Results obtained by using a self-administered treatment for tuberculosis

Tuberculosis (TB) has a higher incidence in populations with socio-economic deficits and requires prolonged antibiotic therapy to heal, which hinders adherence to the treatment, with an abandonment rate ranging between 15 and 30% in those with self-administered treatment. Objectives: to assess the rate of abandonment and to identify predisposing factors in patients monitored at the hospital with self-administered treatment, implemented with weekly controls during the attack phase, and then monthly controls (consolidation phase) until completing the planned schedule. Materials and methods: all the patients who started treatment between January 1st and December 31st, 2015 were included. A descriptive analysis of the results obtained up to December 31st, 2016 was performed. An interruption ≥ 14 days during the attack phase and ≥ 2 months during the consolidation phase was defined as abandonment by comparing the characteristics of this group with the compliant group using the chi-square test. Results: 73 patients (38 males) aged 34±15 years were included, 32 were Argentine (44%), and the rest was comprised of: 33 Bolivians, 5 Paraguayans, 2 Peruvians and 1 Chilean. In 47 cases (64%), TB was pulmonary. The extrapulmonary damage included: 11 pleural, 5 nodal, 3 bone (one with a concomitant impact on the psoas and another one on the lung), 2 laryngeal and pulmonary, 2 peritoneal, 2 meningeal and 1 intestinal. In all the cases (except for one that started treatment empirically), the disease was confirmed by direct AFB smear or culture, or by finding granulomas in biopsies performed in a compatible clinical context. Fifty-two patients completed the treatment (71.2%), 1 patient passed away and 20 abandoned it (27.4%); of the latter, 4 restarted and completed the treatment. The most frequent comorbidities were alcoholism (n = 7), diabetes (n = 6), and HIV positives (n = 6). Compared to the group that completed the treatment, alcoholism was a significant predictive factor for abandonment (2 in 52 vs. 5 in 20; p < .01). There were no significant differences regarding HIV positives (4 in 52 vs. 2 in 20) or gender (9 out of 38 males abandoned treatment vs. 11 out of 34 females). Likewise, there were no differences regarding age, nationality or education level. Conclusion: with the self-administered treatment system, we obtained an abandonment rate no higher than the expected one at our hospital. Alcoholism was associated with a higher risk of abandonment. Identifying other predisposing factors will help to improve adherence to the treatment by defining specific follow-up strategies.

Evaluation on validity and reliability of global physical activity questionnaire by using two methods for collecting data / 重庆医学

Objective To test the validity and reliability of global physical activity questionnaire (GPAQ) by using two methods for collecting data,and to evaluate the equality of two measure methods.Methods The physical activity (PA) in two hypertension groups was examined twice with GPAQ by using self-administered and interview methods respectively.The test-retest reliability coefficient and consistency coefficient were calculated based on the results of two groups.The criterion validity of GpAQ was assessed by adopting pedometer and international physical activity questionnaire (IPAQ).Results The intra-group relative coefficient detected by two methods had statistical difference in the aspects of,the vigorous PA (work),total moderate PA and total moderate-vigorous PA(P＜0.05).In the aspect of different grades of PA level measurement,theconsistency coefficients detected by two methods were 0.37 and 0.31 respectively;in the aspect of whether reaching recommended PA level in hypertensive patients,the consistency coefficients detected by two methods were 0.33 and 0.34 respectively.The relative coefficient detected by pedometer,IPAQ and GPAQ was 0.19-0.46.Conclusion GPAQ has good reliability and validity,is suitable to be popularized and applied in the group of chronic disease hypertension.The validity and reliability of GPAQ measured by the self-administered method are consistent to those measured by using the interview method,promptingthat the self-administered method may be used to measure PA status in population by GPAQ.

