Psychological disorders in tuberculosis: A narrative review.

India is one of the highest tuberculosis burden countries in the world. Tuberculosis has an impact on physical, mental and social well being of patients as well as caregivers. The physical disabilities resulting from tuberculosis have been extensively researched, but there is a gap in knowledge about its psychological impact. Available studies have shown a very high burden of psychological disorders in patients with tuberculosis. The national tuberculosis elimination program has made huge strides in treatment success, but there are lacunae in recognition and management of the associated psychological disorders. This narrative review aims to understand the burden and causes of psychological disorders in tuberculosis, as well as strategies for early identification by treating physician and treatment for the same.

Screening and management of depression among patients on TB treatment in Papumpare district, Arunachal Pradesh, India.

The TB-depression syndemic is a complex health condition. This study demonstrates a collaborative model to screen and manage depression among TB patients and understand the enablers and challenges from the healthcare workers perspective regarding its implementation. The PHQ-9 questionnaire was used to screen for depression and in-depth interviews among five healthcare workers were taken to explore its feasibility. Eight healthcare workers were trained for the screening that was carried out in two tuberculosis units of Papumpare district over a period of three months. Of 46 eligible patients screened, 43 (93.4%) screened positive for depression. Fifteen patients with moderate, moderately severe and severe depression were referred, of which five (33.3%) visited the psychiatric OPD. Two patients were diagnosed with clinical depression by a psychiatrist and started on treatment. The reasons for smaller number of patients being screened were time constraints, lack of manpower, lackadaisical attitude towards TB disease and patients' parents or guardians coming to take medicines. Enablers and challenges were explored under the heads of training, screening tool and PHQ-9 questionnaire, psychiatrist referral and counselling. This study demonstrates implementation of a feasible model for screening of depression among TB patients using the PHQ-9 questionnaire within programmatic settings using available resources.

Occurrence of anxiety and depression among homeless individuals with pulmonary tuberculosis.

BACKGROUND: Tuberculosis and mental health issues are global health concern. Homelessness is a serious public health issue. There has been a relationship established between homelessness and mental illnesses. In this study, we see the mental health problems in homeless people with Pulmonary Tuberculosis (PTB). METHODS: PTB patients who were homeless living in shelter in Delhi, aged 22 years and above, were asked questions related to Anxiety and Depression. The tools used were PHQ-2 (patient health questionnaire), GAD-7 (general anxiety disorder), and CESD-R-10 (centre for epidemiologic studies depression scale revised). RESULTS: Out of 47 PTB patients screened, 4.2% (2, n = 47) had Minimal Anxiety, 51% (24, n = 47) had Mild Anxiety, 40.4% (19, n = 47) had Moderate Anxiety, 4.2% (2, n = 47) had Severe Anxiety, and 95.7% (45/47) had Depression. 78% (37, n = 47) were symptomatic for TB at the time of screening before being diagnosed with PTB and 22% (10, n = 47) were asymptomatic for PTB at the time of screening before being diagnosed with PTB. 34% (16/47) had history of PTB and 66% (31/47) had no history of PTB. CONCLUSION: There is a strong occurrence of Anxiety and Depression in homeless people with PTB. Patients who were symptomatic without history of PTB is more than half (53.19%). 22% of the people were asymptomatic at the time of screening, so it can be assumed that people were unaware that they have been suffering from PTB. In India, there is need to assess mental health issues among homeless TB patients on larger sample size. As the burden of mental illnesses is increasing and homeless population remains an unnoticed population.

Change in psychological parameters and quality of life among individuals with pulmonary and extrapulmonary tuberculosis following the intensive phase of therapy: A longitudinal observational study from central India.

