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Bibliography #6 – Tuberculosis – June
2007
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 Order #: 15113
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Authors: |
Barker,
A., Alvarra, M., Caughlan, J., Post, P.
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Title: |
Comorbid TB and HIV in a Chronically Homeless Male:
Social Isolation Compounds Stress of Medical Confinement. |
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Source: |
Homeless Health Care Case
Report: Sharing Practice-Based Experience 1(2): 1-7, 2006. (Newsletter: 7
Pages)
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Abstract: |
Of all tuberculosis (TB)
cases reported in the United States between 1994 and 2003, over 6 percent
were among persons classified as homeless during the 12 months prior to
diagnosis; 34 percent of TB-infected homeless persons tested nationwide had
coinfection with the human immunodeficiency virus (HIV). In Maryland, the reported number of
homeless persons with TB increased more than threefold between 2003 and
2004- from 4 cases (1.5 percent of all reported cases) to 15 cases (4.8
percent). During the same period, the overall incidence of TB in Baltimore
increased from 4.9 cases to 5.6 cases per 100,000 population,
while the national case rate decreased from 5.1 to 4.9 (authors). Available
From: National Health Care for the Homeless Council, P.O. Box 60427,
Nashville, TN 37206, (615) 226-2292, www.nhchc.org. |
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Order #: 15511 |
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Authors: |
Macaraig,
M., Agerton, T., Driver, C.R., Munsiff, S.S., Abdewahab, J., Park, J.,
Kreiswirth, B., Driscoll, J., Zhao, B.Y.
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Title: |
Strain-Specific Differences in Two Large
Mycobacterium Tuberculosis Genotype Clusters in Isolates Collected from
Homeless Patients in New York City from 2001 to 2004. |
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Source: |
Journal of Clinical
Microbiology 44(8): 2890-2896, 2006. (Journal
Article: 7 Pages)
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Abstract: |
This study examined two
large Mycobacterium tuberculosis genotype clusters associated with recent
outbreaks in people experiencing homelessness to determine factors
associated with these tuberculosis (TB) strains.
Isolates from all culture-positive TB cases diagnosed from January 1, 2001 to December 31, 2004 were genotyped. Patients whose isolates had
identical restriction fragment length polymorphism patterns and
spoligotypes were considered clustered. Health department records were
reviewed and reinterviews attempted for clustered cases. Patients with the
Cs30 and BEs75 strains were compared to other genotypically clustered cases
and to each other. The two largest genotype clusters among people
experiencing homelessness were the Cs30 strain and the BEs75 strain.
Fifty-one patients with the Cs30 strain and 28 with the BEs75 strain were
experiencing homelessness. Compared to patients with the BEs75 strain,
patients with the Cs30 strain were less likely to be respiratory acid-fast
bacillus smear positive. Furthermore, patients with the BEs75 strain were
more likely to be HIV infected, which suggests that most patients with this
strain advanced to disease after recent infection. Cases in clusters of
strains that have been circulating in the community over a long time
period, such as the Cs30 strain, require additional investigation to
determine whether clustering is a result of recent transmission or
reactivation of remote infection [authors].
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Order #: 15512 |
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Authors: |
Nyamathi,
A.M., Christiani, A., Nahid, R., Gregerson, P., Leake, B.
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Title: |
A Randomized Controlled Trial of Two Treatment
Programs for Homeless Adults with Latent Tuberculosis Infection. |
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Source: |
International Journal of
Tuberculosis and Lung Disease 10(7): 775-782, 2006. (Journal Article: 8 Pages)
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Abstract: |
This study's aims were to
compare the effectiveness of an intervention program employing nurse case
management and incentives (NCMI) vs. a control program with standard care
and incentives on completion of latent tuberculosis infection (LTBI)
treatment; and to compare the impact of the two programs on tuberculosis
(TB) knowledge among participants. This was a prospective, two-group
site-randomized design conducted among 520 adults experiencing homelessness
residing in the Skid Row region of Los Angeles from 1998 to 2003, assessing
completion rates of a 6-month isoniazid (INH) treatment program and change
in TB knowledge. Using intent-to-treat analysis, 62% of participants in the
intervention program, compared with 39% of controls, completed the full
6-month course of LTBI treatment with WH. Logistic regression modeling
revealed that intervention participants had three times greater odds of
completing INH treatment than controls. TB knowledge improved in both
programs, but the increase was greater among the intervention participants.
Nurse case management combined with education, incentives, and tracking
dramatically improves both adherence to LTBI treatment and TB knowledge in
persons experiencing homelessness compared to a standard approach of
outreach and incentives [authors]. |
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Order #: 14491 |
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Authors: |
Berg, J.,
Nyamathi, A., Christiani, A., Morisky, D., Leake, B.
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Title: |
Predictors of Screening Results for Depressive
Symptoms Among Homeless Adults in Los
Angeles with Latent Tuberculosis. |
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Source: |
Research in Nursing and
Health 28(3): 220-229, 2005. (Journal
Article: 9 Pages)
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Abstract: |
The purpose of this study
was to examine predictors of screening results for depressive symptoms in a
Los Angeles homeless population with latent tuberculosis (TB).
Four hundred and fifteen homeless adults participating in a nurse case
managed intervention were included in this analysis. Logistic regression
results indicated that those who reported a physical health limitation,
multiple sex partners, daily drug use, alcohol dependence, or not having
completed high school, were more likely to screen positive. Social support
from non-drug users was protective. Given the importance of adherence to TB
treatment regimens, the high prevalence of a positive screening for
depressive symptoms in the homeless and the potential for depression to
reduce adherence rates, routine screening and treatment for depression in
high risk homeless adults being treated for TB may be warranted. |
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Order #: 14645 |
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Authors: |
Centers
for Disease Control and Prevention.
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Title: |
Tuberculosis Transmission in a Homeless Shelter
Population: New York, 2000-2003. |
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Source: |
Atlanta, GA: Centers for
Disease Control and Prevention, 2005. (Report:
5 Pages)
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Abstract: |
This report summarizes a
recent outbreak of TB and highlights the challenges of preventing TB among
homeless persons, particularly when multiple chains of transmission are
occurring and multiple jurisdictions are involved. The findings underscore
the complementary role of rapid DNA genotyping in the detection of possible
TB transmission in homeless populations. To ensure early detection of
unsuspected TB transmission in homeless populations, health department
TB-control programs are encouraged to use CDC's universal Mycobacterium
tuberculosis rapid genotyping system (authors). Available From: Superintendent
of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402,
(202) 512-1800, www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a4.htm |
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Order #: 14489 |
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Authors: |
Haddad,
M.B., Wilson, T.W., Ijaz, K., Marks, S.M., Moore, M.
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Title: |
Tuberculosis and Homelessness in the United States,
1994-2003. |
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Source: |
The Journal of the
American Medical Association 293(22): 2790-2793, 2005. (Journal Article: 3 Pages)
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Abstract: |
This study sought to
describe homeless persons with tuberculosis (TB) and to compare risk
factors and disease characteristics between homeless and nonhomeless
persons with TB. Of 185,870 cases of
TB disease reported between 1994 and 2003, 11,369 were among persons
classified as homeless during the 12 months before diagnosis. The annual
proportion of cases associated with homelessness was stable. Individual TB risk factors often overlap
with risk factors for homelessness, and the social contexts in which TB
occurs are often complex and important to consider in planning TB
treatment. Nevertheless, given good case management, homeless persons with
TB can achieve excellent treatment outcomes (authors). |
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Order #: 14490 |
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Authors: |
Lobato,
M.N., Reves, R.R., Jasmer, R.M., Grabau, J.C., Bock, N.N., Shang, N.
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Title: |
Adverse Events and Treatment Completion for Latent
Tuberculosis in Jail Inmates and Homeless Persons. |
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Source: |
Chest 127(4): 1296-1303,
2005. (Journal Article: 7 Pages)
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Abstract: |
This study's objective was
to determine the acceptability, tolerability, and completion of treatment.
Recently, a short-course treatment using 60 daily doses of rifampin and
pyrazinamide was recommended for latent tuberculosis (TB) infection (LTBI).
This study detected the first treatment-associated fatality with the
rifampin and pyrazinamide regimen, prompting surveillance that detected
unacceptable levels of hepatotoxicity and retraction of recommendations for
its routine use. Completion rates for LTBI treatment
using a short-course regimen exceeds historical rates using
isoniazid. Efforts to identify an effective short-course treatment for LTBI
should be given a high priority (authors).
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Order #: 14213 |
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Authors: |
Malakmadze,
N., Gonzalez, I.M., Oemig, T., Isiadinso, I., Rembert, D., McCauley, M.M.,
Wand, P., Diem, L., Cowan, L., Palumbo, G.J., Fraser, M., Ijaz, K.
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Title: |
Unsuspected Recent Transmission of Tuberculosis
Among High-Risk Groups: Implications of Universal Tuberculosis Genotyping
in its Detection. |
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Source: |
Clinical Infectious
Diseases 40(3): 366-73, 2005. (Journal
Article: 8 Pages)
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Abstract: |
The initiation of
universal genotyping revealed 3 clusters of 19 patients with tuberculosis
(TB) in Wisconsin, with no apparent epidemiologic links among most of them.
An epidemiologic investigation was conducted to determine whether genotype
clustering resulted from recent transmission. The authors conducted
additional interviews with patients and reviewed medical records. Places frequented
by the patients while they were infectious were visited to identify
contacts. The investigation revealed several previously unrecognized
possible sites of TB transmission: a single-room occupancy hotel, 2
homeless shelters, 1 bar, and 2 crack houses. Seven patients with
previously diagnosed TB were added to the clusters. Of 26 patients, the
authors identified epidemiologic links for all but one. Common risk factors
among patients included alcohol abuse, crack cocaine use, homelessness, and
unemployment. Additionally, 98 contacts missed during routine contact
investigation were identified. Transmission of TB, particularly among
high-risk groups, may go undetected for years. This investigation
demonstrated the value of universal genotyping in revealing unsuspected
recent TB transmission and previously unrecognized sites of transmission,
which can be targeted for specific TB interventions (authors). |
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Order #: 15250 |
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Authors: |
Pirl,
W.F., Greer, J.A., Weissgarber, C., Liverant, G., Safren, S.A.
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Title: |
Screening for Infectious Diseases Among Patients in
a State Psychiatric Hospital. |
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Source: |
Psychiatric Services
56(12): 1614-1616, 2005. (Journal Article:
3 Pages)
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Abstract: |
This cross-sectional
retrospective study examined the frequency of positive tests for infectious
diseases among 655 patients who were admitted to a state psychiatric
hospital from 1997 to 1999. Not all
patients who were admitted to the hospital were tested for each disease. Rates of positive tuberculin, hepatitis
B, and hepatitis C tests were all significantly greater than estimates for
the U.S. general population. A minority of patients were tested for HIV, and 29.0
percent were positive. The rate of
hepatitis A was similar to that in the general population. Independent risk factors for markers of
disease included age, immigrant status, homelessness, and history of
substance use. These results confirm
the importance of screening for infectious diseases among individuals with
severe and persistent mental illness (authors). |
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Order #: 14548 |
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Authors: |
Hansel,
N.N., Wu, A.W., Chang, B., Diette, G.B.
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Title: |
Quality of Life in Tuberculosis: Patient and
Provider Perspectives. |
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Source: |
Quality of Life Research : An International Journal of Quality of Life
Aspects of Treatment, Care and Rehabilitation 13(3): 639-652, 2004. (Journal Article: 14 Pages)
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Abstract: |
This study describes the
impact of TB on patients' QOL by using focus groups to assess the domains
of QOL that are affected. Participants included patients who received treatment
for active TB and physicians and nurses caring for patients with TB at a
public health clinic in Baltimore, Maryland. TB affected all predicted
domains of QOL, including general health perceptions, somatic sensation,
psychological health, spiritual well-being, and physical, social and role
functioning. Social stigmatization, isolation, pill burden, long duration
of therapy, sexual dysfunction, loss of income, and fear were additional
specific problems related to TB. Surprisingly, 11% of the comments
described benefits of TB illness, including increased spirituality and
improved life perspectives. In addition, four additional QOL domains and
three elements of treatment specific to TB which substantially impact QOL
were identified. While patients and clinicians both identified issues in
many areas of QOL, only patients mentioned the impact on sexual function,
spirituality and improved life perspectives. Despite available curative
therapy, TB and its treatment still have significant short and long-term consequences
on patients' QOL (authors). |
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Order #: 13883 |
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Authors: |
Lobato,
M., Roberts, C., Bazerman, L., Hammett, T.
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Title: |
Public Health and Correctional Collaboration in
Tuberculosis Control. |
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Source: |
American Journal of
Preventive Medicine 27(2): 112-117, 2004. (Journal
Article: 6 pages)
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Abstract: |
In this article, the
authors assess the extent that twenty large jail systems and their
respective public health departments collaborate to prevent and control
tuberculosis (TB). The authors state that only thirty-five percent of jail
systems and health departments reported having effective collaboration in
TB prevention and control activities. The authors also state that four
barriers were reported by a majority of the jail systems: funding, staffing,
staff training, and communication. The article states that lack of advance
notice of a patient's release was rated as the greatest barrier to
discharge planning, and that characteristics associated with increased
collaboration include having designated liaisons between jail systems and
health departments and holding periodic meetings of staff. The authors
conclude that collaborations between health departments and jail systems
need strengthening, especially discharge planning
and evaluation of TB control activities (authors). |
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Order #: 14133 |
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Authors: |
National Tuberculosis Center.
