Compliance With TB Treatment, Ventilatory Control

Main Category: Tuberculosis
Also Included In: Respiratory / Asthma;  Complementary Medicine / Alternative Medicine
Article Date: 25 Jul 2007 - 8:00 PDT

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Patients with tuberculosis should be more involved in decisions about their treatment

Tuberculosis (TB) is a major killer, causing up to two million deaths worldwide every year. Treatment takes many months and many patients fail to complete the course of drugs prescribed. Now a study published in PLoS Medicine casts new light on the difficulties patients face in trying to stick to the treatment they are given.

Salla Munro of the South African Medical Research Council, with colleagues in South Africa, Norway and the UK, conducted a systematic review of research into adherence to TB treatment that has been carried out using qualitative methods. In other words, they searched the medical literature for studies where patients and their families had been asked to say how they felt about their treatment. (This is different from 'quantitative' research where numbers are collected, rather than recording what patients actually say.)

The researchers found 44 qualitative studies on TB treatment that met their prespecified criteria. From a careful appraisal of these studies they were able to classify the major factors associated with difficulties in completing treatment. They conclude that adherence to treatment is influenced by: structural factors (including poverty and gender discrimination), social context factors, health service factors and personal factors (including attitudes towards treatment and illness).

From this research, it is clear that patients often take their TB medications under very difficult conditions and that they cannot control many of the factors that prevent them from taking their drugs. So, although current efforts to improve adherence to tuberculosis treatments emphasize instilling into patients a willingness to take their medications, this new study suggests that more must be done to address how factors such as poverty and gender affect treatment adherence and to tailor support systems to patients' needs.

Most importantly, it indicates that future interventions should involve patients far more in the decisions made about their treatment. As Salla Munro of the Medical Research Council notes: "Adherence to treatment is a complex phenomenon. We need more patient-centred interventions, and more attention to structural barriers, to improve treatment adherence and reduce the global disease burden of tuberculosis."

Citation: Munro SA, Lewin SA, Smith H, Engel ME, Fretheim A, et al. (2007) Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Med 4(7): e238.

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CONTACT:
Salla Munro
Medical Research Council of South Africa Health Systems Research Unit PO Box 19070 Tygerberg, Cape Town 7505 South Africa

Neuroplasticity in ventilatory control

Albert Dahan and colleagues from the University of Leiden describe the results of bilateral carotid body resection in three individuals. This procedure led to reduced sensitivity of central chemoreceptors to CO2, followed by a gradual return. They thus provide evidence of central plasticity within the human ventilatory control system.

Citation: Dahan A, Nieuwenhuijs D, Teppema L (2007) Plasticity of central chemoreceptors: Effect of bilateral carotid body resection on central CO2 sensitivity. PLoS Med 4(7): e239.

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CONTACT:
Albert Dahan
Leiden University Medical Center
Anesthesiology
Albinusdreef 2
Leiden, 2300 RC
Netherlands

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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource.

For more information please visit http://www.plos.org/

Source: Andrew Hyde
Public Library of Science

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