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Corral , R. Eur Addict Res 1 April ; 19 3 : — Background: The current study aims to identify predictors of pathological gambling PG severity, taking gender differences into account, in an outpatient sample of pathological gamblers seeking treatment. Linear and logistic regression analyses were used to examine different risk factors gender, age, impulsivity, sensation seeking, self-esteem and risk markers depression, anxiety, gambling-related thoughts, substance abuse as predictors of PG severity. Results: Impulsivity, maladjustment in everyday life and age at gambling onset were the best predictors in the overall sample. When gender differences were taken into account, duration of gambling disorder in women and depression and impulsivity in men predicted PG severity. In turn, a high degree of severity in the South Oaks Gambling Screen score was related to older age and more familiy support in women and to low self-esteem and alcohol abuse in men. Female gamblers were older than male gamblers and started gambling later in life, but became dependent on gambling more quickly than men. Sign In or Create an Account. Search Dropdown Menu. Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 19, Issue 3. Article Navigation. Research Articles November 23 This Site. Google Scholar. Corral ; P. Alberich S. Eur Addict Res 19 3 : — Article history Received:. Cite Icon Cite. Abstract Background: The current study aims to identify predictors of pathological gambling PG severity, taking gender differences into account, in an outpatient sample of pathological gamblers seeking treatment. You do not currently have access to this content. View full article. Sign in Don't already have an account? Buy Token. This article is also available for rental through DeepDyve. View Metrics. Email alerts Online First Alert. Latest Issue Alert. Citing articles via Web Of Science CrossRef Karger International S. Karger AG P. Karger AG, Basel. Close Modal.
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The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and.
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Respiratory Research volume 10 , Article number: Cite this article. Metrics details. The adherence to long tuberculosis TB treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment. Predictive factors of completion outcome cured plus completed treatment vs. Of the patients included, The treatment outcomes were: cured Completion outcome reached Case fatality was 1. Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required for patients who are retired, HIV-infected, IDU, and those with treatment comprehension difficulties. Tuberculosis TB is an infectious disease requiring adherence to long-term treatment and the tracing of patient's contacts, thus justifying it being a notifiable disease in most countries of the world. This ancient disease continues to be an important public health problem, and for this reason the World Health Organisation WHO declared it to be a global emergency in \\\\\[ 1 \\\\\]. In it was estimated that, worldwide, there had been 9. Moreover, to these new cases one must add the millions already in existence, making it the most prevalent infectious disease\\\\\[ 3 \\\\\]. The rise of immigration over the last decade in Spain has substantially altered the characteristics of TB patients. The Spanish population was 45,, inhabitants in , of whom 4,, 9. The Tuberculosis and Respiratory Infections section of SEPAR Spanish Society of Pneumology and Thoracic Surgery has previously published a study on adherence to anti-tuberculosis treatment and on fatality, referring to a cohort of patients followed during the period to \\\\\[ 6 \\\\\]. The findings indicated that immigrant status and being an injecting drug user were associated with worse treatment adherence, while patients who were HIV-infected, alcoholics, or of advanced age presented higher fatality. The aims of the present study were to analyse antituberculosis treatment adherence and fatality during standard TB treatments in patients with TB in Spain, and to identify factors associated with these events. The study will also permit changes in relation to the earlier study\\\\\[ 6 \\\\\] to be assessed, and to determine whether demographic changes experienced in Spain due to the considerable rise in immigration have had any influence on adherence to tuberculosis treatment. A multicentric prospective study was carried out involving prospective follow-up of an extensive cohort of TB patients, provided by 61 collaborators from 53 hospitals throughout Spain. Patients diagnosed with TB between 1 January and 31 December , aged 18 years or over, were included. Those patients with known resistances were excluded, as were those in whom initiation of standard TB treatment was not advisable, such as patients with hepatic problems. Cases were followed up according to an evaluation calendar Table 1. An informed consent to participate in the study was elicited. The information collected covered the following aspects: sociodemographic data, toxic habits, clinical history, diagnostic methods, drug-susceptibility, medication, clinical course, and adherence to and outcome of treatment. Data was collected through an electronic diary made available through a computerised application, accessed by each study collaborator via the SEPAR Web site using a personalised username and password. Any patient