Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: a scoping review.

BACKGROUND: Improving adherence to anti-TB treatment is a public health priority in high-income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.METHODS: Key terms related to TB, treatment and adherence were used to search MEDLINE, EMBASE, Web of Science, PsycINFO and CINAHL in June 2019. Quantitative studies examining determinants (demographic, clinical, health systems or psychosocial) of non-adherence to anti-TB treatment in HILI settings were included.RESULTS: From 10,801 results, we identified 24 relevant studies from 10 countries. Definitions and methods of assessing adherence were highly variable, as were documented levels of non-adherence (0.9-89%). Demographic factors were assessed in all studies and clinical factors were frequently assessed (23/24). Determinants commonly associated with non-adherence were homelessness, incarceration, and alcohol or drug misuse. Health system (8/24) and psychosocial factors (6/24) were less commonly evaluated.CONCLUSION: Our review identified some key factors associated with non-adherence to anti-TB treatment in HILI settings. Modifiable determinants such as psychosocial factors are under-evidenced and should be further explored, as these may be better targeted by adherence support. There is an urgent need to standardise definitions and measurement of adherence to more accurately identify the strongest determinants.

Does getting away with it count? An application of stafford and warr's reconceptualised model of deterrence to drink driving.

Drink drivers continue to be disproportionately represented in road mortalities and morbidities. Given these costs, countermeasures that effectively reduce the behaviour (and its consequences) are imperative. Research has produced inconsistent findings regarding the deterrent effects of some countermeasures on drink driving behaviour, namely legal sanctions, suggesting other factors may be more influential. This study aimed to determine which deterrence measures based on Classical Deterrence Theory and Stafford and Warr's (1993) reconceptualised model of deterrence influence the propensity to drink and drive over the legal blood alcohol content limit of 0.05. In total, 1257 Australian drivers aged from 16 to 85 years completed a questionnaire assessing their self-reported drink driving behaviour and perceptions of legal sanctions. Consistent with previous research, past experiences of direct punishment avoidance was the most significant predictor of drink driving. Additionally, perceptions of personal certainty of apprehension were a significant (albeit weak) negative predictor of drink driving. Counterintuitively, experiences of indirect punishment were predictive of self-reported drink driving. Similarly, penalty severity produced mixed results as those who considered a penalty would be severe were less likely to drink and drive. However those that considered the penalty would cause a considerable impact on their lives, were more likely to drink and drive. Taken together, these findings suggest that while the threat of apprehension and punishment may influence self-reported drink driving behaviours, committing and offence while avoiding detection is a significant influence upon ongoing offending. This paper will further elaborate on the findings in regards to developing salient and effective deterrents that produce a lasting effect.

Assessing fatigue in inflammatory bowel disease: comparison of three fatigue scales.

BACKGROUND: Fatigue is commonly reported by patients with inflammatory bowel disease (IBD), both in quiescent and active disease. Few fatigue scales have been tested in IBD. AIM: To assess three fatigue assessment scales in IBD and to determine correlates of fatigue. METHODS: Potential participants (n = 2131) were randomly selected from an IBD organisation's members' database; 605 volunteered and were posted three fatigue scales: Inflammatory Bowel Disease Fatigue scale, Multidimensional Fatigue Inventory and Multidimensional Assessment Fatigue scale and questionnaires assessing anxiety, depression, quality of life (QoL) and IBD activity. The questionnaires were tested for stability over time with another group (n = 70) of invited participants. Internal consistency was measured by Cronbach's alpha and test-retest reliability by the intraclass correlation coefficient (ICC). RESULTS: Four hundred and sixty-five of 605 (77%) questionnaires were returned; of 70 invited, 48/70 returned test (68.6%) and 41/70 (58.6%) returned retest. The three scales are highly correlated (P < 0.001). Test-retest suggests reasonable agreement with ICC values between 0.65 and 0.84. Lower age, female gender, IBD diagnosis, anxiety, depression and QoL were associated with fatigue (P < 0.001) on univariable analysis. However, on multivariable analysis only depression and low QoL were consistently associated with fatigue, while female gender was associated on most scales. IBD diagnosis, age and other factors were not consistently associated with severity or impact of fatigue once other variables were controlled for. CONCLUSIONS: All three fatigue scales are likely to measure IBD fatigue adequately. Responsiveness to change has not been tested. Depression, poorer QoL and probably female gender are the major associations of fatigue in IBD.