High mortality during tuberculosis treatment does not indicate long diagnostic delays in Vietnam: a cohort study

<p>Abstract</p> <p>Background</p> <p>Delay in tuberculosis diagnosis and treatment initiation may increase disease severity and mortality. In evaluations of tuberculosis control programmes high fatality rates during tuberculosis treatment, are used as an indicator of long delays in low HIV-prevalence settings. However, data for this presumed association between delay and fatality are lacking. We assessed the association between diagnostic delay and mortality of new smear-positive pulmonary tuberculosis patients in Vietnam.</p> <p>Methods</p> <p>Follow-up of a patient cohort included in a survey of diagnostic delay in 70 randomly selected districts. Data on diagnosis and treatment were extracted from routine registers. Patients who had died during the course of treatment were compared to those with reported cure, completed treatment or failure (survivors).</p> <p>Results</p> <p>Complete data were available for 1881/2093 (89.9%) patients, of whom 82 (4.4%) had died. Fatality was 4.5% for patients with ≤ 4 weeks delay, 5.0% for 5- ≤ 8 weeks delay (aOR 1.11, 95%CI 0.67–1.84) and 3.2% for > 9 weeks delay (aOR 0.69, 95%CI 0.37–1.30). Fatality tended to decline with increasing delay but this was not significant. Fatality was not associated with median diagnostic delay at district level (Spearman's rho = -0.08, P = 0.5).</p> <p>Conclusion</p> <p>Diagnostic delay is not associated with treatment mortality in Vietnam at individual nor district level, suggesting that high case fatality should not be used as an indicator of long diagnostic delay in national tuberculosis programmes.</p

Urban Movement and Alcohol Intake Strongly Predict Defaulting from Tuberculosis Treatment: An Operational Study

BACKGROUND: High levels of defaulting from treatment challenge tuberculosis control in many African cities. We assessed defaulting from tuberculosis treatment in an African urban setting. METHODS: An observational study among adult patients with smear-positive pulmonary tuberculosis receiving treatment at urban primary care clinics in Kampala, Uganda. Defaulting was defined as having missed two consecutive monthly clinic visits while not being reported to have died or continued treatment elsewhere. Defaulting patients were actively followed-up and interviewed. We assessed proportions of patients abandoning treatment with and without the information obtained through active follow-up and we examined associated factors through multivariable logistic regression. RESULTS: Between April 2007 and April 2008, 270 adults aged ≥15 years were included; 54 patients (20%) were recorded as treatment defaulters. On active follow-up vital status was established of 28/54 (52%) patients. Of these, 19 (68%) had completely stopped treatment, one (4%) had died and eight (29%) had continued treatment elsewhere. Extrapolating this to all defaulters meant that 14% rather than 20% of all patients had truly abandoned treatment. Daily consumption of alcohol, recorded at the start of treatment, predicted defaulting (adjusted odds ratio [OR(adj)] 4.4, 95%CI 1.8-13.5), as did change of residence during treatment (OR(adj) 8.7, 95%CI 1.8-41.5); 32% of patients abandoning treatment had changed residence. CONCLUSIONS: A high proportion of tuberculosis patients in primary care clinics in Kampala abandon treatment. Assessing change of residence during scheduled clinic appointments may serve as an early warning signal that the patient may default and needs adherence counseling

Mortality and failure among tuberculosis patients who did not complete treatment in Vietnam: a cohort study

<p>Abstract</p> <p>Background</p> <p>Tuberculosis treatment failure and death rates are low in the Western Pacific Region, including Vietnam. However, failure or death may also occur among patients who did not complete treatment, i.e. reported as default or transfer-out. We aimed to assess the proportion failures and deaths among new smear-positive pulmonary tuberculosis patients with reported default or transfer-out.</p> <p>Treatment outcomes rates were 1.4% default, 3.0% transfer-out, 0.4% failure and 2.6% death in northern Vietnam in 2003.</p> <p>Methods</p> <p>Tuberculosis patients in 32 randomly selected district tuberculosis units in northern Vietnam were followed up 1 to 3 years after treatment initiation for survival, recent treatment history and bacteriologically confirmed tuberculosis.</p> <p>Results</p> <p>Included were 85 transferred patients and 42 who defaulted. No information was available of 41 (32%), 28 (22%) had died. Fifty-eight were available for follow-up (46%); all had sputum smear results. Tuberculosis was recorded in 11 (13%), including 6 (7%) with positive sputum smears, 3 (3%) with negative smears but positive culture and 2 (2%) who had started re-treatment for bacteriologically confirmed tuberculosis. Fifteen (17%, 95%CI 10–27%) had died within 8 months after treatment initiation. Of 86 patients with known study outcomes, 39 (45%, 95%CI 35–56%) had died or had bacteriologically confirmed tuberculosis. This was recorded for 29/53 (55%, 95%CI 40–68%) transferred patients and 10/33 (30%, 95%CI 16–49%) patients who defaulted.</p> <p>Conclusion</p> <p>The total failure and death rates are 0.6% and 0.8% higher than based on routine reporting in northern Vietnam. Although this was a large proportion of treatment failures and deaths, failure and death rates were low. Defaulting and transfer carry a high risk of failure and in particular death.</p

A comprehensive analysis of common genetic variation around six candidate loci for intrahepatic cholestasis of pregnancy.