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Title: |
Shelters and TB: What Staff Need to Know. |
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Source: |
San
Francisco, CA: National Tuberculosis Center, 2004. (Video/Manual:
18 Minutes)
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Abstract: |
This 18-minute video helps
to train shelter staff about how to prevent the spread of TB in homeless
shelters. It describes what TB is, how it is spread, what to do when staff
suspects someone has TB, how to develop and implement a TB infection
control policy, and how to work together with the local health department
to create a healthy and safe environment for staff and clients. A viewer’s
guide accompanies the video and contains main points from the video, tools,
checklists and resources that can be put to immediate use (authors). Available
From: Francis J. Curry National Tuberculosis Center, 3180 Eighteenth
Street, Suite 101, San Francisco, CA 94110, (415) 502-4600,
tbcenter@nationaltbcenter.edu, www.nationaltbcenter.edu |
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Order #: 14124 |
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Authors: |
Nyamathi,
A., Sands, H., Pattatucci-Aragon, A., Berg, J., Leake, B.
|
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Title: |
Tuberculosis Knowledge, Perceived Risk and Risk
Behaviors Among Homeless Adults: Effect of Ethnicity and Injection Drug
Use. |
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Source: |
Journal of Community
Health 29(6): 483-497, 2004. (Journal
Article: 15 Pages)
|
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Abstract: |
This study's objectives
were to investigate Tuberculosis (TB) knowledge, perceived risk, and risk
behaviors in a sample of homeless persons with latent TB in the Skid Row
district of Los Angeles. Particular
emphasis was given to comparing these variables among homeless persons of
varying ethnic backgrounds and among those who did and did not report a
history of injection drug use (IDU).
Baseline data were collected from 415 homeless individuals recruited
to participate in a Tuberculosis chemoprophylaxis intervention. Areas of interest relative to TB
knowledge and perceived risk for infection were behavioral factors
surrounding substance use and abuse; personal factors measured in terms of
current depression; and sociodemographic and situational factors, such as
age, ethnicity, history of incarceration, and duration of
homelessness. Findings revealed
differences in substance abuse. IDUs
were more likely to have histories of daily drug use and alcohol
dependency, but were less apt to report recent use of crack cocaine. TB knowledge deficits centered on
ignorance with respect to modes of transmission and risk factors for TB
infection. IDU was also associated with
depression. Latinos and IDUs were
most likely to lack TB knowledge.
There is a pressing need for accessible, available, culturally
acceptable and sustained TB screening and intervention programs designed to
address multiple risk factors and knowledge deficits with respect to TB
infection in homeless populations (authors). |
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Order #: 14196 |
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Authors: |
Tulsky,
J.P., Hahn, J.A., Long, H.L, Chambers, D.B., Robertson, M.J., Chesney,
M.A., Moss, A.R.
|
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Title: |
Can the Poor Adhere? Incentives for Adherence to TB
Prevention in Homeless Adults. |
|
Source: |
International Journal of
Tuberculosis and Lung Disease 8(1): 83-91, 2004. (Journal Article: 9 Pages)
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Abstract: |
This study's objective was
to compare the effect of cash and non-cash incentives on adherence to
treatment for latent tuberculosis infection and length of time needed to
look for participants who missed their dose of medications. This was done by conducting a randomized
clinical trial that compared a 5 dollar cash or a
5 dollar non-cash incentive in a community-based population of homeless
adults living in San
Francisco, CA. All
participants received directly observed preventive therapy and standardized
follow-up per a predetermined protocol.
Completion rates and amount of time needed to follow up participants
was measured. Of the 119
participants, 102 completed therapy.
There was no difference between the cash and non-cash arms. Completion was significantly higher among
males and persons in stable housing at study entry. No substance use or mental health
measures were associated with completion.
Participants in the cash arm needed significantly less follow-up to
complete therapy compared to the non-cash arm. In multivariate analysis, non-cash
incentive, use of crack cocaine, and no prior preventive therapy were
associated with more follow-up time.
Simple, low cost incentives can be used to improve adherence to TB
preventive therapy in indigent adults (authors). |
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Order #: 14197 |
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Authors: |
Centers
for Disease Control and Prevention.
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Title: |
Public Health Dispatch: Tuberculosis Outbreak in a
Homeless Population - Portland, Maine, 2002-2003. |
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Source: |
Morbidity and Mortality
Weekly Report 52(48): 1184, 2003. (Journal
Article: 1 Page)
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Abstract: |
This report summarizes the
preliminary results of an ongoing investigation conducted by the Maine
Bureau of Health (MBH) in its efforts to work with health-care providers
statewide to improve early detection of TB among homeless persons. During June 2002-July 2003, seven men
with active pulmonary tuberculosis (TB) disease in Portland, ME were reported to MBH. Six were linked through residence at
homeless shelters; four had matching Mycobacterium tuberculosis
genotypes. Prompt investigation and
identification of approximately 1,100 contacts likely prevented further
spread of TB (authors). |
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Order #: 13248 |
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Authors: |
Centers
for Disease Control.
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Title: |
Public Health Dispatch: Tuberculosis Outbreak Among
Homeless Persons - King County, Washington 2002-2003. |
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Source: |
Morbidity and Mortality
Weekly Report 52(49): 1209-1210, 2003. (Journal
Article: 1 page)
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Abstract: |
In this article, the
authors investigate an ongoing outbreak of tuberculosis (TB) disease among
homeless persons in Seattle.
This report describes patient characteristics, methods used to identify
active TB cases and contacts at highest risk for exposure, and control
measures under way to prevent further transmission of this outbreak strain
of Mycobacterium tuberculosis (authors).
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Order #: 13610 |
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Authors: |
Li, J.,
Driver, C., Munsiff, S., Fujiwara, P.
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Title: |
Finding Contacts of Homeless Tuberculosis Patients
in New York City. |
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Source: |
International Journal of
Tuberculosis and Lung Disease 7(12): 397-404, 2003. (Journal Article: 8 pages)
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Abstract: |
In this article, the
authors determine factors associated with no contacts identified for
homeless patients in New York City. The article states that
homeless patients had a significantly lower median number of contacts than
non-homeless patients, and that among homeless patients, having AFB
smear-positive sputum with cavitary lesions reduced the likelihood of having
no contacts identified. The authors assert that homeless patients who lived
on the street at the time of diagnosis were more likely to have no contacts
identified compared to those with contacts identified; however, the
difference was not statistically significant. The authors also assert that unlike
non-homeless patients, being hospitalized at the time of tuberculosis
diagnosis was not associated with having contacts identified in homeless
patients. The article concludes that
homelessness independently predicted the likelihood of having no contacts
identified, and strategies such as interviews that focus on location rather
than persons may be more effective for identifying contacts (authors). |
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Order #: 13606 |
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Authors: |
LoBue,
P., Moser, K.
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Title: |
Use of Isoniazid for Latent Tuberculosis Infection
in a Public Health Clinic. |
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Source: |
American Journal of
Respiratory and Critical Care Medicine 168(4): 443-447, 2003. (Journal Article: 5 pages)
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Abstract: |
In this article, the
authors discuss isoniazid, an efficacious treatment for latent
tuberculosis, and address the concerns regarding hepatotoxicity associated
with this medication. The authors extracted
information from a latent tuberculosis treatment database to determine
adverse effects and treatment completion rates associated with the use of
isoniazid at a county tuberculosis clinic. The article states that outcomes
were available for 3,788 patients started on isoniazid between 1999 and
2002, and that six hundred seventy-two patients experienced one or more
adverse effects, including ten determined to have isoniazid-associated
liver injury. The article also states that sixty-four percent of patients
completed at least 6 months of isoniazid, and higher completion rates were
associated with younger age, Hispanic ethnicity, and non-U.S. country of
birth, and that lower completion rates were associated with being
homelessness, using excess alcohol, and having experienced an adverse
effect. The authors conclude that in this clinic population isoniazid is a
safe therapy for latent tuberculosis, but its effectiveness is limited by
modest completion rates (authors). |
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Order #: 13249 |
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Authors: |
McElroy,
P., Southwick, K., Fortenberry, E., Levine, E., Diem, L., Woodley, C.,
Williams, P., McCarthy, K., Ridzon, R., Leone, P.
|
|
Title: |
Outbreak of Tuberculosis Among Homeless Persons
Coinfected with Human Immunodeficiency Virus. |
|
Source: |
Clinical Infectious
Diseases 36(10): 1305-1312, 2003. (Journal
Article: 8 pages)
|
|
Abstract: |
In this article, the
authors investigated a cluster of patients with tuberculosis (TB) in North Carolina and determined the extent of transmission of one
strain of Mycobacterium tuberculosis.
According to the article, a retrospective cohort study was
conducted, and homeless shelter attendance and medical records for 1999 and
2000 were reviewed. The period of exposure to M. tuberculosis was
determined, and shelter residents were offered TB screening. The authors state that all but one
patient was male, twenty-two were African American, and fourteen were human
immunodeficiency virus-infected. The authors also assert that an
epidemiological link to a single shelter was identified for all but one
patient. The authors suggest that earlier recognition of this shelter as a
site of M. tuberculosis transmission could have been facilitated through
innovative approaches to contact investigation and through genetic typing
of isolates (authors). |
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Order #: 14198 |
|
Authors: |
Morrow,
C.B., Cibula, D.A., Novick, L.F.
|
|
Title: |
Outbreak of Tuberculosis in a Homeless Men's
Shelter. |
|
Source: |
American Journal of
Preventive Medicine 24(4 Suppl):124-127, 2003. (Journal Article: 4 Pages)
|
|
Abstract: |
This case is one of a
series of teaching cases in the Case-Based Series in Population-Oriented
Prevention (C-POP). It has been
developed for use in medical school and residency prevention
curricula. The complete set of cases
is presented in this supplement to the American Journal of Preventive
Medicine. Tuberculosis presents a
significant public health challenge.
In this teaching case, medical students are given information about
four cases of active tuberculosis that occurred over a short period of time
in residents of a homeless men's shelter.
The students then walk through the steps that a local health
department takes to identify and screen those individuals at risk for
transmission of tuberculosis during an outbreak. During this process, they learn skills in
epidemiology (such as defining "epidemic" and distinguishing uses
for incidence and prevalence) as well as in population-based prevention of
tuberculosis. Finally students
discuss health policy as it relates to the control and prevention of
tuberculosis (authors). |
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Order #: 13252 |
|
Authors: |
Munsiff,
S., Nivin, B., Sacajiu, G., Mathema, B., Bifani, P., Kreiswirth, B.
|
|
Title: |
Persistence of a Highly Resistant Strain of
Tuberculosis in New York City During
1990-1999. |
|
Source: |
Journal of Infectious
Disease 188(3): 356-363, 2003. (Journal
Article: 7 pages)
|
|
Abstract: |
This article discusses one
multidrug-resistant Mycobacterium tuberculosis (MDRTB) strain, strain W,
which caused several nosocomial outbreaks in New York City (NYC) during
January 1990 through July 1993. The
authors reviewed all MDRTB cases verified during August 1993 throught December 1999
that had isolates with either this DNA pattern or a variant of this strain,
and compared them to the outbreak cases. The authors assert that of 427
DNA-confirmed cases from 1990 to 1999, one hundred-sixty-one were from
August 1993 through December 1999 and constituted twenty-eight percent of
all MDRTB cases in NYC during this period. The article states that compared
with those from January 1990 through July 1993, patients from August 1993
through December 1999 were less likely to be infected with human immunodeficiency
virus, to have been born in the United States, to be homeless, to have been
incarcerated, and to have epidemiological links. The article concludes that this strain
was disseminated widely in the community during the outbreaks and that
postoutbreak cases likely represent reactivated disease among individuals
infected during the outbreak periods in the community (authors). |
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Order #: 13152 |
|
Authors: |
Yun, L.,
Reves, R., Reichler, M., Bur, S., Thompson, V., Ford, M.
|
|
Title: |
Outcomes of Contact Investigation Among Homeless
Persons With Infectious Tuberculosis. |
|
Source: |
International Journal of
Tuberculosis and Lung Disease 7(12): 405-411, 2003. (Journal Article: 7 pages)
|
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Abstract: |
In this article, the
authors describe the outcomes of identification, tuberculin skin testing
(TST), clinical evaluation and treatment for contacts of infectious
homeless TB cases. According to the
authors, twenty-seven of 349 TB cases were homeless. Failure to identify
contacts occurred in six of 12 cases residing in shelters versus one of 15
non-shelter cases. The article also states that of 479 contacts identified,
297 were fully evaluated, 97 had only initial testing, and 85 were not
evaluated. Of the 394 evaluated contacts, 13 had a prior positive TST. Of
the remaining 381 contacts, six had active TB and 67 were TST-positive.