born outside Spain was classified as an immigrant. Men consuming over g of alcohol per week, and women over g, were considered alcoholics. Intravenous users of illegal drugs heroin and cocaine were classified as intravenous drug users IVDU. Toxicity was defined as an adverse effect that requires to change at least one drug, and treatment comprehension was defined as the perception of the treating doctors of the patient. The chest X-Rays were performed at the moment of the diagnosis and at the 2 nd and 6 th month and when necessary, and the evolution was classified by the treating doctor of the patient as improvement, stable or progression. A patient was included in the previous treatment category only if he or she had taken antituberculosis treatment over one year before the current active TB episode. Control of questionnaire completion and the database was carried out via telephone and e-mail contacts between the field worker and study collaborators. The following definitions were employed for treatment outcome, in accordance with European recommendations\\\\\[ 7 \\\\\]:. Cured : when the patient has completed a full course of anti-TB therapy and a negative culture is obtained during the continuation phase culture-positive patients or two negative sputum smears during the continuation phase, one of which must be at the end of treatment patients diagnosed by microscopy. Treatment completed : if the course of treatment prescribed was completed but no bacteriological conversion occurred culture-positive patients or no smear result is available at the end of treatment patients diagnosed by microscopy. Treatment failure : A patient who fails to achieve bacteriological conversion within 5 months after the start of treatment or, after previous conversion, becomes sputum smear or culture positive again. Death : A patient who died of any cause during the course of treatment is recorded under death. In the present study, the category of transfer out\\\\\[ 7 \\\\\] was redefined into two subcategories:. Lost to follow-up : when it is known that the patient disappeared and no additional information is available. Transfer out : when a patient moves to another town or health centre and whose follow-up with medical report available is the responsibility of a doctor not collaborating in the present study. Successful outcome : the percentage of patients who were cured or completed treatment out of all those detected. Completion outcome : the percentage of patients who were cured or completed treatment out of all patients who were cured or completed treatment, were defaulters, or were lost to follow up. Case-fatality rate : the percentage of patients who died during TB treatment out of all patients who were cured or completed treatment or were defaulters. Potentially unsatisfactory outcome : the percentage of patients who interrupted treatment, were lost to follow up, or failed treatment out of all detected patients. In accordance with guidelines of the Council for International Organizations of Medical Sciences CIOMS, Geneva, , and with recommendations of the Spanish Epidemiology Association regarding review of ethical aspects of epidemiological studies, the present study was submitted for evaluation to the Research Ethical Committee of the Teknon Medical Center, Barcelona and was approved on February 24 th , Principles of the Helsinki Declaration were followed at all times. Each patient had an informed consent card read aloud to them. A descriptive study was carried out of the qualitative and quantitative variables collected in order to characterise the study population. Frequency distributions and medians for quantitative variables were calculated. Quantitative variables were compared using Student's t-test or its non-parametric equivalent, the Mann-Whitney U-test, when assumptions of normality and homogeneity of variances were not met. The analysis of factors associated with poor adherence treatment defaulting comparing: cured plus treatment completed vs. A p-value of under 0. The test of Hosmer and Lemeshow was used to check the goodness-of-fit of the models. Analyses were conducted using the SPSS statistical package, version The number of patients included initially was , however 10 0. Table 2 presents the final outcomes of therapy, where it may be noted that It is estimated that 1. According to these data, the outcome was 'successful' in Completion was Among the immigrants, these percentages were The outcome of 'potentially unsatisfactory' accounted for 6. The analysis of factors possibly associated to poor adherence are presented in table 3. As presented in the table, at the univariate level poorer adherence was observed for men, immigrants, younger patients, those not retired, those not living with their family, HIV-infected patients, previously treated subjects, those who had difficulty understanding the treatment, those diagnosed via emergency services, and IDU patients, whereas being in DOT had no influence. Multivariate analysis confirmed the influence of being an immigrant, living alone, being residents of confined institutions, previous TB treatment, having difficulty understanding the treatment, and being IDU. The case-fatality was 1. The analysis of factors associated with fatality is presented in table 4. Variables having an influence at the univariate level were: immigrant, disabled or retired, residents of confined institutions or incarcerated, HIV-infected, IDU, no radiological