OBJECTIVES: Intrahepatic cholestasis of pregnancy (ICP) has a complex etiology with a significant genetic component. Heterozygous mutations of canalicular transporters occur in a subset of ICP cases and a population susceptibility allele (p.444A) has been identified in ABCB11. We sought to expand our knowledge of the detailed genetic contribution to ICP by investigation of common variation around candidate loci with biological plausibility for a role in ICP (ABCB4, ABCB11, ABCC2, ATP8B1, NR1H4, and FGF19). METHODS: ICP patients (n=563) of white western European origin and controls (n=642) were analyzed in a case-control design. Single-nucleotide polymorphism (SNP) markers (n=83) were selected from the HapMap data set (Tagger, Haploview 4.1 (build 22)). Genotyping was performed by allelic discrimination assay on a robotic platform. Following quality control, SNP data were analyzed by Armitage's trend test. RESULTS: Cochran-Armitage trend testing identified six SNPs in ABCB11 together with six SNPs in ABCB4 that showed significant evidence of association. The minimum Bonferroni corrected P value for trend testing ABCB11 was 5.81×10(-4) (rs3815676) and for ABCB4 it was 4.6×10(-7)(rs2109505). Conditional analysis of the two clusters of association signals suggested a single signal in ABCB4 but evidence for two independent signals in ABCB11. To confirm these findings, a second study was performed in a further 227 cases, which confirmed and strengthened the original findings. CONCLUSIONS: Our analysis of a large cohort of ICP cases has identified a key role for common variation around the ABCB4 and ABCB11 loci, identified the core associations, and expanded our knowledge of ICP susceptibility

Wrijvende meningen. Media en openbaarheid in Delft, 1850-1914

Friction of Opinions. The media and the Publics Sphere in Delft, 1850-1914The title of this article refers to a phrase, taken from an editorial of a radical liberal newspaper, expressing its faith in the power of reason and the freedom of the press: 'Truth will come to light by means of the friction of opinions' ('Du choc des opinions jaillit la vérité'. Cf. C.P. Colardeau, 1732-1766). The remark was quoted in 1885, at a moment when the relatively well developed media landscape in the small town of Delft (pop.: 20.000) was undergoing dramatic changes, the sort of changes with a striking resemblance of the patterns Juergen Habermas has described in his famous study The Structural Transfirmation of the Public Sphere. This contribution tracks the development of the local media culture; firstly from an institutional point of view, from the rise of a liberal public sphere around the middle of the nineteenth century till its 'usurpation' by the partisan media, linked to the rising political and religious movements or 'pillars' (zuilen). Special attention is paid to the social origins of these changes and the interaction between local and national developments. Finally the question is raised in what sense these local media did contribute to a modern view of the world, by the 'rational' way they presented the daily events, creating an image of a more or less transparent society and offering a sense of progress on a human level

Media History in the Netherlands: Some Observations1 (1993)

Article published in 1993 in GBG-nieuws related to a seminar on Media History in the Netherlands. Republished in 2014 in Tijdschrift voor mediageschiedenis in the context of a seminar held in september 2014 at Sound and Vision on the past 25 years of Media History and its future

DE VLAG als lieu de mémoire: Film en de publieke herinnering aan de bezetting

In april 1955 ging DE VLAG in première, een korte film van de vooral als dichter en tekstschrijver bekend geworden Kees Stip. DE VLAG werd gemaakt in opdracht van de Rijksvoorlichtingsdienst, ter gelegenheid van de tiende verjaardagvan de bevrijding. De wijze waarop Stip de naoorlogse zuivering in DE VLAG heeft verbeeld, is niet alleen typerend voor zijn visie op de bezetting en de naoorlogse samenleving, en voor zijn filmstijl. De film is een van de zuiverste uitdrukkingen van de nationale herdenkingscultuur rond de Tweede Wereldoorlog — een cultuur die ons, enkele decennia later, in meer dan één opzicht vreemd geworden is.DE VLAG (THE FLAG) as lieu de mémoire. Film and the public remembrance of the occupationApril 1955 marked the premier of THE FLAG, a short film by Kees Stip, who is best known as a poet and writer. The Rijksvoorlichtingsdienst (Central Office for Information) commissioned him to make the film to commemorate the 10th anniversary of the liberation. The manner in which Stip presented the post-war purging not only embodies his vision of the occupation and post-war society but also his personal style of cinematography. The film is one of the purest expressions of the national culture of commemoration surrounding World War II - a culture which has become alien to us in many ways only several decades later. Van Vree approaches the film searching for its relevance within the commemoration culture of the 1950s. In brief, he asks how the film relates to experiences, memories and conclusions related to World War 11: What image did survivors wish to pass along to the next generations and what was perceived as the heart of the events that occurred