Only 27 of 61 contacts completed treatment for latent TB infection. The authors conclude that despite the
failure to identify contacts for some cases, contact investigations for
homeless TB cases identified large numbers of contacts for whom evaluation
and treatment were often not completed. Prospective studies with more
complete documentation are suggested (authors). |
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Order #: 14031 |
|
Authors: |
Cheung,
R.C., Hanson, A.K., Maganti, K., Keeffe, E.B., Matsui, S.M.
|
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Title: |
Viral Hepatitis and Other Infectious Diseases in a
Homeless Population. |
|
Source: |
Journal of Clinical
Gastroenterology 34(4): 476-480, 2002. (Journal
Article: 4 Pages)
|
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Abstract: |
This study's objective was
to determine the prevalence of four common infectious diseases-hepatitis B,
hepatitis C, human immunodeficiency virus (HIV), and tuberculosis-as well
as co-infection rates and risk factors in a homeless population. The prevalence of infectious diseases,
especially viral hepatitis, among the homeless population is largely
unknown. This study consists of a
retrospective analysis of the history and laboratory data collected from
all homeless veterans admitted to a Veterans Administration (VA)
domiciliary from May 1995 to March 2000.
Of the homeless veterans admitted to a VA domiciliary program, 597
of 829 were screened for markers of all four infectious diseases. The overall prevalence of anti-hepatitis
C virus (HCV) antibody, and positive result for purified protein derivative
(PPD), anti-HIV antibody, and hepatitis B surface antigen (HbsAg) were
41.7%, 20.6%, 1.84% and 1.17%, respectively. At least one of the four markers was
positive in 52.6% and more than one in 12%.
Co-infection with HCV occurred commonly in veterans who were
positive for anti-HIV and HBsAg.
Four self-reported major risk factors (intravenous drug use, alcohol
abuse, previous imprisonment, and prior stay in a shelter) were evaluated. Multivariate analysis indicates that
intravenous drug use and anti-HBs reactivity are independent risk factors
for HCV infection, HCV infection for anti-hepatitis B surface antibody
reactivity, and older age for PPD positivity. Chronic hepatitis C and co-infections are
common among the homeless population.
Patients infected with HIV and hepatitis B virus frequently are
co-infected with HCV. Infections
frequently are associated with certain identifiable risk factors (authors). |
|
|
Order #: 14417 |
|
Authors: |
Garcia de
Olalla, P., Martinez-Gonzalez, M.A., Cayla, J.A., Jansa, J.M., Iglesias,
B., Guerrero, R., Marco, A., Gatell, J.M., Ocana, I.
|
|
Title: |
Influence of Highly Active Anti-Retroviral Therapy
(HAART) on the Natural History of Extra-Pulmonary Tuberculosis in HIV
Patients. |
|
Source: |
The International Journal
of Tuberculosis and Lung Disease 6(12): 1051-1057, 2002. (Journal Article: 7 Pages)
|
|
Abstract: |
This study's objective was
to determine factors related to survival in acquired immune-deficiency
syndrome (AIDS) patients with extra-pulmonary tuberculosis (EPTB), when
this condition is the first AIDS-defining disease. A retrospective cohort-study of 549 AIDS
patients with EPTB as the first AIDS-defining disease was conducted. Potential candidates to predict survival
were sex, human immunodeficiency virus (HIV) exposure, the coexistence of
pulmonary and EPTB at diagnosis, tuberculin skin test, directly observed
therapy for tuberculosis (DOT), and highly active anti-retroviral therapy
(HAART). The Kaplan-Meier method and
Cox regression models were used to assess factors associated with
survival. Estimated 3-year survival
was 47.0% for those diagnosed before 1993, 72.6% for patients with first
AIDS diagnosis during 1995-1996 and 84.6% for those diagnosed after 1996. A negative tuberculin test, not being on
DOT and having pulmonary tuberculosis involvement also were independently
associated with poorer survival. The
survival of patients significantly improved after the introduction of
HAART. The survival of HIV patients
with EPTB as their first AIDS-defining disease has substantially improved
during the last decade. A negative
tuberculin skin test and not receiving DOT are associated with poorer
survival among HIV-infected patients whose first AIDS-defining disease is
EPTB (authors). |
|
|
Order #: 11725 |
|
Authors: |
Geng, E.,
Kreiswirth, B., Driver, C., Li, J., Burzynski, J., DellaLatta, P., LaPaz,
A., Schluger, N.W.
|
|
Title: |
Changes in the Transmission of Tuberculosis in New
York City from 1990-1999. |
|
Source: |
New England Journal of
Medicine 346(19): 1453-1458, 2002. (Journal
Article: 6 pages)
|
|
Abstract: |
In this article, the
authors discuss the importance of understanding the reasons for the lack of
reduction among non-U.S.-born persons, in forming new strategies for
tuberculosis control. The study
examined was performed in northern Manhattan, between 1990 and 1999, and
was designed to identify the strains responsible for multiple
infections. Findings show that among
foreign-born persons, tuberculosis is largely caused by reactivation of
latent infection, whereas among U.S. born persons,
many cases were a result of recent transmission. The authors assert that strategies for
the control and elimination of tuberculosis among foreign born people at
high risk should be directed toward the treatment of latent tuberculosis
infection (authors). |
|
|
Order #: 9115 |
|
Authors: |
Homeless
Health Care Los Angeles.
|
|
Title: |
Tuberculosis Prevention Guide for Homeless Service
Providers, Sixth Edition. |
|
Source: |
Los Angeles, CA: Homeless
Health Care Los Angeles, 2002. (Guide:
1 page)
|
|
Abstract: |
This comprehensive guide
includes the latest TB information for providers of services to the
homeless population. It is especially useful for directors, administrators,
disease control managers and front line staff of homeless shelters, clinics,
mental health facilities, drug treatment programs and governmental
agencies. An easy-to-implement curriculum allows providers to incorporate
basic disease prevention practices into their work with clients.
Administrators will benefit from sample agency policies and model TB
programs that can be easily adapted to meet the particular needs of
different agencies and communities. Available From: Homeless Health Care
Los Angeles, 1010 South Flower Street, Suite 500, Los Angeles, CA 90015.
(213) 744-0724. Attn: Director of Training and Education. COST: $10.00
($5.00 for five or more). |
|
|
Order #: 14199 |
|
Authors: |
Kong,
P.M., Tapy, J., Calixto, P., Burman, W.J., Reves, R.R., Yang, Z., Cave,
M.D.
|
|
Title: |
Skin-Test Screening and Tuberculosis Transmission
Among the Homeless. |
|
Source: |
Emerging Infectious
Diseases 8(11): 1280-1284, 2002. (Journal
Article: 5 Pages)
|
|
Abstract: |
This article describes the
implementation of a mandatory tuberculosis (TB) screening program that uses
symptom screening and tuberculin skin testing in homeless shelters. The results of DNA fingerprinting of
Mycobacterium tuberculosis isolates were used to evaluate the effect of the
program on TB incidence and transmission.
After the program was implemented, the proportion of cases among
homeless persons detected by screening activities increased, and the
estimated TB incidence decreased from 510 to 121 cases per 100,000 population per year.
Recent transmission, defined by DNA fingerprinting analysis as
clustered patterns occurring within 2 years, decreased from 49% to
14%. It was concluded that the
shelter-based screening program decreased the incidence of TB by decreasing
its transmission among the homeless (authors). |
|
|
Order #: 13467 |
|
Authors: |
Lathan,
M., Mukasa, L., Hooper, N., Golub, J., Baruch, N., Mulcahy, D., Benjamin,
W., Cronin, W.
|
|
Title: |
Cross-Jurisdictional Transmission of Mycobacterium
Tuberculosis in Maryland and
Washington, D.C., 1996-2000, Linked to Homeless. |
|
Source: |
Emerging Infectious
Diseases 8(11): 1249-1251, 2002. (Journal
Article: 3 pages)
|
|
Abstract: |
This article discusses the
twenty-three Maryland and Washington, D.C., tuberculosis cases identified in one six-band DNA
cluster from 1996 to 2000. According to the authors, these cases were
clustered on the basis of their Mycobacterium tuberculosis isolates.
Medical record reviews and interviews were conducted to identify
epidemiologic linkages. The article asserts that eighteen of the
twenty-three case-patients with identical restriction fragment length
polymorphism patterns were linked to another member; half the patients were
associated with a Washington, D.C., homeless shelter. Molecular epidemiology defined
the extent of this large, cross-jurisdictional outbreak (authors). |
|
|
Order #: 14418 |
|
Authors: |
Libbus,
M.K., Phillips, L.J., Knudson, K.
|
|
Title: |
TB-HIV Registry Matching in Missouri,
1987-1999. |
|
Source: |
Public Health Nursing
19(6): 470-474, 2002. (Journal Article:
5 Pages)
|
|
Abstract: |
This study investigated
whether all cases of mycobacterium tuberculosis (MTB) reported to the
HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information
Management System (TIMS) to determine the sensitivity of TIMS and the
predictive value of HARS. Wthe
authors found 262 total MTB cases registered in HARS. Of those, 145 were included in the
TIMS. Thirty-eight of the remaining
117 were caused by mycobacteria other than TB, leaving 79 for
investigation. Chart review of the
79 revealed 16 cases of MTB.
Sensitivities and predictive values were calculated first including
unknown/unreported group as being MTB-positive and the second including
this group as being MTB-negative.
Sensitivities for TIMS were 83 and 90%, respectively, and predictive
values for HARS were 68 and 63%, respectively. The fact that there were at least 16
unreported cases of MTB has significant public health implications for TB
control in Missouri. Public
health nursing could work with HARS surveillance staff to help improve the
accuracy of case finding and reporting.
By whatever means necessary, communications between the TB and HIV
programs within the Missouri Department of Health should be enhanced
(authors). |
|
|
Order #: 14201 |
|
Authors: |
Miller,
A.C., Butler, W.R., McInnis, B., Boutotte, J., Etkind, S.,
Sharnprapai, S., Bernardo, J., Driscoll, J., McGarry, M., Crawford, J.T.,
Nardell, E.
|
|
Title: |
Clonal Relationships in a Shelter-Associated
Outbreak of Drug-Resistant Tuberculosis: 1983-1997. |
|
Source: |
International Journal of
Tuberculosis and Lung Disease 6(10): 878, 2002. (Journal Article: 1 Pages)
|
|
Abstract: |
This study attempted to
determine, using mixed-linker PCR (M-L PCR) finger-printing, whether or not
cases of tuberculosis reported among Boston’s homeless population in the
late 1990’s were due to the same strain of Mycobacterium tuberculosis (TB)
as cases reported in 1984. The 1984
outbreak was caused by Mycobacterium TB that was resistant to isoniazid and
streptomycin (HS-resistant). Isolates
from 10 HS-resistant patients (four non-viable isolates from the 1980s and
six viable isolates from 1996-1997) were sent to the Centers for Disease
Control and Prevention for M-L PCR fingerprinting. These results were combined with record
reviews of older cases and an ongoing epidemiologic investigation. Eight of ten of the isolates were clonal,
and the other two were strongly suspected matches. Epidemiologic investigation determined
that transmission continued to occur after the initial outbreak in
1984-1985, and that a streptomycin-monoresistant variant of the strain was
also circulating. M-L PCR
fingerprinting combined with epidemiology was able to document links
between cases across 15 years (authors).
|
|
|
Order #: 11786 |
|
Authors: |
Weis,
S.E., Pogoda, J.M., Yang, Z., Cave, M.D., Wallace, C., Kelley, M., Barnes,
P.F.
|
|
Title: |
Transmission Dynamics of Tuberculosis in Tarrant
County, Texas. |
|
Source: |
American Journal of
Respiratory and Critical Care Medicine 166 (1): 36-42, 2002. (Journal Article: 7 pages)
|
|
Abstract: |
This article explains the
transmission dynamics of tuberculosis in an urban area where the prevalence
of HIV infection is relatively low, and evaluates the utility of photograph
recognition as a tool to establish epidemiological connections between
patients with tuberculosis who are linked by recent disease transmission. The authors assert that the use of
photograph recognition of other patients with tuberculosis, in combination
with RFLP analysis, has the potential to enhance tuberculosis control by
facilitating identification of local foci of disease transmission
(authors). |
|
|
Order #: 14419 |
|
Authors: |
Badri,
M., Ehrlich, R., Wood, R., Pulerwitz, T., Maartens, G.
|
|
Title: |
Association Between Tuberculosis and HIV Disease
Progression in a High Tuberculosis Prevalence Area. |
|
Source: |
The International Journal
of Tuberculosis and Lung Disease 5(3): 225-232, 2001. (Journal Article: 8 Pages)
|
|
Abstract: |
This study's objective was
to assess the impact of tuberculosis on HIV-1 disease progression in an
area with high tuberculosis prevalence and minimal antiretroviral therapy
use. A prospective patient cohort
study was conducted in adult human immunodeficiency virus (HIV) clinics
affiliated with the university of Cape Town, South Africa. Factors
such as age, race, risk status, CD4+ T-lymphocyte count, history of AIDS,
prophylactic co-dependents, and Cox proportional hazards regression models
were evaluated. Tuberculosis
fulfilling the case definition developed in 158/609 patients in the 5-year
observation period. Tuberculosis was
associated with an increased risk of AIDS.
