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Across six preregistered studies (N = 1,292; recruited from university subject pools and Prolific Academic), we investigate how face perception along the dimensions of gender/sex and race can vary based on immediate contextual information as well as personal experience. In Studies 1a and 1b, we find that when placing stimuli along a continuum from male to female, cisgender participants sort prototypical gender/sex faces in a bimodal fashion and show less consensus and greater error when placing faces of intermediate gender/sex. We replicate and extend these findings to race in Study 2. In Study 3, we test whether sorting patterns can be influenced by preexisting experiences, and find evidence that transgender/nonbinary participants show less error than cisgender heterosexual participants when sorting intermediary faces. Finally, in Studies 4 and 5, we test whether cisgender participants' judgments of intermediary faces along the continuum are influenced by the specific circumstances under which they are asked to sort. Here, we find that changing the sorting framework to include a third category resulted in less error when placing intermediary faces along the continuum than when participants were provided with only two category labels or two categories and a line at the midpoint, suggesting that new perceptual categories introduced with minimal training can be adopted quickly and successfully in a perceptual task. These data suggest that both long-term life experiences and quick experimental interventions can shape how we think about gender/sex and race. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Previous work has shown the robust nature of gender bias in both children and adults. However, much less attention has been paid toward understanding what factors shape these biases. The current preregistered study used parent surveys and child interviews to test whether parents' conversations with their children about and modeling of gender intergroup relations and/or children's self-guided interests about gender (self-socialization) contribute to the formation of gender attitudes, status perceptions, and gender intergroup behaviors among young 4- to 6-year-old children. Our participant sample also allowed us to explore variation by child gender, ethnicity (Asian-, Black-, Latiné-, and White-American), and U.S. geographical region (Northeast, Pacific Northwest, West, Southeast, and Hawaii). Data suggest that children whose parents reported they were especially active in seeking information about gender tended to allocate more resources to same-gender versus other-gender children and expressed less positive evaluations of other-gender children in comparison to children who were less active. By contrast, we found that parents' conversations with their children about gender intergroup relations and about gender-play stereotypes showed few connections with children's gender attitudes. In terms of demographic differences, boys raised in households with more unequal versus equal division of labor perceived that men had higher status than women, but few differences by ethnicity or geographic region emerged. In sum, our study suggests that both self- and parent socialization processes are at play in shaping early gender attitudes, status perceptions, and gender intergroup behavior, although self-socialization seemed to play a larger role. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
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Algoritmos , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
BACKGROUND: Evidence of the effectiveness of the WHO-recommended design of longer individualized regimens for multidrug- or rifampicin-resistant TB (MDR/RR-TB) is limited.OBJECTIVES: To report end-of-treatment outcomes for MDR/RR-TB patients from a 2015-2018 multi-country cohort that received a regimen consistent with current 2022 WHO updated recommendations and describe the complexities of comparing regimens.METHODS: We analyzed a subset of participants from the endTB Observational Study who initiated a longer MDR/RR-TB regimen that was consistent with subsequent 2022 WHO guidance on regimen design for longer treatments. We excluded individuals who received an injectable agent or who received fewer than four likely effective drugs.RESULTS: Of the 759 participants analyzed, 607 (80.0%, 95% CI 77.0-82.7) experienced successful end-of-treatment outcomes. The frequency of success was high across groups, whether stratified on number of Group A drugs or fluoroquinolone resistance, and ranged from 72.1% to 90.0%. Regimens were highly variable regarding composition and the duration of individual drugs.CONCLUSIONS: Longer, all-oral, individualized regimens that were consistent with 2022 WHO guidance on regimen design had high frequencies of treatment success. Heterogeneous regimen compositions and drug durations precluded meaningful comparisons. Future research should examine which combinations of drugs maximize safety/tolerability and effectiveness.
