability not reduced (58%, p \u2009<\u20090.001); drinking not reduced (56%, p \u2009<\u20090.001)); cannabis use increased (69%, p \u2009<\u20090.001); more binge drinking (73%, p \u2009<\u20090.001); discrimination experienced (77%, p \u2009<\u20090.001); increased ..
Knowledge, attitudes and practices regarding tuberculosis care among health workers in Southern Mozambique
No full textAbstract
Background
Tuberculosis (TB) control is more likely to be achieved if the level of knowledge regarding TB is increased among health workers managing high-risk groups. No formal assessments regarding knowledge, attitudes and practises of health workers about TB have been published for Mozambique, a country facing challenges in the fight against TB, with a fragile health system and considerable work overload of health personnel. The main objective of the study was to determine the level of knowledge, identify attitudes and assess practices regarding TB care and control among health care workers of the district of Manhi\ue7a.
Methods
A descriptive cross-sectional study was performed through the use of a specifically designed Knowledge, Attitudes and Practices (KAP) questionnaire in the district of Manhi\ue7a, a high tuberculosis and HIV burden rural area in Southern Mozambique. In this district, 14 health care facilities service a population of approximately 160,000 people. The questionnaire took 30\u201345 min to administer with external assistance not permitted. The survey contained 79 questions pertaining to four different areas: demographics, TB knowledge, attitudes and practices.
Results
The study sample included 170 health care workers. The average knowledge score was 14.89 points (SD\u2009=\u20093.61) out of a total possible 26 points. Less than 30% of respondents had heard of Xpert MTB/RIF\uae. Seventy per cent agreed there was stigma associated with TB and 48.2% believed this stigma was greater than that associated with HIV. The average practice score was 3.2 out of 9 points (35.6%, SD\u2009=\u20092.4).
Conclusion
Health care worker\u2019s knowledge gaps identified in this study may result in substandard patient care. Specific deficiencies in understanding existed in terms of paediatric TB and Xpert MTB/RIF\uae testing. The present study provides impetus for tailored TB education among health care workers from a high TB burden rural area in Southern Mozambique
B-type natriuretic peptides in chronic obstructive pulmonary disease: a systematic review
No full textAbstract
Background
Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. Natriuretic peptides (NP) in other populations are useful in identifying cardiovascular disease, stratifying risk, and guiding therapy.
Methods
We performed a systematic literature review to examine NP in COPD, utilising Medline, EMBASE, and the Cochrane Library.
Results
Fifty one studies were identified. NP levels were lower in stable compared to exacerbation of COPD, and significantly increased with concomitant left ventricular systolic dysfunction or cor pulmonale. Elevation occurred in 16\ua0to 60% of exacerbations and persisted in approximately one half of patients at discharge. Cardiovascular comorbidities were associated with increased levels. Levels consistently correlated with pulmonary artery pressure and left ventricular ejection fraction, but not pulmonary function or oxygen saturation. NP demonstrated high negative predictive values (0.80 to 0.98) to exclude left ventricular dysfunction in both stable and exacerbation of COPD, but relatively low positive predictive values. NP elevation predicted early adverse outcomes, but the association with long term mortality was inconsistent.
Conclusion
NP reflect diverse aspects of the cardiopulmonary continuum which limits utility when applied in isolation. Strategies integrating NP with additional variables, biomarkers and imaging require further investigation
Intermittent catheterisation with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses
No full textAbstract
Background
Intermittent catheterisation is the method of choice for the management of bladder dysfunctions. Different urinary catheters are available, but there is conflicting evidence on which type of catheter is best. The present study provides an objective evaluation of the clinical effectiveness of different subsets of urinary catheters.
Methods
A systematic literature review was performed for published RCTs regarding hydrophilic coated and PVC (standard) catheters for intermittent catheterisation. Separate meta-analyses were conducted to combine data on frequencies of urinary tract infections (UTIs) and haematuria. Two separate analyses were performed, including or excluding reused standard catheters.
Results
Seven studies were eligible for inclusion in the review. The meta-analyses exploring UTI frequencies showed a lower risk ratio associated with hydrophilic catheters in comparison to standard ones (RR\u2009=\u20090.84; 95% CI, 0.75\u20130.94; p \u2009=\u20090.003). Results for the \u201creuse\u201d scenario were consistent with the ones related to \u201csingle-use\u201d scenario in terms of frequency of UTIs. The meta-analyses exploring haematuria were not able to demonstrate any statistically significant difference between hydrophilic catheters in comparison to standard ones.
Conclusions
The findings confirm previously reported benefits of hydrophilic catheters but a broader evaluation that takes into account also patient preferences, compliance of therapy, quality of life and costs would be needed to assess the economic sustainability of these advanced devices
Patterns of use of oral health care services and barriers to dental care among ambulatory older Chilean
No full textAbstract
Background
This paper describes the patterns of use of oral health care services among ambulant 65-74 years or older adults, living in the Maule Region of Chile, factors associated with their use of oral health care services, and self-reported barriers to using oral health care services.
Methods
Four hundred and thirty eight older adults, aged 65\u201374 years, living independently in the community were orally examined and underwent an oral health interview. Recency of visits was related to the use of oral health care services within the 12\ua0months prior to the study.