In a stratified analysis, the increased mortality associated with
tuberculosis was observed only in patients with CD4+ T-lymphocyte count
> 200 cells/microliter and in those without AIDS at baseline. The onset of tuberculosis in HIV-infected
patients is associated with an increased risk of AIDS and death. Although a casual link cannot be
established in an observational study, our findings support the view that
prolonged immune activation induced by tuberculosis leads to prolonged
increased HIV replication and consequent accelerated disease progression
(authors). |
|
|
Order #: 14202 |
|
Authors: |
Brewer,
T.F., Heyman, S.J., Krumplitsch, S.M., Wilson, M.E., Colditz, G.A., Fineberg, H.V.
|
|
Title: |
Strategies to Decrease Tuberculosis in U.S. Homeless
Populations: A Computer Simulation Model. |
|
Source: |
Journal of the American
Medical Association 286(7): 834-42, 2001. (Journal
Article: 9 Pages)
|
|
Abstract: |
The objective of this
article is to examine the effects of tuberculosis (TB) control strategies
on projected TB cases and deaths in U.S. homeless populations using a computer-based
simulation model. The U.S. general population and a theoretical population of
2 million homeless individuals in 1995 were divided into 18 clinical states
based on the risk for the presence of TB and human immunodeficiency virus
(HIV) infected in a semi-Markov model.
The main outcome measures used were prevalence of transiently and
chronically homeless individuals with active TB and deaths from TB as a
function of public health measures taken to control and eliminate TB,
including improvement of treatment effectiveness, improvement of treatment
effectiveness, improvement in access to treatment, and vaccination with
BCG. A 10% increase in access to
treatment among homeless persons with active TB produced larger declines in
predicted TB cases and deaths after 10 years than improvements in the
effectiveness of treatment programs.
A 10% increase in access to treatment among homeless persons with
latent TB infection led to a 6.7% decline in TB among chronically homeless
persons and a 5.7% decline among transiently homeless persons, while a 10%
improvement in effectiveness of treatment for latent TB infection was
associated with declines of 3.0% and 3.3%, respectively. When treatment for latent TB infection
was modeled to be the same in vaccinated and non-vaccinated populations,
BCG vaccination led to TB case declines of 15.4% and 21.5% in chronically
and transiently homeless populations, respectively. Overcoming barriers faced by homeless individuals
in accessing TB treatment programs will be crucial to reducing the burden
of TB in the high-risk group.
Increased treatment access, improvement in the
effectiveness of treatment programs, and BCG vaccination of HIV-negative
homeless individuals have the best chance to markedly decrease TB
morbidity and mortality (authors). |
|
|
Order #: 10861 |
|
Authors: |
Centers
for Disease Control and Prevention.
|
|
Title: |
CDC TB Information Guide. |
|
Source: |
Atlanta, GA: Centers for Disease Control and Prevention, 2001.
(Guide: )
|
|
Abstract: |
The Centers for Disease
Control and Prevention (CDC) Division of Tuberculosis Elimination (DTBE)
has developed a CD-ROM that includes many of the materials found on DTBE's
Web site. The CD-ROM is a quick
resource for those who do not have time to connect to the Internet or for
those who have slow or intermittent access to the Internet. The sections of the CD-ROM are as
follows: Education materials- Health care provider and patient education
and training materials; Major TB guidelines- Guidelines from CDC's
Morbidity and Mortality Weekly (MMWR) series and joint statements from CDC
and the American Thoracic Society; Morbidity and Mortality Weekly Reports-
TB related articles from CDC's MMWR series; Surveillance reports- Tabular
and graphic information about reported TB cases from 59 reporting areas;
Slide sets- Various slide sets developed as an accompaniment to select
publications; Ordering information- Information on how to order free
materials from DTBE (authors). Available From: www.cdc.gov/nchstp/tb. |
|
|
Order #: 11817 |
|
Authors: |
Colton, R.D., Colton, S.D.
|
|
Title: |
An Alternative to Regulation in the Control of
Occupational Exposure to Tuberculosis in Homeless Shelters. |
|
Source: |
New Solutions: A Journal
of Environmental and Occupational Health Policy 11(4): 307-324, 2001. (Journal Article: 17 pages)
|
|
Abstract: |
The occupational risk of
exposure to TB at homeless shelters is particularly acute. This article
concludes that the risk of TB exposure within homeless shelter workers is
best viewed as a public health problem rather than as exclusively a worker
protection problem. The authors
assert that, in addition to seeking worker protections through regulatory
controls, the U.S. Occupational Safety and Health Administration (OSHA)
should seek to promote occupational health and safety thought a public
health response as well (authors). |
|
|
Order #: 9958 |
|
Authors: |
Davila,
R.
|
|
Title: |
TB up 25% in county - Homeless found to be hardest
hit. |
|
Source: |
Sacramento Bee, Sacramento, CA, March 16, 2001. (Newspaper Article:
1 page)
|
|
Abstract: |
This newspaper article
appeared in the Sacramento Bee, Sacramento, California on March 16, 2001. It reveals that active tuberculosis cases are
increasing in Sacramento County, especially among homeless people,
accelerating a public health crisis that could take more that a decade to
bring under control. Homeless people are at high risk because they sleep
and congregate in group settings. In Sacramento, as more cases are discovered and contact
investigation continues, it has become clear to top health officials that
this outbreak will not be contained quickly. Available From: Sacramento Bee archives, Sacramento, CA, March 16, 2001. |
|
|
Order #: 10600 |
|
Authors: |
New Jersey Medical School National Tuberculosis Center.
|
|
Title: |
Performance Guidelines for Contact Investigation:
The TB Interview, A Supervisor's Guide for the Development and Assessment
of Interviewing Skills |
|
Source: |
New
Jersey Medical School National Tuberculosis Center. (Guide: 40 pages)
|
|
Abstract: |
This guide lays the
foundation for TB control supervisors to identify the areas of health care
workers' strengths and weaknesses in TB interviewing. It provides interviewer evaluation
instruments and guidelines for training and education based on these
assessment results (authors). Available From: www.umdnj.edu/ntbcweb or
(973) 972-8453. |
|
|
Order #: 10601 |
|
Authors: |
New Jersey Medical School National Tuberculosis Center.
|
|
Title: |
TB Interviewing for Contact Investigation: A
Practical Resource for Health Care Workers. |
|
Source: |
New
Jersey Medical School National Tuberculosis Center. (Guide: 16 pages)
|
|
Abstract: |
This is a set of two tools
designed to assist the health care worker in conducting a TB
interview. The set contains the TB
Interview Outline, a detailed guide to the tasks and essential points to be
covered during an interview, as well as the TB Interview Checklist, an
abridged version of the outline, which lists prompts for the interviewer
and can be used while interacting with patients (authors). Available From: www.umdnj.edu/ntbcweb
or (973) 972-8453. |
|
|
Order #: 14423 |
|
Authors: |
Riley,
E.D., Chaisson, R.E., Robnett, T.J., Vertefeuille, J., Strathdee, S.A., Vlahov, D.
|
|
Title: |
Use of Audio Computer-Assisted Self-Interviews to
Assess Tuberculosis-Related Risk Behaviors. |
|
Source: |
American Journal of
Respiratory and Critical Care Medicine 164(1): 82-85, 2001. (Journal Article: 4 Pages)
|
|
Abstract: |
This study's objective was
to compare self-reported TB and HIV risk factors obtained from computer
assisted and interviewer-assisted questionnaires among participants of a
needle exchange program. Between
June 1998 and May 1999, needle exchange program participants requesting TB
screening underwent interviews regarding demographics and risk factors for
TB and HIV infection. The first 190
participants underwent traditional interviewer-assisted questionnaires,
whereas the remaining 92 underwent computer-assisted questionnaires. Among 282 participants, demographic
characteristics, health status, HIV serostatus, visits to homeless
shelters, alcohol intake, and cigarette smoking were all similar by
interview technique. However,
respondents receiving computer-assisted questionnaires were more likely
than those receiving interviewer-assisted questionnaires to report smoking
marijuana, crack, and heroin; as well as sharing cocaine smoking equipment,
sharing heroin smoking equipment, shotgunning, and visiting crack
houses. In the final model,
respondents receiving computer-assisted questionnaires were more likely to
report shotgunning and visiting a crack house relative to respondents
receiving interviewer-assisted questionnaires (authors). |
|
|
Order #: 14424 |
|
Authors: |
Sackoff,
J.E., Torian, L.V., Frieden, T.R.
|
|
Title: |
TB Prevention in HIV Clinics in NY City. |
|
Source: |
The International Journal
of Tuberculosis and Lung Disease 5(2): 123-128, 2001. (Journal Article: 6 Pages)
|
|
Abstract: |
This study's objective was
to evaluate tuberculosis (TB) prevention in HIV clinics based on the
prevalence and incidence of TB and the efficacy of preventative therapy
with isoniazid (INH). The medical
records of 2393 HIV infected patients with a first clinic visit in 1995
were reviewed retrospectively.
Deaths and TB cases through December 1997 were ascertained through a
match the TB and AIDS registries. At
first visit, 92 patients had a history of TB, 98 were being treated for TB,
and six were diagnosed with TB.
During follow-up, 23 cases were diagnosed, and the incidence was
0.53 per 100 person-years (py).
Among 439 tuberculin skin test (TST) positive patients, the
incidence of TB/100 py was 1.63 in patients with no INH, 1.28 in patients
with <12 months of INH, and 1.06 in patients with 12 months of INH. The incidence/100 py was 0.0 in
TST-negative patients and 0.37 in anergic patients. The relative risk of TB was 0.65 in
TST-positive patients with 12 months of INH. The benefits of TB prevention efforts in
these HIV clinics from 1995 to 1997 were limited because most TB occurred
before the first clinic visit.
Methods for reaching HIV-infected patients earlier should be
identified (authors). |
|
|
Order #: 10227 |
|
Authors: |
World
Health Organization.
|
|
Title: |
Tuberculosis (TB) and HIV Linked, Joint Efforts
Needed. |
|
Source: |
Health Education Research
16(3): 2001. (Newsletter: 2 pages)
|
|
Abstract: |
The link between HIV and
TB is inescapable. Joint efforts are needed to confront tuberculosis and
HIV. TB is a leading killer of people living with HIV and it is highest in
countries with the highest rates of HIV. TB and HIV are both enhanced by
poverty, homelessness, substance abuse, psychological stress, poor
nutritional status, and crowded living conditions. Effectively treating TB
will not solve the world wide AIDS crisis, but it will significantly reduce
its burden. |
|
|
Order #: 9107 |
|
Authors: |
Curtis,
A.B., Ridzon, R., Novick, L.F., Driscoll, J., Blair, D., Oxtoby, M.,
McGarry, M., Hiscox, B., Faulkner, C., Taber, H., Valway, S., Onorato, I.M.
|
|
Title: |
Analysis of Mycobacterium Tuberculosis Transmission
Patterns in a Homeless Shelter Outbreak. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 4(4): 308-313, 2000. (Journal Article: 6 pages)
|
|
Abstract: |
This investigation’s
objective was to determine extent of a tuberculosis outbreak that took
place in a Syracuse, NY homeless shelter for men from July 1997 through
May 1998, and prevent the further transmission of Mycobacterium
tuberculosis. Epidemiologic and
laboratory evidence suggests that eight of the ten cases were related. Seven cases had isolates with matching six-band
IS6110 DNA fingerprints; the isolate from another case had a closely
related fingerprint pattern and this case was considered to be caused by a
variant of the same strain. Isolates from eight cases had identical
spoligotypes. The source case had extensive
cavitary disease and stayed at the shelter nightly, while symptomatic, for
almost 8 months before diagnosis. A
contact investigation was conducted among 257 shelter users and staff, 70%
of whom had a positive tuberculin skin test,
including 21 with documented skin test conversions. An outbreak of related TB cases in a
high-risk setting was confirmed through the use of IS6110 DNA
fingerprinting in conjunction with spoligotyping and epidemiologic
evidence. Because of the high rate
of infection in the homeless population, routine screening for TB and
preventive therapy for eligible persons should be considered in shelters
(authors). |
|
|
Order #: 9108 |
|
Authors: |
Falchook,
G., Gaffga, C., Eve, S., Ali, J.
|
|
Title: |
Tuberculosis Screening, Referral, and Treatment in
an Inner City Homeless Shelter in Orleans Parish. |
|
Source: |
Journal of Louisiana State
Medical Society 152(8) 398-404, 2000. (Journal
Article: 7 pages)
|
|
Abstract: |
Tuberculosis screening and
preventive therapy among the homeless has been a challenge because of the
lack of coordinated follow-up.