BACKGROUND: Tuberculosis (TB) is a global health concern, impacting millions annually, with limited attention to the psychological distress it inflicts. Psychological comorbidities, such as depression, anxiety, and stress, significantly affect the quality of life (QoL) of TB patients. Available literature on this topic is restricted to the pulmonary TB (PTB) patients; while psychological issues of the extrapulmonary TB (EPTB) patients who comprise a significant proportion of this disease entity remains unexplored. Additionally, the impact of anti-TB treatment on psychological parameters has received limited attention and vice-versa. This study aimed to assess depression, anxiety, stress, and QoL of TB patients at diagnosis and to understand how these parameters change after the intensive phase of treatment. METHODS: A longitudinal observational study involving 40 TB patients (31 EPTB and 9 TB) was conducted to assess depression, anxiety, stress and QoL among them. Participants were followed up after the intensive treatment phase. RESULTS: At baseline, 32.5% (n = 13) and 65% (n = 26) participants experienced moderate-severe depression, and moderate-severe anxiety, and stress, respectively. QoL was notably compromised, especially in the psychological domain. Post-intensive treatment, anxiety and depression showed significant improvement (Z = -2.271, p = 0.023 and Z = -2.093, p = 0.036), but QoL and stress levels remained largely unchanged (p > 0.05). CONCLUSION: This study highlights the high prevalence of psychological distress and poor QoL among TB patients. Following intensive phase of therapy, severity of depression and anxiety reduced significantly; however, change in stress-level and QoL was non-significant. Although study is limited by in terms for small sample size, the need of holistic, multidisciplinary treatment approach (including mental health professionals) for such patients can't be overemphasized. Implementing baseline psychological screenings and providing mental health support if required, are critical to improve the overall health and QoL of these individuals.

Assessment of anxiety and depression among tuberculosis patients of Ahmedabad, India.

BACKGROUND: India has high prevalence of Tuberculosis (TB). The long duration of treatment and chronic nature of illness predispose a person to anxiety as well as depression. Various addiction habits may affect treatment outcome and impact mental wellbeing in TB patients. This study was planned with the objectives of finding prevalence of anxiety and depression in tuberculosis patients at Ahmedabad district and to find association between anxiety, depression and different variables of TB patients as well as to assess the addiction profile of TB patients. METHODS: A total of 600 TB patients above 18 years and having completed 3 months of anti TB treatment without any psychiatric illness were selected randomly from 3 types of health institutes where patients receive treatment namely Ahmedabad district TB center (Institute 1), one medical college attached hospital (Institute 2) and one private hospital (Institute 3).Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. RESULTS: The mean age of study patients was 41.57 ± 13.44 years and 66.3% (398) patients were males. The prevalence of anxiety and depression was found to be 37.5% and 41.2% respectively while in 18.66% patients both anxiety and depression coexisted simultaneously. Institute 1 reported highest prevalence of anxiety (45.4%) while institute 2 reported highest prevalence of depression (42.9%). The prevalence of anxiety among drug sensitive TB patients was 32.7% while among drug resistant TB patients was 80%.The prevalence of depression in drug sensitive TB patients was 37.03% while among drug resistant TB patients was 78.3%. Anxiety had a statistically significant association with gender, occupation, socioeconomic class, type of TB, site of TB and perceived social isolation (p < 0.05).Except gender, depression was significantly associated with all the variables (p < 0.05).Tobacco addiction was found in 37.5% patients, alcohol addiction in 8.3% while 4.5% patients had both types of addiction. There was a statistically significant association found between addiction and variables like gender, residence, occupation, type of TB and site of TB. CONCLUSION: One third of patients had anxiety and more than one third had depression in which the prevalence of depression was higher than anxiety. District TB Center had highest prevalence of anxiety while medical college attached hospital had highest prevalence of depression. Anxiety and depression were higher in drug resistant TB patients. Tobacco addiction was more common than alcohol. Addiction had a significant association with depression, nonworking rural males and patients who had drug resistant pulmonary TB.

Cross-cultural reliability of Van Rie TB perceived Stigma Scale among TB survivors in North India.

BACKGROUND: As India progresses towards TB elimination five years ahead of Sustainable Development Goals (SDG), Community-based perceptions of tuberculosis stigma become particularly relevant in the context of TB elimination efforts. This study aims to assess the cross-cultural reliability of 'Community Perspectives Van Rie TB Stigma Scale' which can been used for screening and rapid evaluation of prevalent stigma themes in community. METHODS: A community based cross-sectional study was conducted in North India among 400 TB survivors to assess the cross-cultural reliability of 'Community Perspective Van Rie TB stigma Scale'. Cronbach Alpha and McDonald's Omega were used for reliability analysis. RESULTS: Cronbach ɑ value for the Van Rie TB Stigma Scale was 0.826 and McDonald's ω is 0.832 indicative of good reliability of the TB Stigma Scale. CONCLUSION: The study is one the first studies to assess the cross-cultural reliability of Community Perspective of Van Rie TB Stigma Score in India. The reliability analysis indicates that the 'Community Perspectives Van Rie TB Stigma Scale' can be used in the Indian settings for screening of TB associated stigma.