Results
31.5% of respondents had used oral health services in the previous 12\ua0months. In multivariate analyses, those living in rural areas ( OR\u2009= \u20092.15; 95% CI:1.27\u20133.63), and those with secondary or higher education ( OR\u2009= \u20091.65; 95% CI:1.03\u20132.64) visited the dentist in the last 12\ua0months in a higher proportion. Those with more filled tooth-surfaces were more likely to have visited the dentist ( OR\u2009= \u20094.02; 95% CI;3.58\u20134.51). Participants who self-reported dental fear, were less likely to have visited the dentist than those who did not ( OR\u2009= \u20090.43; 95% CI;0.24\u20130.76).
Conclusion
Comparing with existing data in Chile, participants in this study appear to have a slightly lower attendance. Findings question assumptions regarding oral health services utilization by rural residents and highlight the need to identify factors that influence the use of oral health services by older Chileans
A prospective study on the characteristics and subjects of pediatric palliative care case management provided by a hospital based palliative care team
No full textAbstract
Background
Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case management program compared for patients with malignant disease (MD) and non-malignant disease (NMD).
Methods
A three-month prospective study, with questionnaires filled in by members of a pediatric palliative care team (PPCT) for each contact with parents.
Results
Four hundred fifty-five contacts took place with parents of 70 patients (27MD, 43NMD). Sixty-two percent of all contacts were with the specialized nurse. The child life specialists, psychologist and social worker were also regularly consulted, the chaplain was not consulted. Ninety-five percent of all contacts took place between 8\ua0am and 6\ua0pm during weekdays, a limited number between 6\ua0pm and 9\ua0pm. Twenty-five percent of all contacts were proactively initiated by the PPCT, 25\ua0% were initiated by parents. In these care characteristics, no differences were seen for MD and NMD patients. Psychosocial topics were addressed most frequently. MD patients consulted the PPCT more often about school and NMD patients about socio-economic issues.
Conclusions
All different disciplines of the PPCT were regularly consulted, except for the chaplain. With an easy accessible team with a highly pro-active approach, availability from 8\ua0am to 9\ua0pm seems sufficient to accommodate patient\u2019s and parent\u2019s needs. More anticipation seems required for socio-economic topics. This insight in pediatric palliative case management can provide guidance in the development of a new PPCT
Non-linear parameters of specific resistance loops to characterise obstructive airways diseases
No full textAbstract
Background
Specific resistance loops appear in different shapes influenced by different resistive properties of the airways, yet their descriptive ability is compressed to a single parameter - its slope. We aimed to develop new parameters reflecting the various shapes of the loop and to explore their potential in the characterisation of obstructive airways diseases.
Methods
Our study included 134 subjects: Healthy controls ( N \u2009=\u200922), Asthma with non-obstructive lung function ( N \u2009=\u200922) and COPD of all disease stages ( N \u2009=\u200990). Different shapes were described by geometrical and second-order transfer function parameters.
Results
Our parameters demonstrated no difference between asthma and healthy controls groups, but were significantly different ( p \u2009<\u20090.0001) from the patients with COPD. Grouping mild COPD subjects by an open or not-open shape of the resistance loop revealed significant differences of loop parameters and classical lung function parameters. Multiple logistic regression indicated RV/TLC as the only predictor of loop opening with OR\u2009=\u20091.157, 95% CI (1.064\u20131.267), p -value\u2009=\u20090.0006 and R
2
\u2009=\u20090.35. Inducing airway narrowing in asthma gave equal shape measures as in COPD non-openers, but with a decreased slope ( p \u2009<\u20090.0001).
Conclusion
This study introduces new parameters calculated from the resistance loops which may correlate with different phenotypes of obstructive airways diseases
No convincing association between genetic markers and respiratory symptoms: results of a GWA study
No full textAbstract
Background
Respiratory symptoms are associated with accelerated lung function decline, and increased hospitalization and mortality rates in the general population. Although several environmental risk factors for respiratory symptoms are known, knowledge on genetic risk factors is lacking. We aim to identify genetic variants associated with respiratory symptoms by genome-wide association (GWA) analyses.
Methods
We conducted the first GWA study on cough, dyspnea and phlegm among 7,976 participants in the LifeLines I cohort and used the LifeLines II cohort ( n\u2009= \u20095,260) and the Vlagtwedde-Vlaardingen cohort ( n\u2009= \u20091,529) for replication.
Results
We identified 50 SNPs that were assessed for replication. Rs16918212, located in the alpha-2-macroglobulin pseudogene 1 ( A2MP1 ), was associated with cough in both the identification (odds ratio (OR)\u2009=\u20090.72, p\u2009= \u20095.41\u2009\ud7\u200910
\u22125
) and the meta-analyzed replication cohorts (OR\u2009=\u20090.83, p\u2009= \ua00.033). No other significant replicated associations were found.
Conclusions
Given that only 1 out of 50 SNPs showed significant replication (i.e. 2%) we conclude that we did not find a convincing association between genetic markers and respiratory symptoms. Since, environmental exposures are important risk factors for respiratory symptoms, the next step is to perform a genome-wide interaction (GWI) study to identify genetic susceptibility loci for respiratory symptoms in interaction with known harmful environmental exposures