Homeless persons at a homeless shelter in inner city New Orleans
were screened for tuberculosis infection and referred for follow-up
evaluation and preventive therapy.
Fifty-two percent of the 104 persons screened completed the initial
evaluation. Twenty-two percent of
these patients had latent tuberculosis infection. Forty-two percent of infected patients
completed the referral and follow-up process. Patients during the second 3 months of
the program were twice as likely to complete the initial evaluation, the
referral, and the follow-up process as were patients during the first 3
months due to enhanced awareness and increased educational
intervention. A competent referral
system for homeless persons may be achieved by implementing a
single-clinic, on-site tuberculosis screening and follow-up system with the
active participation and coordination of state agencies, the medical
community, and organizations which operate homeless facilities. |
|
|
Order #: 9109 |
|
Authors: |
Gelberg,
L., Andersen, R.M., Leake, B.D.
|
|
Title: |
The Behavioral Model for Vulnerable Populations:
Application to Medical Care Use and Outcomes for Homeless People. |
|
Source: |
Health Services Research
34(6): 1273-1302, 2000. (Journal Article:
20 pages)
|
|
Abstract: |
Objectives were to present
the Behavioral Model for Vulnerable Populations, a major revision of a
leading model of access to care that is particularly applicable to
vulnerable populations and to test the model in a prospective study
designed to define and determine predictors of the course of health
services utilization and physical health outcomes within one vulnerable
population: homeless adults. We paid
particular attention to the effects of mental health, substance use, residential
history, competing needs, and victimization. A community-based probability sample of
363 homeless individuals was interviewed and examined for four study
conditions (high blood pressure, functional vision impairment,
skin/leg/foot problems, and tuberculosis skin test positivity). Persons with at least one study condition
were followed longitudinally for up to eight months. Homeless adults had high rates of
functional vision impairment, skin/leg/foot problems, and TB skin test
positivity, but a rate of high blood pressure similar to that of the
general population. Utilization was
high for high blood pressure and TB skin test positivity, but lower for
vision impairment and skin/leg/foot problems. Health status for high blood pressure,
vision impairment, and skin/leg/foot problems improved over time. In general, more severe homeless status,
mental health problems, and substance abuse did not deter homeless
individuals from obtaining care.
Better health outcomes were predicted by a variety of variables,
most notably having a community clinic or private physician as a regular
source of care. Generally, use of
currently available services did not affect health outcomes. Homeless persons are willing to obtain
care if they believe it is important.
Our findings suggest that case identification and referral for
physical health care can be successfully accomplished among homeless
persons and can occur concurrently with successful efforts to help them
find permanent housing, alleviate their mental illness, and abstain from
substance abuse (authors). |
|
|
Order #: 14203 |
|
Authors: |
Jerant,
A.F., Bannon, M., Rittenhouse, S.
|
|
Title: |
Identification and Management of Tuberculosis. |
|
Source: |
American Family Physician
61(9): 2667-2678, 2681-2682, 2000. (Journal Article:
14 pages)
|
|
Abstract: |
This article looks at how
although the resurgence of tuberculosis in the early 1990s has largely been
controlled, the risk of contracting the disease remains high in homeless
persons, recent immigrants and persons infected with the human
immunodeficiency virus (HIV).
Purified protein derivative testing should be targeted at these
groups and at persons with known or suspected exposure to active
tuberculosis. Most patients with
latent tuberculosis are treated with isoniazid administered daily for nine
months. In patients with active
tuberculosis, the initial regimen should include four drugs for at least
two months, with subsequent therapy determined by mycobacterial
sensitivities and clinical response.
To avoid harmful drug interactions, regimens that do not contain
rifampin may be employed in HIV-infected patients who are taking protease
inhibitors or nonucleoside reverse transcriptase inhibitors. To maximize compliance and minimize the
emergence of mycobacterial drug resistance, family physicians should
consider using directly observed therapy in all patients with tuberculosis
(authors). |
|
|
Order #: 14204 |
|
Authors: |
Kearns,
A.M., Barrett, A., Marshall, C., Freeman, R., Magee, J.G., Bourke, S.J.,
Steward, M.
|
|
Title: |
Epidemiology and Molecular Typing of an Outbreak of
Tuberculosis in a Hostel for Homeless Men. |
|
Source: |
Journal of Clinical
Pathology 53(2): 122-124, 2000. (Journal
Article: 3 pages)
|
|
Abstract: |
This study investigated a
possible outbreak of tuberculosis in a hostel for homeless men using IS6110
profiling, a polymerase chain reaction (PCR) based
fingerprinting technique. Eight
cases of tuberculosis were diagnosed in residents of the hostel over a
period of 28 months. To provide epidemiological
data, a heminested inverse PCR (HIP) assay targeting the insertion sequence
IS6110 together with its upstream flanking region was used to fingerprint
the eight isolates of M tuberculosis under investigation. The HIP technique gave IS6110 profiles
which showed that while three isolates were clearly distinct,
the remaining five strains were indistinguishable, suggesting the latter
were representatives of a single outbreak strain. The HIP assay proved discriminatory and
facilitated repeated testing for the direct comparison of strains as more
patients presented over the protracted course of this outbreak (authors). |
|
|
Order #: 8423 |
|
Authors: |
Marks,
S.M., Taylor, Z., Burrows, N.R., Qayad, M.G., Miller, B.
|
|
Title: |
Hospitalization of Homeless Persons with
Tuberculosis in the United States. |
|
Source: |
American Journal of Public
Health 90(3): 435-438, 2000. (Journal
Article: 4 pages)
|
|
Abstract: |
This study assessed
whether homeless patients are hospitalized for tuberculosis (TB) more
frequently and longer than other patients and possible reasons for
this. The authors prospectively
studied hospitalizations of a cohort of TB patients. HIV-infected homeless patients were
hospitalized more frequently than other patients, while homeless patients
who had no insurance or whose insurance status was unknown were
hospitalized longer. Hospitalization
cost $2000 more per homeless patient than for other patients. The public
sector paid nearly all costs. The
authors conclude that homeless people may be hospitalized less if given
access to medical care that provides early detection and treatment of TB
infection and disease and HIV infection.
Providing housing and social services may also reduce hospital
utilization and increase therapy completion rates (authors). |
|
|
Order #: 9110 |
|
Authors: |
Moss,
A.R., Hahn, J.A., Tulsky, J.P., Daley, C.L., Small, P.M., Hopewell, P.C.
|
|
Title: |
Tuberculosis in the Homeless. A Prospective Study. |
|
Source: |
American Journal of
Respiratory & Critical Care 162: 460-464, 2000. (Journal Article: 5 pages)
|
|
Abstract: |
This study attempted to
determine tuberculosis incidence and risk factors in the homeless
population in San Francisco, and examined the transmission of tuberculosis
by molecular methods. The authors
followed a cohort study of 2,774 of the homeless first seen between 1990
and 1994. There were 25 incident
cases during the period 1992 to 1996, or 270 per 100,000 per year. Ten cases were persons with seropositive
HIV. Independent risk factors for
tuberculosis were HIV infection.
African American or other nonwhite ethnicity, positive tuberculin
skin test (TST) results, age, and education; 60% of the cases had clustered
patterns of restriction fragment length polymorphism, thought to represent
recent transmission of infection with rapid progression to disease. Seventy-seven percent of African-American
cases were clustered, and 88% of HIV-seropositive
cases. The high rate of tuberculosis
in the homeless was due to recent transmission in those HIV-positive and
nonwhite. African Americans and
other nonwhites may be at high risk for infection or rapid
progression. Control measures in the
homeless should include directly observed therapy and incentive approaches,
treatment of latent tuberculous infection in those HIV-seropositive, and
screening in hotels and shelters. |
|
|
Order #: 8443 |
|
Authors: |
Murphy,
D.A., Rotheram-Borus, M.J., Joshi, V.
|
|
Title: |
HIV-infected Adolescent and Adult Perceptions of
Tuberculosis Testing, Knowledge and Medication Adherence in the USA. |
|
Source: |
AIDS Care Journal 12(1):
59-63, 2000. (Journal Article: 5 pages)
|
|
Abstract: |
HIV-infected adolescent
and adult perceptions of tuberculosis (TB) infection rates and physician TB
behaviour, and patient knowledge of TB transmission and treatment adherence
were assessed. HIV-infected youth from
adolescent clinical care sites in three cities and HIV-infected adults in
New York were interviewed.
Adolescent self-report was compared to medical chart review. Adolescents reported they were
significantly less likely to be tested, although testing rates were high
for both samples. Approximately 9%
of both samples reported infection with TB; the majority of whom reported
receiving medication, and consistent medication adherence. The overall mean knowledge score was 66%,
with significant age differences: adolescents were less knowledgeable than
adults, and young males tended to be less knowledgeable than young
females. Age, gender and experience
with TB (self-perception of TB, testing history and clinic choice)
significantly predicted accuracy of knowledge about TB. Results suggest that if HIV-infected
individuals, a population at very high risk and often among the least able
to afford health care resources, receive the education and support they
need from their community health care sources they may substantially reduce
their chances of contracting and spreading TB (authors). |
|
|
Order #: 9491 |
|
Authors: |
Poss,
J.E.
|
|
Title: |
Factors Associated with Participation by Mexican
Migrant Farmworkers in a Tuberculosis Screening Program. |
|
Source: |
Nursing Research 49(1):
20-28, 2000. (Journal Article: 9 pages)
|
|
Abstract: |
This study’s objective was
to analyze the relationship between variables (susceptibility, severity,
barriers, benefits, cues to action, normative beliefs, subjective norm,
attitude, and intention) from the Health Belief Model (HBM) and the Theory
of Reasoned Action (TRA) and participation by Mexican migrant farm workers
in a tuberculosis screening program.
A convenience sample of 206 migrant farm workers were recruited
after a presentation of a tuberculosis education program and were tracked
during the administration and reading of the tuberculosis skin test. Participants were interviewed in Spanish
by the principal investigator using the Tuberculosis Interview Instrument
(TII) developed for this study. Most
subjects were male, aged 18-27 years, and had less than a sixth-grade
education. Of the 206 subjects, 152
received the skin test, 149 had the skin test read, and 44 had positive
skin tests. Based on logistic
regression analysis, the model that best predicted intention included cues
to action, subjective norm, susceptibility, and attitude. Participation in screening was best
predicted by a model containing only two variables: intention and susceptibility. In this study, logistic regression
analysis revealed that a more parsimonious model than the full HBM and TRA
model accurately predicted both intention and behavior. The findings may be helpful in developing
tuberculosis education and screening programs for Mexican migrant farm
workers (authors). |
|
|
Order #: 14205 |
|
Authors: |
Rayner,
D.
|
|
Title: |
Reducing the Spread of Tuberculosis in the Homeless
Population. |
|
Source: |
British Journal of Nursing
9(13): 871-875, 2000. (Journal Article:
5 pages)
|
|
Abstract: |
This article examines how
tuberculosis (TB) has re-emerged in recent years and is responsible for
many deaths throughout the world.
Homeless people residing in shelters and hostels within inner city
areas of the U.K. and the U.S. are at risk from this serious disease. Interventions to control the spread of TB
are described in the literature researched; these include the introduction
of inducements to encourage participation in screening programs and the
recommendation of directly observed therapy. The literature reflects the partial
success of these programs in the U.K. and U.S. Targeting homeless persons most at risk
is challenging as is gaining accurate information on those who are affected
by TB. Effective coordination of
care by healthcare providers in hospital and the community is
imperative. It appears that
healthcare professionals are becoming more prescriptive in their approach,
which is relinquishing the homeless population from taking responsibility
for their own health care (authors).
|
|
|
Order #: 9111 |
|
Authors: |
Tulsky,
J.P., Pilote, L., Hahn, J.A., Zolopa, A.J., Burke, M., Chesney, M., Moss,
A.R.
|
|
Title: |
Adherence to Isoniazid Prophylaxis in the Homeless:
A Randomized Controlled Trial. |
|
Source: |
Archive of Internal
Medicine 160(5): 697-702, 2000. (Journal
Article: 6 pages)
|
|
Abstract: |
The objective of this
study was to test two interventions to improve adherence to isoniazid
preventive therapy for tuberculosis in homeless adults. They were: biweekly directly observed
preventive therapy using a $5 monetary incentive; and biweekly directly
observed preventive therapy using a peer health adviser. The interventions were compared to usual
care at the tuberculosis clinic by using a randomized controlled trial in
tuberculosis-infected homeless adults.
Outcomes were completion of 6 months of isoniazid treatment and
number of months of isoniazid dispensed.
A total of 118 subjects were randomized to the 3 arms of the
study. Completion in the monetary
incentive arm was significantly better than in the peer health adviser arm
and the usual care arm, by log-rank test.