Perceived causes and stigmatization of tuberculosis among Apatani tribe of Arunachal Pradesh.

BACKGROUND: Tuberculosis (TB) is a pressing public health issue in many developing countries, with India having the highest number of cases. Lack of awareness and stigmatization of TB remains a significant barrier to addressing this challenge. This paper examines the perceived causes and stigma associated with TB among Apatani tribe of Arunachal Pradesh. METHODS: The study employed a mixed research approach, involving 106 TB patients (both pulmonary and extrapulmonary), both current and retrospective cases, from the Apatani tribe in Ziro valley, Arunachal Pradesh. Participants were selected from all the seven traditionally divided villages using purposive sampling. Semi-structured pre-tested schedules were used to conduct interviews with the patients. RESULTS: Among participants, 29.24% attributed TB to transmission, 34.91% had alternative explanations, and 35.85% remained uncertain about the causes. Notably, more Pulmonary TB patients reported transmission as the cause. A 10.75% higher likelihood of having misconceptions was observed among males. Literate individuals had 13.27% greater chance of being aware, although, higher education levels did not consistently follow this trend. Perceived stigmatization was evident mainly due to the contagious nature of the disease. CONCLUSION: A significant knowledge gap was evident among TB patients, with very few having a clear understanding of the causes of this disease. Gender differences in this regard were minimal. Literate individuals were more likely to understand the causes. Additionally, perceived stigmatization was a notable concern in the study.

Knowledge and perception about tuberculosis among general population attending community pharmacies in Mosul: A cross-sectional study.

OBJECTIVE: To evaluate people's knowledge and perceptions regarding tuberculosis. Method: The cross-sectional study was conducted at 10 community pharmacies in Mosul, Iraq, from December 2021 to March 2022, and comprised individuals of either gender aged >18 years. Data was collected using a 17-item questionnaire, with 12 questions related to knowledge and 5 related to perception regarding tuberculosis. Data was analysed using SPSS 25. Results: Of the 200 participants with mean age 38.79+/-13.72 years, 113(56.5%) were females and 101(50.5%) had education up to university level. Overall, 85(42.5) subjects could differentiate between tuberculosis and pulmonary tuberculosis, and 176(88%) knew TB was curable. Besides, 135(67.5%) subjects said they would not visit patients with tuberculosis. CONCLUSIONS: The national tuberculosis control programme in Iraq seemed to have improved public awareness regarding tuberculosis.

People with pulmonary tuberculosis in primary health care: social networks and repercussions of illness.

OBJECTIVE: to analyze the perceptions of people with pulmonary tuberculosis about their social support networks and the repercussions of becoming ill. METHOD: a qualitative, descriptive study, conducted with 41 individuals undergoing treatment for pulmonary tuberculosis, in Primary Health Care units in two Brazilian capitals: Belém/Pará and Campo Grande/Mato Grosso do Sul. Semi-structured individual interviews were carried out from July to December 2019. The thematic content analysis technique was applied. RESULTS: among the participants, 21 (51.22%) were from Belém and 20 (48.78%) from Campo Grande. Males (n=23/56.10%), age group from 21 to 40 years old (n=16/39.02%), unemployed status (n=28/68.29%) and who did not receive social benefits (n=23/56.10%) predominated. Three thematic categories emerged, presenting perceptions about social networks and the types of support they offer, the impact of the disease on family budget and its impact on work activities. FINAL CONSIDERATIONS: social support networks were characterized by the diversity of people and family or emotional ties maintained with the participants, as well as the diversity of types of support. In this context, they found the necessary human support to face the impact of the illness and deal with their socioeconomic condition.

Depression symptoms among Afghan TB patients: A multi-center study.