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Antituberculosos , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Antituberculosos/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Rifampin/uso terapéutico , Quimioterapia Combinada , Resultado del Tratamiento , Organización Mundial de la SaludRESUMEN
Many studies argue that synchronized movement increases prosocial attitudes and behavior. We reviewed meta-analytic evidence that reported effects of synchrony may be driven by experimenter expectancy, leading to experimenter bias; and participant expectancy, otherwise known as placebo effects. We found that a majority of published studies do not adequately control for experimenter bias and that multiple independent replication attempts with added controls have failed to find the original effects. In a preregistered experiment, we measured participant expectancy directly, asking whether participants have a priori expectations about synchrony and prosociality that match the findings in published literature. Expectations about the effects of synchrony on prosocial attitudes directly mirrored previous experimental findings (including both positive and null effects)-despite the participants not actually engaging in synchrony. On the basis of this evidence, we propose an alternative account of the reported bottom-up effects of synchrony on prosociality: the effects of synchrony on prosociality may be explicable as the result of top-down expectations invoked by placebo and experimenter effects.
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Music is characterized by acoustic forms that are predictive of its behavioural functions. For example, adult listeners accurately identify unfamiliar lullabies as infant-directed on the basis of their musical features alone. This property could reflect a function of listeners' experiences, the basic design of the human mind, or both. Here, we show that US infants (N = 144) relax in response to eight unfamiliar foreign lullabies, relative to matched non-lullaby songs from other foreign societies, as indexed by heart rate, pupillometry and electrodermal activity. They do so consistently throughout the first year of life, suggesting that the response is not a function of their musical experiences, which are limited relative to those of adults. The infants' parents overwhelmingly chose lullabies as the songs that they would use to calm their fussy infant, despite their unfamiliarity. Together, these findings suggest that infants may be predisposed to respond to common features of lullabies found in different cultures.
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Música/psicología , Psicología Infantil , Relajación/psicología , Femenino , Respuesta Galvánica de la Piel , Frecuencia Cardíaca , Humanos , Lactante , Masculino , Reflejo Pupilar , Relajación/fisiologíaRESUMEN
Gender identity is a core feature of human experience, yet our understanding of gender identity is shifting with broader societal changes in recognizing and understanding gender diversity. Here we discuss recent trends and upcoming directions for this burgeoning subfield.
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Identidad de Género , Conducta Sexual , Femenino , Humanos , MasculinoRESUMEN
What is universal about music, and what varies? We built a corpus of ethnographic text on musical behavior from a representative sample of the world's societies, as well as a discography of audio recordings. The ethnographic corpus reveals that music (including songs with words) appears in every society observed; that music varies along three dimensions (formality, arousal, religiosity), more within societies than across them; and that music is associated with certain behavioral contexts such as infant care, healing, dance, and love. The discography-analyzed through machine summaries, amateur and expert listener ratings, and manual transcriptions-reveals that acoustic features of songs predict their primary behavioral context; that tonality is widespread, perhaps universal; that music varies in rhythmic and melodic complexity; and that elements of melodies and rhythms found worldwide follow power laws.
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Antropología Cultural , Música , Canto , Percepción Auditiva , Conducta , Comparación Transcultural , Baile , Humanos , Cuidado del Lactante , Recién Nacido , Amor , Psicoacústica , ReligiónRESUMEN
BACKGROUND AND SIGNIFICANCE: Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the toxicity of second-line medications. Little is known about whether adverse events impact treatment outcome. METHODS: We conducted a retrospective case series of 244 MDR-TB patients enrolled in Tomsk between 10 September 2000 and 10 September 2002. Adverse reactions were determined by laboratory data and/or clinical criteria. A multiple logistic regression model was performed to determine whether the occurrence of adverse reactions was associated with poor treatment outcome. RESULTS: In this cohort, 76.0% were cured, 6.6% failed, 4.9% died and 11.5% defaulted. Adverse events were observed in 73.3% of patients, occurring in 74.8% of patients who were adherent (taking at least 80% of prescribed doses) and 59.1% of non-adherent individuals (P = 0.11). The impact of adverse events on outcome was modified by non-adherence; among adherent patients, the occurrence of any adverse reaction was associated with treatment cure (adjusted odds ratio 3.24, 95% confidence interval 1.56-6.70). CONCLUSION: Adverse reactions occurred frequently in MDR-TB patients in Tomsk, Russia, but did not negatively impact treatment outcome. The occurrence of adverse reactions among adherent patients was associated with treatment cure.