Overall, 19 subjects in the monetary incentive arm completed
preventive therapy compared with 7 in the peer health adviser arm and 10 in
the usual care arm. The median
number of months of isoniazid dispensed was 5 in the monetary incentive arm
vs. 2 months in the peer health adviser arm and 2 months in the usual care
arm. In multivariate analysis,
independent predictors of completion were being in the monetary incentive
arm and residence in a hotel or other stable housing at entry into the
study vs. residence on the street or in a shelter at entry. A $5 biweekly cash incentive improved
adherence to tuberculosis preventive therapy compared with a peer
intervention or usual care. Living
in a hotel or apartment at the start of treatment also predicted the
completion of therapy (authors). |
|
|
Order #: 9112 |
|
Authors: |
Bock,
N.N., Metzger, B.S., Tapia, J.R., Blumberg, H.M.
|
|
Title: |
A Tuberculin Screening and Isoniazid Preventive
Therapy Program in an Inner-city Population. |
|
Source: |
American Journal of Respiratory
Critical Care Medicine 159(1): 295-300, 1999. (Journal Article: 6 pages)
|
|
Abstract: |
As tuberculosis
transmission decreases, case rates decline and an increasing proportion of
cases arises from the pool of persons with latent
infection. Elimination of tuberculosis will require preventing disease from
developing in infected persons. From 1994 to 1996 the Atlanta TB Prevention
Coalition conducted a community-based tuberculin screening and isoniazid
preventive therapy project among high-risk inner-city residents of Atlanta,
GA. The authors established screening centers in outpatient waiting areas
of the public hospital serving inner-city residents, the city jail, clinics
serving the homeless, and with outreach teams in neighborhoods frequented
by drug users. All services were provided free. A total of 7,246 persons
participated in tuberculin testing; 4,701 adhered with skin test reading,
809 had a positive test, 409 fit current guidelines for isoniazid
preventive therapy, 84 the authors intended to
treat completed therapy. The major limitations of this community-based
tuberculin screening and preventive therapy project were the low proportion
of infected individuals who were eligible for isoniazid preventive therapy
and the poor adherence with a complete regimen among those the authors
intended to treat. For community-based programs to be efficacious,
preventive therapy regimens that are of shorter duration and safe for older
persons will need to be implemented.
|
|
|
Order #: 9113 |
|
Authors: |
Gasner,
M.R., Maw, K.L., Feldman, G.E., Fujiwara, P.I., Frieden, T.R.
|
|
Title: |
The Use of Legal Action in New York City to Ensure
Treatment of Tuberculosis. |
|
Source: |
New England Journal of Medicine 340(5):
359-366, 1999. (Journal Article: 8 pages)
|
|
Abstract: |
After an increase in the
number of cases of tuberculosis, New York City passed regulations to
address the problem of nonadherence to treatment regimens. The commissioner of health can issue
orders compelling a person to be examined for tuberculosis, to complete
treatment, to receive treatment under direct observation, or to be detained
for treatment. On the basis of a review of patients' records, we evaluated
the use of these legal actions between April 1993 and April 1995. Among more than 8000 patients with
tuberculosis, regulatory orders were issued for less than 4 percent. Among patients with a variety of social
problems, only a minority required regulatory intervention: 10 percent of
those with injection-drug use, 16 percent of those with alcohol abuse, 17
percent of those who were homeless, 29 percent of those who used
"crack" cocaine, and 38 percent of those with a history of
incarceration. A total of 150
patients were ordered to undergo directly observed therapy, 139 patients to
be detained during therapy, 12 patients to be examined for tuberculosis,
and 3 patients to complete treatment.
These 304 patients had a median of three prior hospitalizations
related to tuberculosis and one episode of leaving the hospital against
medical advice. Repeatedly
noncompliant patients and those who left the hospital against medical
advice were more likely than others to be detained. The median length of detention was 3
weeks for infectious patients and 28 weeks for noninfectious patients. As compared with patients ordered to
receive directly observed therapy, the patients who were detained remained
infectious longer, had left hospitals against medical advice more often,
and were less likely to accept directly observed therapy voluntarily. Altogether, excluding those who died or
moved, 96 percent of the patients completed treatment, and 2 percent
continued to receive treatment for multidrug-resistant tuberculosis. For most patients with tuberculosis, even
those with severe social problems, completion of treatment can usually be
achieved without regulatory intervention.
Patients were detained on the basis of their history of
tuberculosis, rather than on the basis of their social characteristics, and
the less restrictive measure of mandatory directly observed therapy was
often effective. |
|
|
Order #: 9114 |
|
Authors: |
Griffin,
R.G., Hoff, G.L.
|
|
Title: |
Tuberculosis Screening in Kansas City Homeless
Shelters. |
|
Source: |
Modern Medicine 96(10):
496-499, 1999. (Journal Article: 4 pages)
|
|
Abstract: |
Voluntary tuberculin skin
testing, coupled with on-site radiographic examination of persons with
indurations greater or equal to 10 mm, was conducted in five home-less shelters in Kansas City. Of 856 skin tests
administered, 654 were read and 89 were positive. Males were nearly four
times as likely to have a positive skin test than
females. None of the positive individuals had abnormal chest radiographs.
Of 42 persons who initiated preventive therapy, only eight completed the
course of treatment. |
|
|
Order #: 7994 |
|
Authors: |
Health
Care for the Homeless Clinicians' Network.
|
|
Title: |
Healing Hands. |
|
Source: |
Healing Hands, 3(1):
January, 1999. (Newsletter: 4 pages)
|
|
Abstract: |
This issue focuses on the
problem of tuberculosis among homeless people. Articles include: TB as a
reflection of society's concern, or lack of concern, for its most
vulnerable citizens; how to combat TB in homeless shelters; best practices
for HCH projects; and an OSHA standards update. Available From: National
Health Care for the Homeless Council, P.O. Box 60427, Nashville, TN 37206,
(615) 226-2292, www.nhchc.org |
|
|
Order #: 9116 |
|
Authors: |
Ijaz, K.,
Bates, J.H.
|
|
Title: |
Tuberculosis Rises in Homeless Shelters. |
|
Source: |
Journal of the Arkansas
Medical Society 96(3): 101, 103, 1999. (Journal
Article: 2 pages)
|
|
Abstract: |
|
|
|
Order #: 9117 |
|
Authors: |
Kimerling,
M.E., Shakes, C.F., Carlisle, R., Lok, K.H., Benjamin, W.H., Dunlap, N.E.
|
|
Title: |
Spot Sputum Screening: Evaluation of an
Intervention in Two Homeless Shelters. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 3(7): 613-619, 1999. (Journal Article: 7 pages)
|
|
Abstract: |
This study’s objective was
to interrupt tuberculosis transmission and evaluate the utility of spot
sputum screening. Two homeless
shelters in Birmingham, AL participated in the study between May 1996 and
February 1997. A spot sputum
specimen was collected on a given evening from each overnight client. Information was obtained regarding
symptoms and tuberculin skin test (TST) status. There were four screenings during two
rounds, with TST in round one only.
Of 127 persons involved in the study, 120 provided specimens, and
four tuberculosis cases were identified.
Symptoms were infrequently reported.
RFLP analysis confirmed a two-band cluster in three of the four
cases; another matching two-band strain was found in a drug rehabilitation
client staying in one shelter.
Secondary RFLP typing confirmed the homeless cluster. Costs were $1311 per case
identified. Among 92 clients with a
prior TST, 40% reported a positive result.
Of 21 PPD tests read, 11 were greater than or equal to 10 mm. Spot sputum screening is effective in
identifying unsuspected tuberculosis cases in shelters. It has acceptable costs, and is
logistically simple and efficient.
Symptom screening was not useful in this general homeless
population. RFLP analysis showed
cloning of the two-band strain.
Given the evidence for ongoing transmission, sputum screening should
be considered in shelter settings (authors). |
|
|
Order #: 9118 |
|
Authors: |
LoBue,
P.A., Cass, R., Lobo, D., Moser, K., Catanzaro, A.
|
|
Title: |
Development of Housing Programs to Aid in the
Treatment of Tuberculosis in Homeless Individuals: A Pilot Study. |
|
Source: |
Chest 115(1): 218-223,
1999. (Journal Article: 6 pages)
|
|
Abstract: |
This study described the
authors’ experiences with novel supervised housing programs developed to
aid in the treatment of tuberculosis (TB) in homeless individuals,
including a preliminary analysis of their effectiveness and estimate of
potential cost savings. The San
Diego County TB Control Program's computer database was used to identify
homeless individuals placed in one of two supervised housing programs for
treatment of TB: the Young Men's Christian Association (YMCA), for noninfectious
patients; or the Bissell House, for infectious patients. Charts for all these patients were
reviewed and information regarding their demographics, underlying medical
conditions, therapy, microbiologic markers of response to therapy,
hospitalizations, and participation in supervised housing programs was
recorded. The sputum culture
conversion and treatment completion rates for those housed in the YMCA were
100 and 84.6%, respectively. Of the
patients in the Bissell House program, 100% had converted their smear and
culture. In addition, all patients
in this program completed an adequate course of supervised therapy. These rates of microbiologic conversion
and treatment completion compare favorably with historical data from San
Diego County and other locations.
Estimated cost savings for placing medically stable infectious
patients in the Bissell House for respiratory isolation and supervised
treatment were estimated to be $27,034 per patient. Use of supervised housing to aid
treatment of TB in the homeless appears to be effective and results in
substantial cost savings. A larger
multicenter study should be considered to confirm these findings and better
quantify the cost-effectiveness of such programs (authors). |
|
|
Order #: 9456 |
|
Authors: |
Mehta,
J.B., Roy, T.M., Hughes, S.K., Byrd Jr., R.P., Harvill, L.M.
|
|
Title: |
Demographic Changes in Tuberculosis: High Risk
Groups. |
|
Source: |
Southern Medical Journal
92(3): 280-284, 1999. (Journal Article:
5 pages)
|
|
Abstract: |
The authors conducted a
statistical analysis of all verifiable tuberculosis (TB) cases in Tennessee
from 1990 through 1996 to determine the demographic changes in TB. They studied variables, including age,
sex, race, site of the disease, and possible impact of known risk factors
such as human immunodeficiency virus (HIV) infection, homelessness, foreign
birth, and residency in extended care facility. The percentage increase in all such
categories, except in the nursing home population, had a statistically
significant increase. Unlike national
epidemiologic findings, foreign-born TB comprised less than 1% of the total
cases. Association of HIV as a
co-infection increased from 16 in 1990 to 41 in 1996. These findings will have significant
impact on TB control measures and the clinical practice of TB cases in
Tennessee and other areas of the southeastern U.S. |
|
|
Order #: 9119 |
|
Authors: |
Peterson
Tulsky, J., Castle White, M., Young, J.A., Meakin, R., Moss, A.R.
|
|
Title: |
Street Talk: Knowledge and Attitudes About
Tuberculosis and Tuberculosis Control Among Homeless Adults. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 3(6): 528-533, 1999. (Journal Article: 6 pages)
|
|
Abstract: |
This study’s objective was
to measure knowledge and perceived susceptibility to tuberculosis among homeless
adults in San Francisco and attitudes toward control measures used to
improve adherence to treatment for tuberculosis. A cross-sectional survey via interview of
homeless shelter residents was done at five shelters. Of 292 persons interviewed, 21.6%
reported a positive skin test, and 57.1% of the positives had received
preventive therapy. Over 60% had
misconceptions about transmission, in particular confusion with
transmission of the human immunodeficiency virus (HIV). Knowledge of skin testing procedures and
symptoms was generally good, and most reported health care providers as the
main source of information. Over
half reported concern about catching tuberculosis and over 80% favored
controls to ensure adherence, in particular directly observed therapy. Higher TB knowledge score and male sex
were associated with a favorable attitude toward directly observed
therapy. Health care providers
should expand educational messages beyond skin testing. Greater knowledge about tuberculosis may
increase acceptance of control measures.
Targeted education plus social norms favoring completion of therapy
may improve screening and treatment outcomes in this population (authors). |
|
|
Order #: 9120 |
|
Authors: |
Rendleman,
N.J.
|
|
Title: |
Mandated Tuberculosis Screening in a Community of
Homeless People. |
|
Source: |
American Journal of
Preventative Medicine 17(2): 108-113, 1999. (Journal Article: 6 pages)
|
|
Abstract: |
This study examined the
effects of a community program on tuberculosis incidence, prevalence, and
transmission requiring users of public facilities to carry cards certifying
their compliance with a tuberculosis screening, prophylaxis, and treatment
program. Community knowledge of
tuberculosis and costs and benefits of the program are described. The study was conducted in a West Coast
"skid row" community with historically high rates of
tuberculosis, homelessness, poverty, and use of drugs and alcohol. Tuberculosis activity in communities in
Oregon was analyzed using Oregon Health Division Tuberculosis Data Bank
data. An 89% drop in active disease
in the highest-risk community in Oregon occurred over the first 10 years of
the program. Compliance with the
program permitting the use of public facilities, based on cooperation with
skin testing, radiology, sputum collection, and therapy has been between
33% of converters completing prophylaxis in the worst year to 100% of
active cases completing 4-drug therapy in the best. Facilities that provide services have
been almost universal in requiring cooperation for participants. Costs have been reduced. A program of mandated compliance with
tuberculosis skin testing, radiologic and sputum examination and treatment,
coupled with education and outreach, succeeded in drastically reducing
active tuberculosis, transmission, deaths, and cost in a homeless community
(authors). |
|
|
Order #: 9121 |
|
Authors: |
Turner,
C., Chambers, M.
|
|
Title: |
Housing for Infectious TB Patients Who are
Homeless: An Alternative Housing Program. |
|
Source: |
Continuum 19(2): 17-18,
1999. (Journal Article: 2 pages)
|
|
Abstract: |
|
|
|
Order #: 9122 |
|
Authors: |
Asch, S.,
Leake, B., Knowles, L., Gelberg, L.
|
|
Title: |
Tuberculosis in Homeless Patients: Potential for
Case Finding in Public Emergency Departments. |
|
Source: |
Annales of Emergency
Medicine 32(2): 144-147, 1998. (Journal
Article: 4 pages)
|
|
Abstract: |
This study’s objective was
to evaluate the optimal clinical site for screening homeless patients for
active tuberculosis (TB). It was
hypothesized that homeless patients with TB would not frequently reside in
shelters at the time of their diagnosis and would be more likely than other
patients with TB to seek care in public hospitals, thus presenting an
opportunity for screening radiography.