improvement, and being in DOT. Multivariate analysis confirmed the influence of being aged over 50, being retired, being HIV-infected, having comprehension difficulties, being IDU, and having been treated under DOT. In the present study, the completion outcome was The treatment completion outcome published by the Barcelona Tuberculosis Control Program was However, according to several studies, antituberculosis therapy adherence percentages are variable: USA\\\\\[ 10 \\\\\] In our opinion, completion outcome is a better indicator of adherence than successful outcome because is not influenced by the number of deaths sometimes related to old patients or co morbidities but not to the quality of the Program. It is therefore essential to unify definition criteria: even though there is agreement over how to calculate the successful outcome, different methodologies are employed in calculating completion, making comparisons difficult. We consider that the ideal formula for calculating completion outcomes is that used in the present study percentage of patients who were cured or completed treatment out of all patients who were cured or completed treatment, were defaulters, or were lost to follow-up. Furthermore, we believe it would be important to add the category 'lost to follow-up' to the European definition when it is known that the patient disappeared and no additional information is available, only considering as 'transfer out' a patient who moves to another town or changes to another health centre and whose follow-up is performed by some other physician not collaborating in the study. Several risk factors of poor adherence have already been identified in other studies residents of confined institutions, incarcerated, IDU, previous antituberculosis treatment, HIV-infected and immigrant \\\\\[ 8 , 14 \\\\\]. In our earlier study\\\\\[ 6 \\\\\], the variables found to be associated were IDU and immigration while sex, age, and residents of confined institutions, incarceration, DOT or hospitalisation were not associated. In the present study, IDU and immigrant status continue to be associated, and we have also detected the influence of living alone, being residents of confined institutions, having difficulty understanding the treatment, and having previously undergone antiTB treatment. Sex, age group, occupational status, HIV status and having been diagnosed via emergency department had no influence. It is worth stressing the importance of not living with a family and the initial assessment made by the clinician in relation to the ease with which the patient comprehends the treatment. Many of those having difficulty understanding the treatment were immigrants, although some were native patients. The case-fatality rate is low compared with other studies\\\\\[ 15 \\\\\] due to the fact that in our study one of the criteria for exclusion was non-applicability of standard treatment for whatever reason known resistances, various types of co morbidity , and also due to the fact that the frequency of HIV-infected patients with neoplasms or of advanced age was relatively low. In an European study, it was observed that advancing age and resistance to isoniazid and rifampicin were the strongest determinants of death, while male sex, European origin, pulmonary site of disease and previous anti-TB treatment were weaker predictors\\\\\[ 16 \\\\\]. In an inner-city cohort, underlying illnesses such as diabetes mellitus, renal failure, chronic obstructive pulmonary disease, and HIV infection were predictors of death\\\\\[ 17 \\\\\]. In Mexico, predictors of death included delays in treatment after onset of the disease and low adherence of patients to the treatment regime\\\\\[ 18 \\\\\]. In the present study, the influence of HIV and of retirement a 'proxy' of older age is confirmed, and in addition we identify being aged over 50, being IDU, difficulties in comprehending the treatment, and being treated under DOT. In contrast, sex, immigrant status, sharing accommodation, previous antituberculosis treatment, radiological evolution, and alcoholism had no influence. When the two studies are compared, the distribution by sex, age-group and other variables are fairly similar, but the percentage of immigrants now is steadily increasing, as in other countries of Europe\\\\\[ 19 \\\\\]. In relation to DOT, in the current study only 9. In any case, it should be emphasised from analysing the predictor variables in the present study that the variable of understanding the treatment is very important not only for adherence, but also for fatality. Therefore, patients in whom the clinician observes this difficulty should be candidates for DOT and for closer monitoring in general. In regard to the type of therapy applied, it was observed that, in line with Spanish recommendations during these years and given the low rates of primary resistance to isoniazid, the majority of native patients had received treatment with three drugs fixed dose combinations of rifampicin, isoniazid and pyrazinamide whereas foreign-born patients with a higher proportion of resistance to isoniazid were recommended to take four drugs\\\\\[ 20 \\\\\], i. It has recently been observed that there is a progressive rise in resistances\\\\\[ 21 , 22 \\\\\] and that this is particularly the case in the immigrant population, and hence the use of four drugs has been recommended in the treatment of incident TB patients\\\\\[ 23 \\\\\], in line with