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Antituberculosos/efectos adversos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Terapia por Observación Directa , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Federación de Rusia/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiologíaRESUMEN
SETTING: Tuberculosis (TB) incidence and mortality in Russia have risen dramatically over the past 15 years. OBJECTIVE: To identify risk factors and causes of death among TB patients in Russia. DESIGN: A retrospective study conducted to determine the risk factors and causes of death in patients receiving TB therapy in Tomsk, Siberia. RESULTS: Of 1916 patients who initiated treatment between 1 January 2002 and 31 December 2003, 183 (9.6%) died during treatment, 38 (21%) in the first week of therapy. Twenty-five per cent of deaths were not directly attributable to TB. Risk factors for death included older age, previous treatment for TB, multidrug resistance and alcoholism. CONCLUSIONS: The high death rate during TB treatment observed in this cohort likely reflects an increased risk of dying not only from TB, but also from comorbid conditions, such as alcoholism and cardiovascular disease. Overall, alcoholism and late presentation both contributed substantially to the mortality in this cohort.
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Tuberculosis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Siberia/epidemiología , Análisis de Supervivencia , Factores de Tiempo , Tuberculosis/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/mortalidad , Tuberculosis Pulmonar/mortalidadRESUMEN
Toxic ingestions of acetaminophen and aspirin are clearly distinct in clinical presentations and in implications for laboratory medicine. In acetaminophen ingestion, the serum drug level is the single most important factor in the decision for or against therapy. In aspirin ingestion, the serum drug level is useful at its extremes--when so low as to indicate no need for therapy, and when so high as to indicate the need for dialysis. In the majority of infants and children with clinically significant salicylism, the serum drug level is in an intermediate range. For the management of these patients, the absolute level of salicylate in blood has much less significance than the laboratory assessment of the effects of salicylate on intermediary metabolism, acid-base status, and electrolyte and water balance.
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Acetaminofén/envenenamiento , Aspirina/envenenamiento , Acetaminofén/sangre , Acetilcisteína/uso terapéutico , Desequilibrio Ácido-Base/inducido químicamente , Preescolar , Femenino , Encefalopatía Hepática/inducido químicamente , Humanos , Lactante , Hígado/efectos de los fármacos , Masculino , Intoxicación/sangre , Salicilatos/sangre , Factores de TiempoRESUMEN
We determined how a food's flavor and digestibility, along with an animal's recent experiences, influenced food preference and intake. In three experiments, pregnant heifers were fed a basal ration (7.75 kg/animal) of alfalfa, barley, corn silage, and a vitamin/mineral supplement from 1500 to 2200. Exp. 1 determined the influence of recent exposure to flavored straw. Animals were divided into two groups (n = 16/group) and fed either untreated or ammoniated straw with digestibilities of 43 and 58%, respectively. Within each group, half of the heifers were fed maple-flavored straw and the other half were fed coconut-flavored straw from 1100 one day to 0900 the next day, with no base ration. We then offered straw in both flavors from 1000 to 1200 for the next 5 d. Animals fed maple-flavored straw for 1 d generally preferred coconut- over maple-flavored straw for the next 5 d, whereas animals previously fed coconut-flavored straw preferred maple-flavored straw (P < 0.001). The change in preference was stronger when animals were fed untreated compared with ammoniated straw. Experiments 2 and 3 determined the influence of offering straw in different flavors, either in sequence (Exp. 2) or simultaneously (Exp. 3). In Exp. 2, we offered heifers (n = 16) straw in three flavors (maple from 0900 to 1100, coconut from 1100 to 1300, and unflavored from 1300 to 1500) and compared their intake with that of heifers (n = 16) offered unflavored straw throughout the day. In Exp. 3, we compared intake of heifers (n = 16) simultaneously offered straw in three flavors (coconut, maple, and unflavored) with that of heifers (n = 16) offered only unflavored straw from 1000 to 1500. In both experiments, straw intake and preference differed between heifers offered straw in a variety of flavors as opposed to only unflavored straw (P < 0.05), but animals fed a variety of flavors did not consistently eat more than those fed only one flavor. During a post-trial preference test, heifers previously restricted to straw in one flavor for 5 d preferred straw in alternative flavors, whereas heifers fed straw in all three flavors preferred unflavored straw. Changes in preference were stronger for heifers fed untreated compared with ammoniated straw. Collectively, our results suggest that palatability, as evidenced by changes in preference and intake, is dynamic and depends on a food's flavor and nutritional quality and an animal's recent experiences with the food.