Evaluation on validity and reliability of global physical activity questionnaire by using two methods for collecting data / 重庆医学

Objective To test the validity and reliability of global physical activity questionnaire (GPAQ) by using two methods for collecting data,and to evaluate the equality of two measure methods.Methods The physical activity (PA) in two hypertension groups was examined twice with GPAQ by using self-administered and interview methods respectively.The test-retest reliability coefficient and consistency coefficient were calculated based on the results of two groups.The criterion validity of GpAQ was assessed by adopting pedometer and international physical activity questionnaire (IPAQ).Results The intra-group relative coefficient detected by two methods had statistical difference in the aspects of,the vigorous PA (work),total moderate PA and total moderate-vigorous PA(P＜0.05).In the aspect of different grades of PA level measurement,theconsistency coefficients detected by two methods were 0.37 and 0.31 respectively;in the aspect of whether reaching recommended PA level in hypertensive patients,the consistency coefficients detected by two methods were 0.33 and 0.34 respectively.The relative coefficient detected by pedometer,IPAQ and GPAQ was 0.19-0.46.Conclusion GPAQ has good reliability and validity,is suitable to be popularized and applied in the group of chronic disease hypertension.The validity and reliability of GPAQ measured by the self-administered method are consistent to those measured by using the interview method,promptingthat the self-administered method may be used to measure PA status in population by GPAQ.

Instrumentos de evaluación del trastorno obsesivo compulsivo: revisión / Instruments for the evaluation of obsessive-compulsive disorder: review

El trastorno obsesivo compulsivo (TOC) es una perturbación mental común, cuyo diagnóstico es puramente clínico. Su prevalencia en población colombiana, oscila entre 3.6% en adultos, y 7.4% en adolescentes. La actual revisión pretende orientar al psicólogo clínico, en la elección de los instrumentos que le permitan evaluar exhaustivamente el TOC.

Obsessive compulsive disorder (OCD) is a common mental disorder, whose diagnose is purely clinical. Its prevalence in Colombian population ranges from 3.6% in adults and 7.4% in adolescents. This review aims to guide the clinical psychologist, regarding the choice of instruments to enable it to fully assess the OCD.

Assessment of Knowledge and Practice on Consumption of Expired Pharmaceuticals: A Cross-Sectional Study at Karachi, Pakistan.

The objective is to assess the awareness level and practice for the consumption of expired pharmaceuticals in general public of Karachi, Pakistan. In this regard, a cross-sectional study was conducted and completed from December 2013 to September 2014. Self-administered study instrument was used which consisted of total 11 variables regarding the assessment of participants’ perspective on product expiry and its usage was distributed to 120 participants. Data were analyzed in SPSS version16.0. Primarily descriptive nature was used while frequency percentages of respondents were computed for categorical variables. Mean ± SD were computed for assessment of knowledge scores. Overall response rate was 83.33% in which 74 male and 26 females filled the study instrument. Average scores of respondents’ awareness regarding expiry of pharmaceutical products was 4.62 ± 0.75. The qualification of respondents includes the graduates’ count (64.9% male and 65.4% females) while 16.2% male and 23.1% female were postgraduate. Response distribution of respondents showed that 93.2% male and 92.3% female were aware about the product expiry concept. Similarly, 87.8% male and 96.2% female were in favor for their non-utilization, as 89.2% male and 96.2% female reported its severe harmful effects. Overall, 87.8% male and 76.9% female were interested to discard such products. Interestingly, 82.4% male, 73.1% female were in full opinion to check the product expiry date before its purchase whereas, 78.4% male and 92.3% female have their opinion to purchase long expiry products. Box plot regarding products preference and total aggregated knowledge scores showed consistency. Results concluded that the knowledge, responses and practices of participants were in favor for the non-utilization of expired pharmaceuticals.

Two-Staged scrotal tunnel flap repair: Treatment of self-administered penile injection.

Objective: The numbers of patients, suffered from complications of self-administered penile injection, increase every year. We present 2-staged scrotal tunnel flap repair to solve their problems. Methods: From August 2002-May 2004, we performed 8 cases by this technique. All the patients used olive oil injections except one who misused formalin injection. The case with previous bead-embedded penile skin was included. The first stage operation, the excised skin lesion penis was buried to subscrotal tunnel. Three months later, the second stage operations, flap detachment, were managed in 3 styles: 4 cases by linear incision, 2 cases by W-shapes incision and the last 2 cases by Z-plasty incision orderly. Results: All of the cases, the flaps were healthy and the wounds had neither dehiscence nor infection. The patients had normal sensation and painless erection. Conclusion: We have found that the 2-staged scrotal tunnel flap repair especially Z-plasty style is a simple operation that regains satisfied function and cosmetic outcome to the complicated self-administered penile injection patient.

