Interventions to improve medication adherence in tuberculosis patients:A systematic review of randomized controlled studies

Non-adherence to anti-tuberculosis (anti-TB) medication is a major risk factor for poor treatment outcomes. We therefore assessed the effectiveness of medication adherence enhancing interventions in TB patients. We report a systematic review of randomized controlled trials that included either latent tuberculosis infection (LTBI) or active TB patients. Outcomes of interest included adherence rate, completed treatment, defaulted treatment and treatment outcomes. We identified four LTBI and ten active TB studies. In active TB patients, directly observed treatment (DOT) by trained community workers, short messaging service combined with education, counselling, monthly TB vouchers, drug box reminders and combinations of those were found effective. In LTBI patients, shorter regimens and DOT effectively improved treatment completion. Interestingly, DOT showed variable effectiveness, highlighting that implementation, population and setting may play important roles. Since non-adherence factors are patient-specific, personalized interventions are required to enhance the impact of a programme to improve medication adherence in TB patients

The effect of stimulus context on pitch representations in the human auditory cortex

Neuroimaging studies of pitch coding seek to identify pitch-related responses separate from responses to other properties of the stimulus, such as its energy onset, and other general aspects of the listening context. The current study reports the first attempt to evaluate these modulatory influences using functional magnetic resonance imaging (fMRI) measures of cortical pitch representations. Stimulus context was manipulated using a 'classical stimulation paradigm' (whereby successive pitch stimuli were separated by gaps of silence) and a 'continuous stimulation paradigm' (whereby successive pitch stimuli were interspersed with noise to maintain a stable envelope). Pitch responses were measured for two types of pitch-evoking stimuli; a harmonic-complex tone and a complex Huggins pitch. Results for a group of 15 normally hearing listeners revealed that context effects were mostly observed in primary auditory regions, while the most significant pitch responses were localized to posterior nonprimary auditory cortex, specifically planum temporale. Sensitivity to pitch was greater for the continuous stimulation conditions perhaps because they better controlled for concurrent responses to the noise energy onset and reduced the potential problem of a non-linear fMRI response becoming saturated. These results provide support for hierarchical processing within human auditory cortex, with some parts of primary auditory cortex engaged by general auditory energy, some parts of planum temporale specifically responsible for representing pitch information and adjacent regions that are responsible for complex higher-level auditory processing such as representing pitch information as a function of listening context