RESUMO
OBJECTIVE: There are different socioeconomic variables which determine tuberculosis's epidemiology, diagnosis and treatment. The objective of this paper was to analize these effects in the last years in Spain. METHODS: A systematic review was conducted. Screened studies were original articles written in English or Spanish and published between 2007 and 2020. Searching was performed in Pubmed and Web of Science databases. STROBE criteria were followed to analyze studies's quality, and studies included in the review had 15 points or more. RESULTS: 23 articles were selected, and were classified in different topics. Foreigners's proportion with tuberculosis changed in different autonomous communities between 10%-50%. There were diagnostic delay for this group compared to natives. This group had higher incidence of resistance to isoniazid, but without a clear increase in multidrug resistance. There were less adherence to tuberculosis's treatment in case of immigration, drug addiction, HIV coinfection, or lack of family support. Under-reporting of tuberculosis cases varied between 18%-28%, and it was higher in cases of social marginality, HIV coinfection, Spanish nationality or male sex. There were also other social risk groups in which the diagnostic approach to tuberculosis was relevant, such as in schools and health centers. Tuberculosis was one of the most frequent HIV associated diseases, although screening tests were not performed in almost 18%, depending on the concurrence of social risk factors. CONCLUSIONS: Tuberculosis's incidence, diagnosis, and treatment are influenced by a lot of social and economic factors, which determine the approach to this disease.
OBJETIVO: Existen diferentes variables socioeconómicas que condicionan la epidemiología, diagnóstico y tratamiento de la tuberculosis. El objetivo del siguiente trabajo fue analizar dichos factores en los últimos años en España. METODOS: Se realizó una revisión sistemática de artículos originales escritos en inglés o castellano, entre los años 2007 y 2020. La búsqueda se realizó en las bases de datos Pubmed y Web of Science. Se siguieron los criterios STROBE para analizar la calidad de los estudios y seleccionando para su inclusión en la revisión aquellos que obtuvieron 15 puntos o más. RESULTADOS: Se analizaron 23 artículos, dividiendo las conclusiones por áreas temáticas. La proporción de personas extranjeras con tuberculosis varió en las diferentes comunidades autónomas entre un 10% y un 50%, pudiendo existir demora diagnóstica en este grupo respecto a los autóctonos y presentando mayor incidencia de resistencia a isoniacida, pero sin claro aumento en la multirresistencia. Se halló menor cumplimiento del tratamiento antituberculoso en caso de migración, adicción a drogas, coinfección de tuberculosis y VIH o falta de apoyo familiar. La infranotificación de casos de tuberculosis varió entre un 18% y un 28%, siendo mayor en casos de marginalidad social, coinfección de tuberculosis y VIH, nacionalidad española o sexo varón. La tuberculosis fue una de las enfermedades asociadas a VIH más frecuentes, aunque no se realizaron pruebas de cribado en casi el 18%, según la concurrencia de factores sociales de riesgo. CONCLUSIONES: En la incidencia, diagnóstico y tratamiento de la tuberculosis influyen numerosos factores sociales y económicos que condicionan su abordaje.
Assuntos
Diagnóstico Tardio , Tuberculose , Masculino , Humanos , Espanha/epidemiologia , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , IsoniazidaRESUMO
BACKGROUND: Epilepsy is one of the most common neurological diseases. Its high prevalence, economic relevance and impact on daily life make it crucial that we study this condition in further detail. Our study seeks to investigate whether the lifestyle of people diagnosed with epilepsy is different to that of people without epilepsy, in order to better understand our patients. METHODS: We designed and delivered a questionnaire about quality of life and daily habits to patients from our hospital's Epilepsy Unit. We also delivered the questionnaire to a control group with similar demographic characteristics. Lifestyle differences between patients and control group members were analyzed. Patients were further divided according to the type of epilepsy, time since diagnosis, seizure frequency and pharmacotherapy. RESULTS: A total of 278 people were interviewed (85 patients, 193 controls). There was no difference in educational level, marital status and healthy habits (sports, reading and diet) between the groups. However, patients with epilepsy were more often unemployed (p<0.05) and had a healthier lifestyle (lower body mass index, lower alcohol consumption and a tendency towards smoking less). Anxiolytic-antidepressant intake was higher in patients with epilepsy. In terms of the type of epilepsy, patients with focal epilepsy exercised more than those with generalized epilepsy; no other statistically significant differences were found between the individuals studied. DISCUSSION: Epilepsy diagnosis does not seem to negatively alter the daily life of patients; in fact, many adopt a healthier lifestyle after diagnosis. The risk of antidepressant/anxiolytic intake is, however, higher, which could reflect the impact this chronic condition still has at a social level.