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Alimentación Animal , Bovinos/fisiología , Preferencias Alimentarias/fisiología , Gusto/fisiología , Amoníaco , Animales , Bovinos/psicología , Conducta de Elección , Digestión , Ingestión de Energía , Femenino , Aromatizantes/administración & dosificación , Preferencias Alimentarias/psicología , Valor Nutritivo , EmbarazoRESUMEN
Research findings and management recommendations typically emphasize responses of the "average" individual, yet more than half of the animals in a group may differ significantly from the mean regarding food preference and intake. The productivity of a herd may be adversely affected if animals differing from the mean are fed a uniform diet formulated to meet the needs of the "average" individual. We compared the intake and performance of beef calves offered a choice or no choice among foods. Diets consisted of ad libitum access to either a chopped, mixed ration of rolled barley (31.3%), rolled corn (31.3%), corn silage (15.5%), and alfalfa hay (18.9%) (n = 16 calves) or a choice among those foods offered individually (n = 15 calves). Averaged across the 63-d trial, the two groups did not differ in ratios of protein to energy ingested (43 vs 43 g CP/Mcal ME; P = 0.50), but preference for foods high in energy or protein varied markedly for animals fed free-choice: on d 21 they had protein:energy ratios higher than those of animals fed the mixed ration, on d 2 the ratios were equal, and on d 40 they had protein:energy ratios lower than those of animals fed the mixed ration. Throughout the trial, no two animals consistently chose the same ingredients, and none selected a diet similar to the nutritionally balanced mixed ration, yet each animal ate a diet adequate to meet its needs. Animals offered the mixed ration tended to eat more than animals offered a choice (109 vs 102 g/kg MBW/d; P = 0.10), but they did not gain at a faster rate (0.89 vs 0.92 kg/d; P = 0.65). Gain/unit of food consumed also was similar for both groups (0.09 vs 0.10 kg/kg; P = 0.38). However, food cost/day was higher for animals fed the mixed ration than for those offered a choice ($1.58 vs $1.36; P = 0.03). Consequently, cost/kilograms of gain was higher for the mixed ration than for the choice group ($1.84 vs $1.49/kg; P = 0.045). These findings suggest that 1) animals can more efficiently meet their individual needs for macronutrients when offered a choice among dietary ingredients than when constrained to a single diet, even if it is nutritionally balanced; 2) transient food aversions compound the inefficiency of a single mixed diet by depressing intake even among animals suited to that nutritional profile; and 3) alternative feeding practices may allow producers to efficiently capitalize on the agency of animals, thus reducing illness and improving performance.
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Alimentación Animal/economía , Bovinos/fisiología , Conducta de Elección/fisiología , Dieta/veterinaria , Ingestión de Alimentos/fisiología , Animales , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía/fisiología , Femenino , Preferencias Alimentarias , Masculino , Factores de TiempoRESUMEN
Delhi was the fourth State in India to conduct mass immunization of children (Pulse Polio Immunization) of the < 3 year age group with Oral Polio Vaccine (OPV) as a strategy towards the eradication of poliomyelitis. This study attempted to evaluate the immunization coverage achieved and the channels of communication which were effective in increasing coverage in three high risk areas of Delhi during October 1994. The overall immunization coverage was 89%. Information sources like enumeration visits, posters, television, radio and schools statistically correlated with the Pulse Polio Immunization (PPI) outcome. However, the cost of enumeration was high. Other less expensive channels of communication appeared to be equally effective. Only 11% of the children surveyed were not immunized with PPI OPV. The major reasons why some children did not receive OPV was that parents were "not informed" or they were "too busy".