BACKGROUND: Depression in TB patients carries a heightened risk of treatment failure and a lower quality of life. However, no study to date has documented depression prevalence among TB patients in Afghanistan. OBJECTIVES: We aimed to assess depression prevalence in TB patients in Southern Afghanistan. METHODS: Between February 2023 and May 2024, a sample of 1,003 TB patients aged 18 years and above were randomly sampled in Southern Afghanistan. The questionnaire gathered patients' sociodemographic information, clinical characteristics, social support level, and the PHQ-9 (Patient Health Questionnaire). We fitted a binary logistic regression model to identify correlates of depression symptoms among TB patients. RESULTS: Out of 1,003 patients, 69.6% (95% CI: 66.6%-72.4) had depression symptoms. We found that patients with no formal education [AOR = 3.18, 95%CI (2.35-4.30)], those with severe disease [1.84 (1.30-2.59)], patients with medical comorbidity [1.88 (1.29-2.74)], and those with low social support [1.69 (1.22-2.33)] were more likely to have depression symptoms. CONCLUSION: TB patients in Afghanistan have high levels of depressive symptoms. Therefore, this study advocates for dedicated mental health screening and counseling services for TB patients in Afghanistan.

High stigma prevalence and associated factors among TB patients in Southern Afghanistan: A multi-center cross-sectional study.

BACKGROUND: TB stigma represents a growing threat to TB care. Understanding TB stigma distribution and associating factors is crucial for effective TB control in Afghanistan. OBJECTIVES: To profile the prevalence of TB-related stigma and its associating factors among TB patients in Southern Afghanistan. METHODS: In this multi-center cross-sectional study, we randomly recruited 603 adult TB patients from 2 major TB treatment sites in Southern Afghanistan. A score of >8 on the Stigma Scale for Chronic Illness-8 items (SSCI-8 items) was considered as positive for TB-related stigma. We fitted a binary logistic regression model. RESULTS: Out of the 603 TB patients included in this study, 88.3% (95%CI: 85.8-90.9%) had TB-related stigma using the SSCI-8 cutoff (>8). Being in the age group 18-40 years, rural residence, no formal education, severe perception of illness, lack of TB knowledge, and symptoms of depression had positive associations with TB stigma. CONCLUSION: A considerable percentage (88.3%) of patients had TB stigma. We identified potential risk factors that could serve as a benchmark for guiding policy efforts and interventions that aim to reduce stigma among TB patients in Afghanistan.

Factors affecting the readiness for hospital discharge of initially treated pulmonary tuberculosis patients in China: a phenomenological study.

BACKGROUND: Despite readiness for hospital discharge widespread popularity since readiness for hospital discharge introduction in 1979 and extensive study, readiness for hospital discharge among pulmonary tuberculosis (PTB) patients has not yet been investigated. Moreover, the factors influencing this process remain unclear. OBJECTIVE: The objective of this study was to investigate the factors influencing readiness for hospital discharge in initially treated PTB patients using the capability, opportunity, motivation-behavior (COM-B) model. METHODS: This phenomenological study was conducted from December 2023 to March 2024. Face-to-face individual interviews were conducted with 18 initially treated patients with PTB according to a semistructured interview guide developed on the basis of the COM-B model. The interview data were subjected to analysis using NVivo 14 software and Colaizzi's method. RESULTS: As a result, 6 themes and 14 subthemes were identified. Physical capability for readiness for hospital discharge (subthemes included poor health status, early acquisition of adequate knowledge about PTB, inadequate knowledge about readiness for hospital discharge), psychological capability for readiness for hospital discharge(subthemes included false perceptions about readiness for hospital discharge, high treatment adherence), physical opportunity for readiness for hospital discharge (subthemes included high continuity of transition healthcare, insufficient financial support, insufficient informational support), social opportunity for readiness for hospital discharge (subthemes included stigmatization, inadequate emotional support), reflective motivation for readiness for hospital discharge (subthemes included lack of reflection on coping with difficulties, intention to develop a readiness for hospital discharge plan), and automatic motivation for readiness for hospital discharge (subthemes included strong desire to be cured, negative emotions). CONCLUSION: We established factors related to readiness for hospital discharge in initially treated PTB patients in terms of capability, opportunity and motivation, which can inform the future development of readiness for hospital discharge plans. To improve patients' readiness for hospital discharge, patients need to be motivated to plan and desire readiness for hospital discharge, patients' knowledge and treatment adherence should be improved, and patients' transition healthcare continuity and emotional support should be focused on. Moreover, the quality of readiness for hospital discharge and discharge education should be assessed in a timely manner to identify impeding factors and provide interventions.

