Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire - a TBNET study.

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients' demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient's opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control.

Serodiagnosis of environmental mycobacterial infections.

To demonstrate the usefulness of enzyme-linked immunosorbent assay for serodiagnosis of mycobacterioses due to environmental mycobacteria we utilized a panel of glycolipid antigens selective for Mycobacterium avium-intracellulare, Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium scrofulaceum and Mycobacterium gordonae. The levels of circulating antibodies were determined against the environmental mycobacteria, and Mycobacterium tuberculosis in human immunodeficiency virus-negative and -positive patient sera. The method used immunomagnetic separation of the antigens, with covalent immobilization of antibodies to superparamagnetic amine and carboxyl terminated particles in solutions of the specific antigens. Enzyme-linked immunosorbent assay was performed on 195 patient sera: 34 with infections due to environmental mycobacteria, 114 with tuberculosis, 47 with other respiratory diseases. There were 46 human immunodeficiency virus-1 infected individuals. Among the 34 infections due to environmental mycobacteria, 9 patients were singularly infected with an environmental mycobacterium, and 25 co-infected with both M. tuberculosis and an environmental mycobacterium. Sensitivity, specificity and false positivity ranges were determined for each of the volunteer groups: tuberculosis positive, human immunodeficiency virus negative; tuberculosis positive, human immunodeficiency virus positive; those with infections due to individual environmental mycobacteria (such as M. scrofulaceum and M. kansasii); and those with other respiratory diseases. We demonstrate that such multiple assays, can be useful for the early diagnosis of diverse environmental mycobacterial infections to allow the start of treatment earlier than henceforth.

[Information group--a solution to increase the efficacy of specialized intervention for smoking cessation]. / Grupul de informare--o solutie de crestere a eficacitatii consultatiei specializate pentru renuntarea la fumat.

Since 2007, in Romania, the Ministry of Health implements the national programme for tobacco control which contains also a sub-programme for sustaining smoking cessation through free treatment and counselling. Because the specialised intervention lasts too long (often more than 60 minutes) and the requests for support increased with a high rate, we had to identify methods to increase the efficacity of the intervention and, thus, the efficiency. According to this new situation, since January 2008, all the smokers asking for support to the Center for Smoking Cessation from the National Institute of Pneumology "Marius Nasta" had to participate to an "information group" prior to visit to the doctor or/and psychologist for specialized help. The aim of this group is to offer the common information needed by all smokers and does not have any elements of group therapy. During 1st January 2008 - 31st December 2009, 829 smokers asked for help in Bucharest centers, from which 585 addressed to the physicians and 288 to the psychologists, a percentage being referred to both specialists. The smokers who are going directly to the specialist tend to choose only one specialist (67,8% doctor and 24% psychologist); only 8,1% are going to both specialists. In the meantime, those smokers who are participating to the information group, are using the services of both counsellors: 30,8% comparing with 28,2% only to doctor and 9,4% only to psychologist. Comparing with the smokers who went directly to the doctor, the smokers who underwent the group of information had an increased succes rate at 3 months after quiting with 27,8%. Also, the percentage of "lost" persons decreased with 51%. Participation to the information group increases the likelihood of attendance to both specialists by 2,8 times. The common approach of the smoker increased the abstinence rate independently of the participation to the information group: 44% increase for smokers who participated to the information group, and 67,3% for persons that directly addressed to the physician. In conclusion, organising an information group will increase the double approach of the smoker (by physician and psychologist) which, in turn, will increase the success rate and the efficiency of the medical act.

[The influence of persuasion on smokers with and without pulmonary diseases]. / Influenta principiilor persuasiunii asupra fumatorilor cu ori fara afectiuni pulmonare.

UNLABELLED: The experts of manipulation are using six principles of persuasion: the consistency, the reciprocity, the social proof; the authority, the sympathy, the rarity. The publicity gets them together in different ways. OBJECTIVE: To establish if the principles of persuasion affect the smoker with or without pulmonary diseases. MATERIAL AND METHODS: There were two groups of smokers for a transversal descriptive study: patients from pulmonology hospitals in Bucharest and persons from ambulatory service. The patients were visited in 2003 and 2005. The nest selection (wards) was used. The persons in ambulatory had no known respiratory diseases; they came in two campaigns in 2004--"No smoke" and another to detect asthma. A self-administered questionnaire was used with items about demographic characteristics and the influence of persuasion distributed by age and gender. The data were processed by per cent or by Student test and the Pearson coefficient. RESULTS: There were 428 smokers, 69% men, mean age 45 years. Irrespective of group, men were receptive to publicity (p < 0.01) and rarity (p < 0.01); women were sensitive to social proof (p < 0.01), reciprocity (p < 0.01), sympathy (p < 0.05). To social proof; in group 18-30 years, the answers were 80-100%, in either group. To consistency, in group over 31 years, the answers were 80-100% in both groups of smokers. CONCLUSIONS: Through persuasion, to men is stimulated the spirit of competition; to women the specific of their personality. The youth are influenced by other smokers; the adults are consistent with their habit. The presence or absence of pulmonary diseases is not relevant for automatic behavior.

Rapid immunochromatographic serum assay of nontuberculous mycobacterial infections.

A rapid immunochromatographic serologic assay (Dot assay) is proposed to be applied on patients infected with nontuberculous mycobacteria (NTM). This assay could evidentiate the infecting species and allow the beginning of the treatment. The test is based on the principle of immunoblotting chromatography, a rapid membrane-based assay, capable of diagnosing NTM infections in serum, in less than 1 hour, with no need of special equipment or skilled staff. The secreted extracellular antigens have been isolated from the unheated culture filtrates of the clinically significant NTM (M. avium, MAI, M. kansasii, M. xenopi, M. chelonaei, M. scrofulaceum, M. marinum, M. fortuitum, M. abscesus, M. szulgai). The patients have been tested against these antigens, as well as from M. tuberculosis H37Rv, due to the possibility of co-infection with tuberculous bacilli. A number of 385 tests on patient sera have been performed (10, with NTM suspected infection, with or without M. tuberculosis co-infection, 5 with confirmed diagnosis of NTM infection, 10 with TB, 10 with other respiratory diseases). The preliminary results presented in this paper support the fact that the rapid immunochromatographic serum assay, combined with clinical and radiographic evidence, could evidentiate the infecting NTM species and allow the start of an earlier treatment, but must be confirmed on a higher number of patients.