This registry-based survey included 743 consecutive patients with
confirmed active TB in Los Angeles County.
No therapeutic intervention was involved. When compared with patients with TB who
were not homeless, homeless patients with TB were more likely to be male,
black, living in the inner city, and born in the United States. They were more infectious than other
patients with TB as evidenced by a trend toward more cavitary radiographic
lesions and significantly more positive sputum smears. Less than a third lived in congregate
facilities such as shelters at the time of their diagnosis. Instead, their disease was diagnosed more
often at county hospitals than patients with TB who were not homeless. Widespread screening for TB in shelters
may miss most homeless patients with TB. Because most county-hospital homeless
patients with TB initially present to emergency departments and many do not
live in shelters, future cost-effectiveness studies should evaluate chest
radiograph screening for all homeless ED patients (authors). |
|
|
Order #: 9123 |
|
Authors: |
Bock, N.N.,
McGowan Jr., J.E., Blumberg, H.M.
|
|
Title: |
Few Opportunities Found for Tuberculosis Prevention
Among the Urban Poor. |
|
Source: |
International Journal of
Tubercle and Lung
Diseases 2(2): 124-129, 1998. (Journal
Article: 6 pages)
|
|
Abstract: |
This study’s objective was
to identify specific points of contact with the public health system where
high risk individuals could receive tuberculin testing and isoniazid
preventive therapy. This was done by
conducting patient interviews and examining medical chart reviews of
tuberculosis patients diagnosed in Grady Memorial Hospital in Atlanta, GA between October 1993 and December 1994. In total, 151 tuberculosis patients
participated: 80% were male, 89% African American, the mean age was 40; 50%
were HIV co-infected. Three fourths
reported no regular source of medical care.
The only potential public health sites at least one third of the
patients had encountered in the five years prior to tuberculosis diagnosis
were correctional institutions and public hospital in-patient wards. Duration of incarceration was six months
or more in only 13% of patients. Of
108 patients who had identified substance abuse problems, only 25% had been
in treatment programs. It was
concluded that most tuberculosis cases in this community occurred in
persons with poor access to health care and few opportunities for public
health intervention. Tuberculosis
prevention for this high risk population can best be accomplished by
focusing efforts on early case identification, completion of therapy and
contact investigations (authors). |
|
|
Order #: 8188 |
|
Authors: |
Centers
for Disease Control and Prevention.
|
|
Title: |
Reported Tuberculosis in the United
States, 1997. |
|
Source: |
Atlanta, GA: Centers for Disease Control and Prevention, 1998.
(Report: 1 page)
|
|
Abstract: |
This publication presents
summary data for TB cases reported to DTBE during 1997 and contains five
major sections: overall TB case counts and case rates with selected
demographic characteristics are presented for the 50 states, New York City,
and the District of Columbia; TB case counts and case rates are presented
by state with tables of selected demographic and clinical characteristics;
data collected as part of the expanded system (e.g., initial drug
resistance, HIV status) are presented by reporting area; TB case counts and
case rates are reported by metropolitan statistical area with tables of
selected demographic and clinical characteristics; a collection of figures,
including some data not presented in tabular format is presented (authors).
Available From: Information Technology and Services Office, National Center for HIV, STD, and TB Prevention, CDC, Mailstop E-08, Atlanta, GA 30333 |
|
|
Order #: 9124 |
|
Authors: |
Grant,
P.S.
|
|
Title: |
Evaluation of Infection Control Parameters According
to the 1994 Centers for Disease Control and Prevention Tuberculosis
Guidelines: A 2-year Experience. |
|
Source: |
American Journal of
Infection Control 26(3): 224-231, 1998. (Journal
Article: 8 pages)
|
|
Abstract: |
This article looks at how
a large university-affiliated county hospital, which was classified as a
high-risk institution for potential Mycobacterium tuberculosis exposure and
an employee purified protein derivative conversion rate of 2.7%, enhanced administrative and engineering
controls, as recommended by its tuberculosis task force in early 1994. For 1994 and 1995 the medical records of
all patients with culture-confirmed M. tuberculosis were reviewed according
to the 1994 Centers for Disease Control and Prevention guidelines for case
surveillance and risk assessment (infection control parameters). In 1994 and 1995 there were 253 patients
with tuberculosis, 85% of whom had pulmonary-site tuberculosis. The "representative" patient
with pulmonary tuberculosis was profiled, along with institution-specific
surveillance data on diagnostics, medication regimens, and airborne
isolation practices. Between 1994
and 1995 there was a trend toward increased numbers of homeless patients
with tuberculosis, from 8.2% to 17%.
Decreases in the numbers of HIV seropositive patients with
tuberculosis from 35% in 1994 to 24% in 1995 and of jailed patients with
tuberculosis from 9.8% to 5% were not significant. Drug-resistance patterns increased from
13% to 24%, with borderline significance.
The employee purified protein derivative testing compliance rate
increased from 49% in 1994 to 74% in 1995, with the purified protein
derivative conversion rate also increasing from 2.7% to 3.5%. The infection control parameter data were
beneficial in identification of institution-specific risk factors for our
population with tuberculosis.
Although labor-intensive, the annual tuberculosis reports supported
requests for administrative and engineering controls; however, efficacy of
the 1994 tuberculosis control plan was difficult to assess from purified
protein derivative conversion rates alone, because the testing compliance
rate also increased (authors). |
|
|
Order #: 9125 |
|
Authors: |
Lemaitre,
N., Sougakoff, W., Truffot-Pernot, C., Cambau, E., Derenne, J.P., Bricaire,
F., Grosset, J., Jarlier, V.
|
|
Title: |
Use of DNA Fingerprinting for Primary Surveillance
of Nosocomial Tuberculosis in a Large Urban Hospital: Detection of
Outbreaks in Homeless People and Migrant Workers. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 2(5): 390-396, 1998. (Journal Article: 7 pages)
|
|
Abstract: |
This article examines the
primary surveillance of nosocomial transmission of tuberculosis (TB) by
systematic restriction fragment length polymorphism analysis (RFLP) of
isolates recovered from smear-positive pulmonary TB patients identified
from 1 March 1993 to 28 February 1994, and from all TB patients (with any
form of tuberculous infection) identified from 1 March 1994 to 30 April
1995 in a large urban teaching hospital in the southeast of Paris. Systematic RFLP analysis revealed 12
clusters of patients infected by strains of Mycobacterium tuberculosis
showing matching RFLP patterns. None
of the isolates were multidrug-resistant.
Compared with non-clustered patients, clustered patients were more
likely to be homeless. Further
epidemiological investigations showed that the clustered TB cases actually
resulted not from nosocomial transmission, but from transmission in the
community, very likely in homeless shelters and hostels for migrant workers. No nosocomial transmission of TB was
identified among the patients included during the study period. Systematic RFLP analysis using
hospital-based sampling can detect the spread of TB in specific
environments in the community where transmission is occurring (authors). |
|
|
Order #: 7435 |
|
Authors: |
Malotte,
C. K., Rhodes, F., Mais, K.
|
|
Title: |
Tuberculosis Screening and Compliance with Return
for Skin Test Reading Among Active Drug Users. |
|
Source: |
American Journal of Public
Health 88(5): 792-796, 1998. (Journal
Article: 5 pages)
|
|
Abstract: |
This study assessed the
independent and combined effects of different levels of monetary incentives
and a theory-based educational intervention on return for tuberculosis (TB)
skin test reading in a sample of active injection drug and crack cocaine
users. Prevalence of TB infection in
this sample was also determined.
Active or recent drug users, recruited via street outreach techniques,
were skin tested for TB. They were
randomly assigned to one of two levels of monetary incentive ($5 and $10)
provided at return for skin test reading, alone or in combination with a
brief motivational educational session.
More that 90% of those who received $10 returned for skin test reading,
in comparison with 85% of those who received $5 and 33% of those who
received no monetary incentive. The
education session had no impact on return for skin test reading. The prevalence of a positive tuberculin test
was 18.3%. It was concluded that
monetary incentives dramatically increase the return rate for TB skin test
reading among drug users who are at high risk of TB infection (authors). |
|
|
Order #: 7760 |
|
Authors: |
McKenna,
M., McCray, E., Jones, J., Onorato, I., Castro, K.
|
|
Title: |
The Fall After the Rise: Tuberculosis in the United
States, 1991 Through 1994. |
|
Source: |
American Journal of Public
Health, 88(7): 1059-63, 1998. (Journal
Article: 5 pages)
|
|
Abstract: |
This study analyzed
factors associated with decreases in tuberculosis (TB) cases observed in
the United
States in 1993 and 1994. Changes in
case counts reported to the national surveillance system were evaluated by
dividing the number of incident cases of TB reported in 1993 and 1994 by
the number of cases reported in 1991 and 1992. These ratios were stratified by demographic
factors, AIDS incidence, and changes in program performance. Case counts decreased from 52, 956 in
1991 and 1992 to 49,605 in 1993 and 1994.
The decrease, confined to US-born patients, was generally associated
with AIDS incidence and improvements in completion of therapy, conversion
of sputum, and increases in the number of contacts identified per
case. Recent TB epidemiology
patterns suggest that improvements in treatments and control activities
have contributed to the reversal in the resurgence of this disease in
US-born persons. Continued success
in preventing the occurrence of active TB will require sustained efforts to
ensure appropriate treatment of cases (authors). |
|
|
Order #: 7825 |
|
Authors: |
National
Health Care for the Homeless Council.
|
|
Title: |
Statement on OSHA'S Proposed Standard on
Occupational Exposure to Tuberculosis |
|
Source: |
Nashville, TN: National Health Care for the Homeless Council,
1998. (Report: 8 pages)
|
|
Abstract: |
This statement is in
response to OSHA's proposed Standard on Occupational Exposure to
Tuberculosis, published in the October 17, 1997 Federal Register. The National HCH Council urges
that the proposed Standard not apply to homeless shelters as it is not
feasible either economically or operationally and it lacks clear definition
of the entities to which it would apply. The Council recommends that OSHA
develop a separate proposal directed specifically at tuberculosis exposure
in homeless settings. Available From: National Health Care for the Homeless
Council, P.O.
Box 60427, Nashville, TN 37206, (615) 226-2292, www.nhchc.org. |
|
|
Order #: 9126 |
|
Authors: |
Sakai, J., Kim, M., Shore, J., Hepfer,
M.
|
|
Title: |
The Risk of Purified Protein Derivative Positivity
in Homeless Men with Psychotic Symptoms. |
|
Source: |
Southern Medical Journal
91(4): 345-348, 1998. (Journal Article:
4 pages)
|
|
Abstract: |
This study’s objective was
to ascertain if homeless men with psychotic disorders are at an increased
risk for tuberculosis infection. One
hundred fifty homeless men were interviewed and given purified protein
derivatives (PPDs) at a downtown shelter in New Orleans, Louisiana, during a three-month period. The findings show a strong relationship
between psychotic disorders and positive PPDs, with a relative risk of
4.48. Homelessness and mental
illness present barriers to seeking and completing treatment for medical
illnesses such as tuberculosis. Use
of services may be low even when available; therefore, homeless men with
psychotic disorders may be serving as a reservoir for tuberculosis
(authors). |
|
|
Order #: 9127 |
|
Authors: |
Smirnoff,
M., Goldberg, R., Indyk, L., Adler, J.J.
|
|
Title: |
Directly Observed Therapy in an Inner-city Hospital. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 2(2): 134-139, 1998. (Journal Article: 6 pages)
|
|
Abstract: |
This article reviews the
results of the first 150 patients of a directly observed therapy (DOT)
tuberculosis (TB) program in a large urban teaching hospital in the East Harlem section of New York City. A
multidisciplinary DOT team coordinated treatment at several sites within
and without the institution, according to established medical
regimens. The program served a
hard-to-reach population, 63% human immunodeficiency virus (HIV) positive,
64% substance users, 17% inadequately housed and 15% indigent. In the program's first three years there
was 85% overall compliance with DOT visits.