Assessment of Psychiatric Illness among Pulmonary Tuberculosis Patients at a Tertiary Care Center in India.

INTRODUCTION: Tuberculosis (TB) is a chronic infectious multisystemic disease caused by Mycobacterium tuberculosis and is one of the leading causes of mortality worldwide. Both common mental disorders (CMD) and TB are global public health problems that have a considerable impact on human health. Moreover, TB and CMDs share common risk factors including poverty, drug addiction, and homelessness and the coexistence of CMD and TB leads to difficult management of TB. MATERIALS AND METHODS: This was a hospital-based longitudinal study, carried out between June 2021 and December 2022. In this study, 147 pulmonary TB patients were included as per inclusion and exclusion criteria, and psychiatric illness was evaluated by the Brief Psychiatric Rating Scale. RESULTS: The mean age of study participants was 37.59 ± 15.37 years, there were 99 (67.3%) were male and 48 (32.7%) were female. Psychiatric illness was found in 77 (52.38%) pulmonary TB patients. Among psychiatric illness, anxiety was found in 33 (22.4%) participants and 21 (14.3%) participants had depression. Mixed anxiety and depression were found in 20 (13.6%) patients and 03 (2%) participants had severe psychosis. The association of psychiatric illness with age group and gender was not significant ( P = 0.734, 0.203, respectively). There were 105 (71.40%) patients who had <12 standard education and 42 (28.60%) had >12 standard education and their association with psychiatric illness was statistically significant ( P = 0.044). Adverse drug reactions were found among 80 (54.42%) patients and the association between adverse drug reactions and psychiatric illness was significant ( P = 0.031). CONCLUSION: Psychiatric illness is one of the important domains to be evaluated in timely manner in TB patients and early intervention is needed for better management of the TB because the severity, social factors, and chronicity of the disease make them susceptible to develop psychiatric illness.

Résumé Introduction:La tuberculose (TB) est une maladie infectieuse multisystémique chronique causée par Mycobacterium tuberculosis et constitue l'une des principales causes de mortalité dans le monde. Les troubles mentaux courants (CMD) et la tuberculose sont des problèmes de santé publique mondiaux qui ont un impact considérable sur la santé humaine. De plus, la tuberculose et les troubles mentaux courants (CMD) partagent des facteurs de risque communs, notamment la pauvreté, la toxicomanie et l'itinérance, et la coexistence des CMD et de la tuberculose rend difficile la gestion de la tuberculose.Méthodes:Il s'agissait d'une étude longitudinale en milieu hospitalier, réalisée entre juin 2021 et décembre 2022. Dans cette étude, 147 patients atteints de tuberculose pulmonaire ont été inclus selon les critères d'inclusion et d'exclusion et la maladie psychiatrique a été évaluée par une brève échelle d'évaluation psychiatrique (BPRS).Résultats:L'âge moyen des participants à l'étude était de 37,59 ± 15,37 ans, il y avait 99 (67,3 %) hommes et 48 (32,7 %) femmes. Une maladie psychiatrique a été trouvée chez 77 (52,38 %) patients atteints de tuberculose pulmonaire. Parmi les maladies psychiatriques, l'anxiété a été constatée chez 33 (22,4 %) participants et 21 (14,3 %) participants souffraient de dépression. Une anxiété et une dépression mixtes ont été trouvées chez 20 (13,6 %) patients et 03 (2 %) participants souffraient d'une psychose sévère. L'association entre la maladie psychiatrique et le groupe d'âge et le sexe n'était pas significative (valeur P = 0,734, 0,203 respectivement). Il y avait 105 (71,40 %) patients ayant <12 niveaux d'éducation standard et 42 (28,60 %) avaient >12 niveaux d'éducation standard et leur association avec une maladie psychiatrique était statistiquement significative ( P = 0,044). Des effets indésirables du médicament ont été observés chez 80 (54,42 %) patients et l'association entre l'effet indésirable du médicament et la maladie psychiatrique était significative. ( P = 0,031).Conclusion:La maladie psychiatrique est l'un des domaines importants à évaluer en temps opportun chez les patients tuberculeux et une intervention précoce est nécessaire pour une meilleure prise en charge de la tuberculose car la gravité, les facteurs sociaux et la chronicité de la maladie les rendent susceptibles de développer une maladie psychiatrique.