both USA\\\\\[ 24 \\\\\] and UK\\\\\[ 25 \\\\\] guidelines. It should be noted that the present study was carried out by a scientific society of pneumologists, and that a considerable number of collaborators contributed an extensive cohort of patients. Follow-up of cases was exhaustive, although they cannot be extrapolated to all TB patients in Spain since the study involved physicians particularly motivated by this disease. It is therefore possible that percentages of defaulting and of fatality among TB cases in Spain would be somewhat higher in general. Another limitation of this study is that patients with TB drug resistance were not included because they can have prior history of abandonment of TB treatments. In summary, the percentage of cases coming from foreign countries is greater than recorded previously\\\\\[ 6 \\\\\]. Being an immigrant, living alone, being residents of confined institutions, having a history of antiTB treatment, having difficulty in understanding the treatment, and being IDU are all factors associated with poor adherence. Death was associated with patients who were: over the age of 50, retired, HIV-infected, IDU, having difficulty understanding treatment, and being treated according to DOT explainable since it is applied above all in the most difficult patients\\\\\[ 26 \\\\\]. Therefore, to improve adherence, special care should be taken to treat patients with social problems DOT at home, methadone programs even in prisons, admission to TB DOT centres \\\\\[ 27 \\\\\]. To reduce fatality, earlier suspicion, diagnosis, and treatment are necessary, particularly among the elderly and those patients with comorbidity or immunodepression. Community health worker intervention\\\\\[ 28 \\\\\] and closer monitoring is necessary for patients in whom the physician perceives any difficulty in understanding the treatment whether immigrants or native ; this would lead not only to improved adherence, but also to better survival among these TB patients. It is important that every city, region or country studies adherence to TB treatment and its predictive factors. In our case, this study was performed by a national scientific society of pneumology and these results can help to improve the control of TB patients in our country, and in others. WHO Report Global tuberculosis control - epidemiology, strategy, financing. Global Burden of Tuberculosis. Estimated Incidence, Prevalence, and Mortality by Country. JAMA , — Google Scholar. Informe Int J Tuberc Lung Dis , 8: — PubMed Google Scholar. Eur Respir J , — J Epidemiol Community Health , —7. Int J Tuberc Lung Dis , 5: — Int J Tuberc Lung Dis , 3: — Article PubMed Google Scholar. BMC Public Health , 7: 5— Int J Tubec Lung Dis , 9: — CAS Google Scholar. J Epidemiol Community Health , — Lefebvre N, Falzon D: Risk factors for death among tuberculosis cases: analysis of European surveillance data. Clin Infect Dis , —9. Int J Tuberc Lung Dis , 4: — World Health Organization: Tuberculosis and migration. Med Clin Barc , — Study of Mycobacterium tuberculosis drug reistance in the region of Galicia, Spain. Int J Tuberc Lung Dis , 9: — Arch Bronconeumol , — Article Google Scholar. Thorax , — Download references. Altube H Galdakao, Galdakao ; L. Benoliel H 12 de Octubre, Madrid ; L. Bustamante H Sierrallana, Torrelavega ; J. Ciruelos Hospital de Cruces, Guetxo ; M. Melero H 12 de Octubre, Madrid ; C. Zabaleta H de Laredo, Laredo ; G. You can also search for this author in PubMed Google Scholar. All authors read and approved the final manuscript. Specifically each author made the following contributions:. This article is published under license to BioMed Central Ltd. Reprints and permissions. Tuberculosis treatment adherence and fatality in Spain. Respir Res 10 , Download citation. Received : 08 July Accepted : 01 December Published : 01 December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Results Of the patients included, Conclusion Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. Introduction Tuberculosis TB is an infectious disease requiring adherence to long-term treatment and the tracing of patient's contacts, thus justifying it being a notifiable disease in most countries of the world. Methods A multicentric prospective study was carried out involving prospective follow-up of an extensive cohort of TB patients, provided by 61 collaborators from 53 hospitals throughout Spain. Table 1 Patient evaluation calendar Full size table. Results The number of patients included initially was , however 10 0. Table 2 Distribution of patients in terms of study variables. Full size table. Table 3 Analysis of factors associated with poor adherence to antituberculosis treatment. Table 4 Analysis of factors associated with dying during the expected treatment period among patients with tuberculosis. Discussion In the present study, the completion outcome was Conclusion It is important that every city, region or country studies adherence to TB treatment and its predictive factors. Google Scholar Download references. View author publications. Additional information Competing interests The authors declare that they have no competing interests. Authors' contributions All authors read and approved the final manuscript. JAC and TR coordinated the research. TR supervised data collection and MC analysed and interpreted the findings. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.
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