Complementary and Alternative Medicine and Quality of Life / 日本補完代替医療学会誌

I believe that 21^st century is the century of Quality of Life (QOL). I recognize that QOL assessment plays very important roles to evaluate the usefulness of complementary and alternative medicine (CAM), because both QOL and CAM have the same direction and philosophy to understand the humanbeing as a whole. In addition, not only QOL but also CAM struggle with the difficulty of the translation from subjective evaluation into objective one together. I hope that CAM repairs the demerits of fractionalized medicine with the help of concept based on QOL in order to establish the ideal medicine for humanbeing in future.<br>

A implantação da estratégia DOTS na cidade do Rio de Janeiro / Implementation of the DOTS strategy in the city of Rio de Janeiro

Introdução: o objetivo deste estudo foi descrever a implementação da estratégia DOTS (Estratégia de Tratamento Diretamente Observado de Curta duração) nos centros de saúde na cidade do Rio de Janeiro, apresentando os resultados obtidos após dois anos de desenvolvimento de projetos-piloto. Métodos: análise dos dados contidos nos "Livros de Registro e Controle do Tratamento", regularmente notificados à Secretaria Municipal de Saúde do Rio de Janeiro, visando avaliar o impacto do tratamento diretamente observado (DOT) nos índices de cura e o efeito da implementação da estratégia DOTS na qualidade do programa de controle da tuberculose (PCT). Resultados: De Janeiro de 1999 a Dezembro de 2001, 3657 casos de TB foram registrados nas áreas onde a estratégia DOTS foi implantada. Destes, 1730 receberam DOT e 1927 receberam tratamento auto-administrado (TAA). Entre os caos novos, 81% dos que receberam DOT e 71% dos que receberam TAA foram tratados com sucesso (OR 1,66, IC 95%: 1,3 -1,8), p<0,01. As taxas de negativação da baciloscopia do escarro após 2 e 3 meses de tratamento foram de 84% e 91% respectivamente para aqueles que receberam DOT e 75% e 83% para o grupo em TAA. Nos centros de saúde onde a estratégia DOTS foi implantada houve, em 3 anos, melhora geral dos índices de cura e de abandono, assim como dos percentuais de baciloscopias realizadas para acompanhamento do tratamento. Conclusão: Pacientes que receberam DOTS tiveram maior chance de cura do que aqueles que receberam TAA. A implantação da estratégia DOTS melhorou a qualidade do PCT.

Introduction: The objective of this study is to describe the implementation of DOTS (Directly Observed Treatment, Short course) strategy in health centers in the city of the Rio de Janeiro presenting the results 2 years after teh development of pilot projects. Methods: analysis of data recorded on the "TB treatment and outcome registration books", regularly reported to the City Health Secretariat, to evaluate the results of the directly observed therapy (DOT) on the treatment success rates and the effect of DOTS implementation on the equality of the TB control program. Results: From January 1999 to December 2001, 3,657 TB cases were registered in the areas where the DOTS strategy was implemented. Of these, 1,730 received directly observed treatment (DOT) and 1,927 received self-administered treatment (SAT). In the DOT group 81% of the new cases were treated successfully, whereas in the SAT 71% of the new cases were treated successfully (OR1,66, 95% CI:1,3 -1,8, p <0,01). The sputum smear conversion rates for the new cases after 2 and 3 months' treatment were respectively 84% and 91% for the group on DOT and 75% and 83% for those on SAT. In the health centers where the DOTS strategy was implemented there was a general improvement on the cure and default rates, and also on the proportion of patients monitored bacteriologically during treatment. Conclusion: patients receiving DOT were much more likely to complete treatment than those receiving SAT. The implementation of the DOTS strategy improved the quality of the TB control program.