Effectiveness of food supplement on treatment outcomes and quality of life in pulmonary tuberculosis: Phased implementation approach.

BACKGROUND: By encouraging treatment adherence and lowering mortality, dietary supplements can serve as adjuvant therapy for the success of medical interventions. We determined the effect of locally accessible food supplements on treatment outcomes, and health-related quality of life in patients with pulmonary tuberculosis initiating anti-tuberculosis treatment (ATT) in Odisha, India. METHOD: Between September 2017 and December 2018, implementation research in patients with newly diagnosed sputum smear-positive pulmonary tuberculosis initiating ATT in five districts of the tribal belt of Odisha, offered food supplements along with ATT in a phased manner. Clinical symptoms, anthropometry, sputum for M. tuberculosis (M. tb), health-related quality of life and return to normal function were assessed periodically, and favourable treatment outcome (cure or treatment completed) was measured at the end of treatment. The effect of the food supplement on unfavorable outcomes (treatment failure, death, or lost-to-follow-up) was modelled using mixed-effects Poisson regression to determine the risk factors. RESULTS: Among the 761 participants enrolled, 614 participants received the food supplement and 147 did not receive the food supplement. Among the 614 participants in the supplement group, 537 (87%) had a favorable outcome and among the 147 participants in the no-supplement group, 113 (77%) had a favorable outcome (p = 0.0017). Higher age (>55 years) [aRR = 2.1(95% CI: 1.1-3.8)], male gender [aRR = 1.7(95% CI: 1.2-2.9)], and smear grading ≥2+ [aRR = 1.5 (95% CI: 1.1-2.2)] were associated with unfavorable treatment outcomes. Nutritional status, quality of life and lung health showed significant improvement from baseline in the supplement group. CONCLUSION: Improvement in the nutritional status of the patient can be considered a predictor of treatment success rates. Early food supplementation has a positive impact on the nutritional status.

Factors associated with treatment adherence among pulmonary tuberculosis patients in New Delhi.

BACKGROUND: TB is treated with a six-month course of four antimicrobial drugs, and nearly all cases of TB can be cured if the medications are given and taken correctly. Due to its prolong treatment plans, there can be reasons associated with non-adherence to treatment by TB patients. Hence, the present study aimed to explore the factors associated with medication adherence among TB patients. METHOD: A cross-sectional descriptive survey was conducted among adult pulmonary tuberculosis patients enrolled under RNTCP (now NTEP) in New Delhi among 27 functional RNTCP districts. Around 200 TB patients who are enrolled in the Nikshay App and are also on treatment were considered. A structured questionnaire was prepared for the interview guide. Analysis was done using bivariate analysis, chi-square tests, and Fisher's exact tests. RESULTS: Among the total participants, 173 (86.5%) were adherent and the remaining 27 (13.5%) participants were non-adherent. The majority of the participants (91%) said they were able to follow the routine to the DOTS center, and 9% said they find it difficult to report to the DOTS center as per their schedule. Only 12.35% of non-adherent participants were seen among those who get regular reminders from their families to take medicines, as compared to 18.42% among those who did not get regular reminders from their families. More than one-fourth of the participants (25.9%) who report not getting necessary motivation from healthcare providers were non-adherent. Motivation by healthcare workers to follow drug schedules was found statistically significant to treatment compliance with a P-value of 0.0422. CONCLUSION: TB is a curable disease; this belief has turned out to be a motivational factor for patients suffering from this disease. Studies have shown that faith in the efficacy of treatment helps adherence to TB treatment while other studies describe how patient adherence was adversely affected by the belief that TB is incurable or the treatment is inefficient or that alternative treatment such as traditional medicine is better.

