The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
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Int. J. Tuberc. Lung Dis. · Apr 2019
Multicenter StudyProvider perspectives on liberty and harm in the treatment of persons with tuberculosis and mental illness.
OBJECTIVES To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle-which are often invoked in health care legislation to justify liberty restrictions-in the treatment and care of persons with TB and severe and persistent mental illness (SPMI).DESIGN Qualitative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis.RESULTS Three themes were identified: 1) the contextual nature of liberty restrictions; 2) the concept of liberty as a matter of degree; and 3) the challenges of balancing the treatment and care goals of TB and mental health for persons with both TB and SPMI.CONCLUSION Harm is understood by HCWs caring for persons with TB and/or SPMI in a context-dependent manner. ⋯ Liberty restrictions to advance public health goals entail reciprocal obligations from society, including social protections and additional resources, to ease the effects and range of liberty restrictions. Attention is required to ensure that treatment and care for SPMI does not impede that of TB and vice versa. -
Int. J. Tuberc. Lung Dis. · Jun 2015
Multicenter Study Comparative StudyPyrazinamide resistance in Mycobacterium tuberculosis arises after rifampicin and fluoroquinolone resistance.
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis (TB) constitute a major public health concern. ⋯ pncA mutations associated with PZA resistance were found almost exclusively in MDR-TB strains, underlining the importance of determining PZA resistance when treating MDR- or XDR-TB.
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Int. J. Tuberc. Lung Dis. · May 2015
Multicenter StudyRole of confirmatory interferon-gamma release assays in school outbreaks of tuberculosis in South Korea.
To investigate the usefulness of confirmatory QuantiFERON(®) (QFT) testing among tuberculin skin test (TST) positive contacts to diagnose latent tuberculous infection (LTBI) in tuberculosis (TB) outbreaks among adolescents. ⋯ A confirmatory QFT for TST+ contacts could reduce the number of candidates for LTBI treatment after school TB outbreaks.
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Int. J. Tuberc. Lung Dis. · Dec 2014
Multicenter StudyPrognostic severity scores for patients with COPD exacerbations attending emergency departments.
Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations (eCOPD) are various and inconsistent in the bibliography. ⋯ Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among eCOPD patients. Such a score can be a tool for clinical practice.
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Int. J. Tuberc. Lung Dis. · Dec 2014
Randomized Controlled Trial Multicenter Study Pragmatic Clinical TrialCost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study.
To estimate the incremental cost-effectiveness of tuberculosis (TB) screening and isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV) infected adults in Rio de Janeiro, Brazil. ⋯ Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.