Using the completion of therapy index, 66% of patients completed
therapy, 13% remained on treatment, 7% transferred to self medication and
1% were lost to follow up. No
patient on DOT developed a drug resistant organism. There were no hospital readmissions for
TB. The experience of this program
demonstrates the efficacy of an intensive, personalized DOT program in
ensuring treatment until cure (authors).
|
|
|
Order #: 9128 |
|
Authors: |
Smith,
D.A.
|
|
Title: |
The Need for Tuberculosis Education in the Homeless
Male Population. |
|
Source: |
Minority Nurse Newsletter
5(3): 2, 1998. (Newsletter: 1 page)
|
|
Abstract: |
|
|
|
Order #: 9129 |
|
Authors: |
Barnes,
P.F., Yang, Z., Preston-Martin, S., Pogoda, J.M., Jones, B.E., Otaya, M., Eisenach, K.D., Knowles, L., Harvey, S., Cave, M.D.
|
|
Title: |
Patterns of Tuberculosis Transmission in Central
Los Angeles. |
|
Source: |
Journal of American
Medical Associations 278(14): 1159-1163, 1997. (Journal Article: 5 pages)
|
|
Abstract: |
This study’s objective was
to identify epidemiologic links among recently infected urban patients with
tuberculosis. A prospective
evaluation of 162 patients who had culture-proven tuberculosis was conducted
in Central Los
Angeles, CA. Patients
were prospectively interviewed to identify their contacts and
whereabouts. The IS6110-based and
pTBN12-based restriction fragment length polymorphism analyses were performed
on Mycobacterium tuberculosis isolates. Patients whose isolates had identical or
closely related restriction fragment length polymorphism patterns were
considered a cluster. Unconditional
logistic regression was used to identify independent predictors of
clustering. The degree of
homelessness was an independent predictor of clustering. Compared with nonclustered patients,
patients in 6 clusters were significantly more likely to have spent time at
3 shelters and other locations when at least 1 patient in the cluster was
contagious, and these locations were independent predictors of
clustering. Among nonhomeless
persons, clustered patients were significantly more likely than
nonclustered patients to have used daytime services at three shelters. Two conclusions were reached: traditional
contact investigation does not reliably identify patients infected with the
same M tuberculosis strain; and locations at which the homeless congregate
are important sites of tuberculosis transmission for homeless and
nonhomeless persons. Therefore,
measures that reduce tuberculosis transmission should be based on locations
rather than on personal contacts (authors).
|
|
|
Order #: 9130 |
|
Authors: |
Burman,
W.J., Cohn, D.L., Rietmeijer, C.A., Judson, F.N., Sbarbaro, J.A.,
Reves, R.R.
|
|
Title: |
Noncompliance with Directly Observed Therapy for
Tuberculosis. Epidemiology and Effect on the Outcome of Treatment. |
|
Source: |
Chest 111(5): 1168-1173,
1997. (Journal Article: 16 pages)
|
|
Abstract: |
This study’s objective was
to describe the epidemiology and clinical consequences of noncompliance
with directly observed therapy (DOT) for treatment of tuberculosis. A retrospective review of all patients
treated in an urban tuberculosis control program with outpatient DOT from
1984 to 1994 was conducted.
Noncompliance was defined as follows: missing greater than or equal
to two consecutive weeks of DOT; prolongation of treatment greater than 30
days due to sporadic missed doses; or incarceration for presenting a threat
to public health. Poor outcomes of
therapy were defined as a microbiologic or clinical failure of initial
therapy, relapse, or death due to tuberculosis. Fifty-two of 294 patients who received
outpatient DOT fulfilled one or more criteria for noncompliance. Using multivariate logistic regression,
risk factors for noncompliance were alcohol abuse and homelessness. Noncompliant patients had poor outcomes
from the initial course of therapy more often than compliant patients: 17
of 52 versus 8 of 242. In an urban
tuberculosis control program, noncompliance with DOT was common and was
closely associated with alcoholism and homelessness. Noncompliance was associated with a
10-fold increase in the occurrence of poor outcomes from treatment and
accounted for most treatment failures.
Innovative programs are needed to deal with alcoholism and
homelessness in patients with tuberculosis (authors). |
|
|
Order #: 9134 |
|
Authors: |
Burman,
W.J., Cohn, D.L., Rietmeijer, C.A., Judson, F.N., Sbarbaro, J.A.,
Reves, R.R.
|
|
Title: |
Short-term Incarceration for the Management of
Noncompliance with Tuberculosis Treatment. |
|
Source: |
Chest 112(1): 57-62, 1997.
(Journal Article: 6 pages)
|
|
Abstract: |
This article reviews the
use of incarceration for noncompliance with tuberculosis (TB)
treatment. The legal basis and
practical application of quarantine for active TB, including the use of
incarceration for noncompliance, were examined. The records of patients treated at the
Denver Metro Tuberculosis Clinic during 1984 to 1994 were reviewed to
identify patients who were incarcerated and to evaluate the effectiveness
of this intervention. Of 424 cases
of TB, 20 patients were incarcerated for noncompliance; an additional 21
patients were lost to follow-up prior to completing therapy. Incarcerated patients were predominantly
men who were born in the U.S. and had a history of homelessness and alcohol
abuse. The median duration of the
initial incarceration was 20 days.
Of the 17 patients released prior to completing therapy, 13 were
compliant with outpatient, directly observed therapy after one or two short-term
incarcerations; only three patients were incarcerated for the duration of
treatment. Overall, 18 of 20
incarcerated patients were successfully treated. Approximately 5% of the patients treated
through the program were incarcerated for noncompliance; an additional 5%
were unavailable for follow-up and would have been candidates for
incarceration if found. Homelessness
and alcoholism were closely associated with the use of incarceration. Short-term incarceration followed by
outpatient, directly observed therapy was relatively successful in the
management of this difficult patient population (authors). |
|
|
Order #: 7082 |
|
Authors: |
Centers
for Disease Control
|
|
Title: |
Tuberculosis 2000: Fundamentals of Clinical
Tuberculosis and Tuberculosis Control |
|
Source: |
Rockville, MD: Centers for Disease Control, 1997. (Report: 77
pages)
|
|
Abstract: |
This course syllabus was
designed to bring the latest information about clinical tuberculosis (TB)
and TB control. The course, which was originally presented via satellite,
was divided into three two-hour sessions, each featuring presentations by
leading experts on tuberculosis. The syllabus provides outlines for each
presentation, including text copy from slides used during the
presentations. Topics include: diagnosis; treatment; screening; prevention;
institutional control measures; personal respiratory protection; HIV;
pediatric TB; public health measures; and health care policy and TB
control. |
|
|
Order #: 9135 |
|
Authors: |
Gelberg,
L., Panarites, C.J., Morgenstern, H., Leake, B., Andersen, R.M., Koegel, P.
|
|
Title: |
Tuberculosis Skin Testing Among Homeless Adults. |
|
Source: |
Journal of General
Internal Medicine 12(1): 25-33, 1997. (Journal
Article: 9 pages)
|
|
Abstract: |
This study’s objective was
to document the prevalence of tuberculosis (TB) skin test positivity among
homeless adults in Los
Angeles and
to determine whether certain characteristics of homelessness were risk
factors for TB. A cross-sectional
study of a representative sample of 260 homeless adults was conducted in
shelters, soup lines, and outdoor locations in the Skid Row and Westside
areas of Los
Angeles, CA.
Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test
positivity was 32%: 40% in the inner-city Skid Row area and 14% in the
suburban Westside area. Using
multiple logistic regression, TB skin test positivity was found to be
associated with living in crowded or potentially crowded shelter
conditions, long-term homelessness, geographic area, history of a psychiatric
hospitalization, and age. Homeless
adults living in congested inner-city areas are at high risk of both latent
and active TB. Endemic risk factors
and limited access to medical care support the need for aggressive
treatment of active TB cases and innovative programs to ensure completion
of prophylactic regimens by homeless individuals with latent infection
(authors). |
|
|
Order #: 9136 |
|
Authors: |
Griffiths-Jones,
A.
|
|
Title: |
Tuberculosis in Homeless People. |
|
Source: |
Nursing Times 93(9):
60-61, 1997. (Journal Article: 2 pages)
|
|
Abstract: |
|
|
|
Order #: 9137 |
|
Authors: |
Lau,
E.A., Ferson, M.J.
|
|
Title: |
Surveillance for Tuberculosis Among Residents of
Hostels for Homeless Men. |
|
Source: |
Australian and New Zealand Journal of Public Health 21(5): 447-450, 1997. (Journal Article: 4 pages)
|
|
Abstract: |
Tuberculosis has been
recognized as an important health problem among homeless persons. The New South Wales tuberculosis screening program for residents of
hostels for the homeless has been in operation for several years, but has
not yet been evaluated. This study reviewed the performance of the
tuberculosis surveillance program (which uses mobile chest x-ray screening)
between 1989 and 1993 at the five major hostels for homeless men in the
eastern Sydney area. Reports of the screening x-rays and records
of subsequent follow-up examinations at chest clinics were examined;
information on cases detected by the screening program was compared with
notifications in the same population. Of 3555 residents screened during 23
visits, 506 were found to have an abnormal chest x-ray. However, only two
active cases of tuberculosis were diagnosed as a result of the screening
program, while seven cases were notified on the basis of clinical
presentation. About 50 per cent of those with an abnormal chest x-ray from
the screening program were lost to follow-up. Possible reasons for loss to
follow-up were: long delays in making chest clinic appointments; short-stay
residents changing shelters without trace; and high prevalence of severe
mental illness or organic brain syndrome among residents. Raising awareness
of the disease among primary health care and welfare staff who work with
homeless men may be a more effective approach to improving identification
of cases of active tuberculosis in this population. |
|
|
Order #: 9138 |
|
Authors: |
Mangura,
B.T., Passannante, M.R., Reichman, L.B.
|
|
Title: |
An Incentive in Tuberculosis Preventive Therapy for
an Inner City Population. |
|
Source: |
International Journal of
Tubercle and Lung Diseases 1(6): 576-578, 1997. (Journal Article: 3 pages)
|
|
Abstract: |
Measures known to improve
adherence such as short course chemoprophylaxis and directly observed
therapy can be enhanced to a significant extent/by the use of incentives.
Adherence to tuberculosis therapy is influenced by several factors,
including the health care system, complexity of therapeutic regimens and
patient's characteristics. Individual factors that negatively influence
patient's adherence are the most difficult to counter. Preventive tuberculosis
therapy is doubly challenging because the benefit of treatment is not felt,
while toxicity from the medication, when it occurs, is experienced
immediately. Ingenious incentives therefore have to make it worth the
patient's while. During a study on preventive regimens, a request for an
incentive, Sustacal, was observed to help completion of preventive
regimens. Components of individual TB programs may help in patient
adherence; it is important for health care staff to identify these aspects
and, if they are successful, utilize these as an incentive to complete
treatment. |
|
|
Order #: 9139 |
|
Authors: |
McCurdy, S.A., Arretz, D.S., Bates, R.O.
|
|
Title: |
Tuberculin Reactivity Among California Hispanic
Migrant Farm Workers. |
|
Source: |
American Journal of Industrial
Medicine 32(6): 600-605, 1997. (Journal
Article: 6 pages)
|
|
Abstract: |
A cross-sectional study of
tuberculin reactivity among residents of two northern California migrant-farm-worker housing centers was
conducted. Participants completed a
brief health questionnaire and were offered tuberculin skin testing with
radiologic and medical follow-up.
Four hundred and sixty-nine persons completed questionnaires. All but one were
Hispanic. Two hundred and ninety-six
participants completed tuberculin skin testing and 49 showed
reactivity. Increased prevalence was
seen for the 15-39-year age group (vs. persons younger than 15), former
smokers (vs. never smokers), and persons born outside the U.S. Prophylaxis
with isoniazid was recommended for 23 persons; nine completed therapy. No cases of active TB were found. Prevalence of tuberculin reactivity in
this population is lower than reported among Hispanic farm workers in the
eastern and Midwestern U.S. Higher
prevalence may obtain among California farm workers not included in the study population,
including homeless, single, and highly mobile persons. Public-health efforts in this population
should focus on ever-smokers, young adults, and persons born outside the
U.S (authors). |
|
|
Order #: 6766 |
|
Authors: |
McQuistion,
H.L., Colson, P., Yankowitz, R., Susser, E.
|
|
Title: |
Tuberculosis Infection Among People With Severe
Mental Illness. |
|
Source: |
Psychiatric Services
48(6): 833-835, 1997. (Journal Article:
3 pages)
|
|
Abstract: |
In a study of the
prevalence of tuberculosis infection and risk factors for infection among
people with severe mental illness, 71 participants in a psychiatric day
program were given a tuberculin skin test.
Twelve of the 71 subjects had positive results. None had active tuberculosis. Those with tuberculosis infection were
more likely to be immigrants and to be above the study group's median age
of 32. Eleven of the 12 infected
subjects had experienced at least one of seven risk factors for tuberculosis
infection, which suggests that more clinical attention should be placed on
tuberculosis infection in this population (authors). |
|
| | | |