The correlation between the need for continuing care services, influencing factors, and social support and discharge readiness among discharged patients with pulmonary tuberculosis in China: A cross-sectional study.

OBJECTIVE: To understand the relationship between the need for continuing care services and influencing factors, social support, readiness for discharge among discharged pulmonary tuberculosis (PTB) patients. METHODS: A cross-sectional study was conducted among 170 patients from a database of discharged patients with PTB from September 2023 to January 2024. A demographic and disease characteristics questionnaire, continuing care services basic modality questionnaire, continuing care services need questionnaire, the Social Support Rating Scale (SSRS), and the Readiness for Hospital Discharge Scale (RHDS) were used for this investigation. Univariate analysis and multiple linear regression analysis were used to analyze the associated factors. RESULTS: The mean total score for the need for continuing care services among patients with PTB discharged from the hospital was (121.61 ± 22.98). The dimension with the highest score was health education guidance need. Compared to the the original hospital medical personnel, the primary source of care information after discharge was the local medical institutions was statistically significant and negatively correlated with continuing care service need (P = 0.005). Social support was positively associated with need for continuing care services (P = 0.042). CONCLUSION: Discharged PTB patients had a high degree of continuing care service need. Factors influencing the need for continuing care services are the primary source of care information after discharge was the local medical institutions, the social support. Medical staff need to provide targeted continuing care services based on relevant influencing factors to meet the discharge needs of patients.

Factors associated with Community Health Agents' knowledge about tuberculosis.

OBJECTIVE: To analyze the factors associated with the knowledge of Community Health Agents (ACS) about tuberculosis. METHODS: A cross-sectional study was conducted with 110 ACS. A questionnaire was used to assess knowledge about pulmonary tuberculosis (component 1) and the work functions of ACS in the National Tuberculosis Control Program (component 2). The level of knowledge, according to the scores converted into a scale of 0 to 100, was classified as: 0-50% (low), 51-75% (medium), and over 75% (high). Multiple regression was used in the analysis of associated factors. RESULTS: The global score (average of the scores of components 1 and 2) median knowledge was 68.6%. Overall knowledge about tuberculosis was positively associated with the length of professional experience, having received training on tuberculosis, and access to the tuberculosis guide/handbook. CONCLUSIONS: Investments in training and capacity-building strategies for ACS will contribute to increasing these professionals' knowledge, resulting in greater success in tuberculosis control.

Exploration of Holistic Nursing Strategy for Diabetic Patients with Pulmonary Tuberculosis.

Objective: To explore the application effect of comprehensive nursing based on medical-care integration in diabetic patients with pulmonary tuberculosis. Methods: 80 diabetic patients with pulmonary tuberculosis who were treated at Affiliated Hospital of Hebei University from March 2022 to March 2023 were randomly divided into the routine nursing group and the comprehensive nursing group. The routine nursing group received conventional nursing care, while the comprehensive nursing group received comprehensive nursing based on medical-care integration and routine care. The blood glucose levels, tuberculosis cure rate, negative emotions, quality of life, and satisfaction with nursing care were compared before and after nursing in both groups. Results: After receiving comprehensive nursing care, participants had lower fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin levels than those who received routine nursing care. Compared to patients receiving standard care, patients under comprehensive care demonstrated increased rates of tuberculosis lesion resolution and tuberculosis bacilli conversion. The assessments of patients' negative emotions using SAS and SDS scores showed lower levels, while their scores for physiological, psychological, and social functions were higher. Additionally, they reported heightened levels of satisfaction with nursing care. Conclusion: The provision of comprehensive nursing based on medical-care integration for patients suffering from diabetes complicated by pulmonary tuberculosis by medical and nursing personnel is advantageous for fostering amelioration in the clinical manifestations of individuals afflicted with this condition. Additionally, it facilitates patients' recuperation while significantly enhancing their emotional well-being, quality of life, and nursing satisfaction.

Health-related quality of life among adults newly diagnosed with pulmonary tuberculosis in Lagos State, Nigeria: a prospective study.

PURPOSE: Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL. METHODS: A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors. RESULTS: Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3 years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4 weeks) were negatively associated with change in HRQOL scores over the course of treatment. CONCLUSION: The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure.