RESUMO
AIM: This paper is a report of a study to examine the impact of social factors on the management of tuberculosis including engagement with services, hospitalization and extended treatment. BACKGROUND: Rates of tuberculosis in major European cities have increased greatly in the last 10 years. The changing epidemiology of the disease, concentrated in marginalized groups, presents new challenges to the control of tuberculosis. METHODS: A prospective cohort study of 250 newly diagnosed tuberculosis patients was conducted in London between January 2003 and January 2005. Data were collected by means of a risk assessment tool and from medical records. Outcome measures included missed appointments, frequency and duration of hospitalization and length of treatment. RESULTS: The median age of the study sample was 33.82 (range 16.4-92.5) and 56.8% were male. Thirty-two per cent were hostel/street homeless or temporarily sharing accommodation with friends or relatives. Thirty-nine per cent were in receipt of welfare benefits and 13.2% had no income. Over a third anticipated difficulties taking their medicines and 30.3% had noone to remind them of this. Increased hospitalization was associated with hostel/street homelessness, drug or alcohol use and having noone to remind them to take their medicines (all P Assuntos
Meio Social
, Tuberculose/terapia
, Adolescente
, Adulto
, Idoso
, Idoso de 80 Anos ou mais
, Estudos de Coortes
, Feminino
, Pessoas Mal Alojadas
, Humanos
, Incidência
, Londres/epidemiologia
, Masculino
, Pessoa de Meia-Idade
, Estudos Prospectivos
, Fatores de Risco
, Transtornos Relacionados ao Uso de Substâncias/complicações
, Transtornos Relacionados ao Uso de Substâncias/epidemiologia
, Tuberculose/complicações
, Tuberculose/epidemiologia
RESUMO
AIM: The objective of this study was to investigate issues regarding adherence with tuberculosis therapy and the use of directly observed therapy. METHOD: A small-scale survey of TB nurse specialists at chest clinics in London was carried out to determine the current use of directly observed therapy for patients with tuberculosis in London. RESULTS: Responses to this survey indicate that directly observed therapy is currently used in less than half the available services in London. Many of the specialist TB nurses indicated that lack of resources and time were drawbacks to implementing directly observed therapy. CONCLUSION: Directly observed therapy was found to be a strategy that was infrequently used as a last measure for those people who were previous non-adherers.
Assuntos
Atitude do Pessoal de Saúde , Terapia Diretamente Observada/enfermagem , Terapia Diretamente Observada/estatística & dados numéricos , Enfermeiros Clínicos/psicologia , Tuberculose/tratamento farmacológico , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Terapia Diretamente Observada/normas , Fidelidade a Diretrizes/normas , Humanos , Londres/epidemiologia , Enfermeiros Clínicos/organização & administração , Papel do Profissional de Enfermagem , Guias de Prática Clínica como Assunto , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Recusa do Paciente ao Tratamento/psicologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Tuberculose/epidemiologia , Tuberculose/enfermagem , Tuberculose/psicologia , Carga de TrabalhoRESUMO
Homeless families are vulnerable to considerable health problems, yet are overlooked in the government's national strategy for health. Access to services and contact with agencies are difficult for people displaced to a new area. Helen Lee and Ann Goodburn describe the health visiting service they offer homeless families in Camden, north London, where the majority are from outside the borough and many recent immigrants to this country.