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Programas de Inmunización/organización & administración , Poliomielitis/prevención & control , Vacuna Antipolio Oral/administración & dosificación , Preescolar , Femenino , Humanos , India/epidemiología , Masculino , Tamizaje Masivo/métodos , Poliomielitis/epidemiología , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVE: The Minimum Data Set for Nursing Home Resident Assessment and Care Screening was used to compare staff-report and self-report of residents' capabilities in eight activities of daily living (ADLs) in one long-term-care facility (LTCF). METHOD: The relative values residents placed on independence in each of the eight ADLs were compared with their self-reported capabilities in those ADLs. Subjects were 30 LTCF residents ranging in age from 45 to 96 years. RESULTS: Residents perceived themselves to be significantly more capable than did staff members for dressing (p < .05), toileting (p < .01). locomotion (p < .05), and personal hygiene (p < .001). For five of the ADLs, residents tended to report high capability in the ALDs they valued most. CONCLUSION: These findings support the need to include resident self-assessment in treatment planning, because staff members' and residents' perceptions of ADL capabilities may differ.
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Actividades Cotidianas/psicología , Evaluación Geriátrica , Autoimagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Autoevaluación (Psicología) , Índice de Severidad de la EnfermedadRESUMEN
Probit analysis of current status epidemiological data was used to estimate breastfeeding rates using 3428 mother-baby pairs from randomly selected facilities in the city of Ibadan, Nigeria. The children whose ages range from 1 to 548 days were distributed over 13 age groups. The observed proportions of breastfeeding children (exclusive and ever-breastfed) in each group were transformed into probits, and a weighted linear regression of probits (y) on ages (x) was calculated using the maximum likelihood Iterative procedure. Prevalence rate for exclusive breastfeeding for Ibadan was 39.6 percent and over 99 percent of the children were ever-breastfed. Median duration of exclusive breastfeeding was 61 days, when half of the exclusively breast fed in the study population would have discontinued exclusive breastfeeding. Mean duration was 64.8 +/- 44.4 days. Nationwide efforts to promote exclusive breastfeeding started in 1992, but there remains a lot more that can be done to promote, support and protect the practice of exclusive breastfeeding in this community. Using this simple procedure, current status data, easily obtained from mothers can be used to rapidly assess breastfeeding practices in the community. This will go along way towards improving documentation of rates, thereby making planning easier.
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Lactancia Materna/estadística & datos numéricos , Estadística como Asunto/métodos , Mediciones Epidemiológicas , Femenino , Promoción de la Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Funciones de Verosimilitud , Nigeria , Distribución Aleatoria , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
We demonstrate the utility of antibodies to the DNA polymerase from Thermus aquaticus (TaqPol) as thermolabile inhibitors of TaqPol activity. One of the limitations of the polymerase chain reaction (PCR) is the co-amplification of non-specific products caused by TaqPol activity on low stringency templates present in the initial cycle of PCR. We have used anti-TaqPol antibodies as thermolabile switches that inhibit TaqPol activity at low temperatures (20-40 degrees C) and release fully active TaqPol when they are inactivated by elevated temperatures in the PCR thermal cycling (70-98 degrees C). Several in a set of high affinity anti-TaqPol monoclonal antibodies fully inhibited TaqPol activity at 37 degrees C. The capacity for inhibition was ablated by incubation at temperatures high enough to denature antibodies but not sufficiently high to significantly reduce TaqPol activity. In a PCR model system, preincubation of TaqPol with these antibodies yielded PCR product consisting entirely of the intended product and the absence or significant reduction of non-specific products and primer dimers. In evaluation of clinical samples such antibody triggering yielded defined PCR product and higher sensitivity because of the absence of non-specific products.
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Anticuerpos Monoclonales/farmacología , ADN Polimerasa Dirigida por ADN/inmunología , Calor , Reacción en Cadena de la Polimerasa , Thermus/enzimología , Animales , Humanos , Inmunoglobulina G/farmacología , Ratones , Inhibidores de la Síntesis del Ácido Nucleico , Polimerasa TaqRESUMEN
Treatment of multidrug-resistant tuberculosis (MDR-TB), defined as Mycobacterium tuberculosis resistant to both isoniazid and rifampicin, is challenging under the best of circumstances, and particularly in resource-limited settings. For patients who remain persistently sputum-culture-positive despite therapy with second-line TB drugs, treatment options are limited, especially if disease is too advanced for resective surgery. Salvage therapy refers to the design of a regimen combining new and previously used drugs in a final effort to attain sputum conversion before declaring treatment to have failed. We retrospectively evaluated the outcomes of salvage therapy in 213 Peruvian patients. Salvage regimens included a median of two new drugs (range 1-6) and nine (range 5-13) total (new plus previously used) drugs. The most frequently used new drug was moxifloxacin, followed by capreomycin, amoxicillin-clavulanate, kanamycin and clarithromycin. Culture conversion occurred in 65 (30.5%) patients. Salvage regimens that included moxifloxacin were significantly more likely to be followed by culture conversion (OR 2.2; p 0.02). Later-generation fluoroquinolones such as moxifloxacin should be used in salvage therapy but also in the initial treatment of MDR-TB, if the best clinical strategy is to use the most effective drugs when the patient has the best chance for cure. New TB drugs are most likely to be initially used in salvage patients, in conditions similar to those described here. Close bacteriological monitoring of these patients will be essential, as useful information about the best way to use these new drugs can be gained from analysis of salvage therapy cohorts.
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Antituberculosos/uso terapéutico , Terapia Recuperativa/métodos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Capreomicina/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Kanamicina/uso terapéutico , Masculino , Moxifloxacino , Mycobacterium tuberculosis/efectos de los fármacos , Estudios Retrospectivos , Rifampin/uso terapéutico , Esputo/microbiología , Resultado del Tratamiento , Adulto JovenRESUMEN
SETTING: Multidrug-resistant tuberculosis (MDR-TB) treatment program in Tomsk, Russia. OBJECTIVE: To describe the incidence and management of hepatotoxicity during treatment of MDR-TB, and to assess risk factors associated with its development and impact on treatment outcomes. DESIGN: A retrospective case series performed among 608 patients. RESULTS: Hepatotoxicity, using American Thoracic Society (2006) definitions, was observed in 91/568 patients (16.5%). The median time to the first hepatotoxic event was 196 days post treatment commencement. Baseline factors associated with hepatotoxicity included elevated alanine aminotransferase/aspartate aminotransferase/bilirubin (OR 53.9, 95%CI 6.30-438.7), and renal insufficiency (OR 19.6, 95%CI 2.71-141.6). High treatment adherence (OR 3.25, 95%CI 2.07-5.09) and starting treatment in prison (OR 1.77, 95%CI 1.04-3.01) were associated with treatment success. Smoking (OR 0.44, 95%CI 0.21-0.92) and bilateral cavitary disease (OR 0.51, 95%CI 0.34-0.77) were associated with worse outcomes. For alcohol users, developing hepatotoxicity was associated with better outcomes (OR 4.40, 95%CI 1.79-10.81) than not (OR 0.42, 95%CI 0.25-0.68). One or more medications were permanently stopped in 10/91 patients, but in no case was treatment entirely discontinued. CONCLUSION: MDR-TB treatment in the face of hepatotoxicity during therapy did not result in a statistically significant increase in poor outcomes.
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Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Antituberculosos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Prisioneros/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Fumar/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
SETTING: Alcohol use increases the risk of multidrug-resistant tuberculosis (MDR-TB) and poses challenges for successful MDR-TB treatment, including the potential for additional adverse events. AIM: To investigate the association between alcohol consumption during MDR-TB treatment and adverse events and treatment outcomes in a cohort of patients in Tomsk, Russia. DESIGN: From 2000 to 2004, retrospective data were collected on 407 MDR-TB patients in Tomsk. Factors associated with treatment outcomes were assessed using logistic regression. RESULTS: Of the 407 patients, 253 (62.2%) consumed alcohol during treatment ('drinkers'), and 367 (90.2%) had at least one documented adverse advent. No significant differences were noted in frequency of adverse events in drinkers vs. non-drinkers. Drinkers had less favourable treatment outcomes (OR 0.28, 95%CI 0.18-0.45). Among drinkers, favourable treatment outcome was associated with adherence to at least 80% of prescribed doses (OR 2.89, 95%CI 1.30-6.43) and the occurrence of an adverse event requiring treatment interruption (OR 2.49, 95%CI 1.11-5.59). CONCLUSIONS: Alcohol use did not appear to increase the risk of adverse events during MDR-TB treatment; however, alcohol consumption was associated with poor outcome. Our findings suggest that individuals who drink alcohol should receive aggressive attention to optimise treatment adherence and manage adverse events.