Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa

SETTING: Hlabisa Tuberculosis Programme, Hlabisa, South Africa. OBJECTIVE: To determine trends in and risk factors for interruption of tuberculosis treatment. METHODS: Data were extracted from the control programme database starting in 1991. Temporal trends in treatment interruption are described; independent risk factors for treatment interruption were determined with a multiple logistic regression model, and Kaplan-Meier survival curves for treatment interruption were constructed for patients treated in 1994-1995. RESULTS: Overall 629 of 3610 surviving patients (17%) failed to complete treatment; this proportion increased from 11% (n = 79) in 1991/1992 to 22% (n = 201) in 1996. Independent risk factors for treatment interruption were diagnosis between 1994-1996 compared with 1991-1393 (odds ratio [OR] 1.9, 95% confidence interval [CT] 1.6-2.4); human immunodeficiency virus (HIV) positivity compared with HIV negativity (OR 1.8, 95% CI 1.4-2.4); supervised by village clinic compared with community health worker (OR 1.9, 95% CI 1.4-2.6); and male versus female sex (OR 1.3, 95% CI 1.1-1.6). Few patients interrupted treatment during the first 2 weeks, and the treatment interruption rate thereafter was constant at 1% per 14 days. CONCLUSIONS: Frequency of treatment interruption from this programme has increased recently. The strongest risk factor was year of diagnosis, perhaps reflecting the impact of an increased caseload on programme performance. Ensuring adherence to therapy in communities with a high level of migration remains a challenge even within community-based directly observed therapy programmes.

Trial-of-antibiotic algorithm for the diagnosis of tuberculosis in a district hospital in a developing country with high HIV prevalence

OBJECTIVE: To evaluate a diagnostic algorithm for pulmonary tuberculosis based on smear microscopy and objective response to trial of antibiotics. SETTING: Adult medical wards, Hlabisa Hospital, South Africa, 1996-1997. METHODS: Adults with chronic chest symptoms and abnormal chest X-ray had sputum examined for Ziehl-Neelsen stained acid-fast bacilli by light microscopy. Those with negative smears were treated with amoxycillin for 5 days and assessed. Those who had not improved were treated with erythromycin for 5 days and reassessed. Response was compared with mycobacterial culture. RESULTS: Of 280 suspects who completed the diagnostic pathway, 160 (57%) had a positive smear, 46 (17%) responded to amoxycillin, 34 (12%) responded to erythromycin and 40 (14%) were treated as smear-negative tuberculosis. The sensitivity (89%) and specificity (84%) of the full algorithm for culture-positive tuberculosis were high. However, 11 patients (positive predictive value [PPV] 95%) were incorrectly diagnosed with tuberculosis, and 24 cases of tuberculosis (negative predictive value [NPV] 70%) were not identified. NPV improved to 75% when anaemia was included as a predictor. Algorithm performance was independent of human immunodeficiency virus status. CONCLUSION: Sputum smear microscopy plus trial of antibiotic algorithm among a selected group of tuberculosis suspects may increase diagnostic accuracy in district hospitals in developing countries.

A Delphi study of district nursing research priorities in Australia

This study, using a Delphi approach, sought the opinion of a self-selected panel of 320 district nurses regarding research priorities for district nursing in Australia. Over three rounds of questionnaires, the 419 research clinical problem areas requiring research as suggested by the panel were each rated in importance by the panel and then ranked through analysis from high to low average rating scores, thereby, whittling down the list to the top 15% (68) research questions and to a final list of the top 10 research priorities overall. Research questions focusing on discharge planning are dominant in these top 10 priorities, with documentation issues the second most common focus. Other foci in the top 10 priorities are staffing, aged care, palliative care, and assessment. The organization-specific top 10 research priorities focus on wound care, funding, education, and communication issues. Additionally, the top 68 priorities, which are either finitely practice-based or contextual-issues research questions, were categorized into 20 themes. The results will hopefully lead to scarce human and financial resources being directed to practice-relevant research programs that will facilitate improved health for district nursing (primarily home-nursing) clients in Australia and elsewhere. (c) 2005 Elsevier Inc. All rights reserved.

Forecasting regional crop production using SOI phases: an example for the Australian peanut industry

Using peanuts as an example, a generic methodology is presented to forward-estimate regional crop production and associated climatic risks based on phases of the Southern Oscillation Index (SOI). Yield fluctuations caused by a highly variable rainfall environment are of concern to peanut processing and marketing bodies. The industry could profitably use forecasts of likely production to adjust their operations strategically. Significant, physically based lag-relationships exist between an index of ocean/atmosphere El Nino/Southern Oscillation phenomenon and future rainfall in Australia and elsewhere. Combining knowledge of SOI phases in November and December with output from a dynamic simulation model allows the derivation of yield probability distributions based on historic rainfall data. This information is available shortly after planting a crop and at least 3-5 months prior to harvest. The study shows that in years when the November-December SOI phase is positive there is an 80% chance of exceeding average district yields. Conversely, in years when the November-December SOI phase is either negative or rapidly falling there is only a 5% chance of exceeding average district yields, but a 95% chance of below average yields. This information allows the industry to adjust strategically for the expected volume of production. The study shows that simulation models can enhance SOI signals contained in rainfall distributions by discriminating between useful and damaging rainfall events. The methodology can be applied to other industries and regions.

Prevalence of Toxoplasma gondii and Neospora caninum infections in sheep from Federal District, central region of Brazil

Serum samples from 1028 sheep were collected from 32 herds within Federal District, in the central region of Brazil. The samples were examined by indirect fluorescent antibody test (IFAT) using sera diluted 1:64 and 1:50 as cut-off values for the detection of antibodies against Toxoplasma gondii and Neospora caninum, respectively. The observed prevalence for T. gondii infection was 38.22% (26.81%< CI 0.95 < 49.62%), and the titers ranged from 64 to 65536. The observed prevalence for N. caninum infection was 8.81% (7.08%< CI 0.95 < 10.53%). The titers ranged from 50 to 51200. The reactant sera to both pathogens corresponded to 4.67% of the samples. The risk factors were not determined because of the absence of negative herds for T. gondii and the high proportion of positive herds for N. caninum (87.50%). The prevalence for T. gondii infection was significantly higher among males than in females. The present work is the first report on seroprevalence of T. gondii and N. caninum in sheep from Federal District and shows that infection by both parasites is widespread in the ovine population from this region.

A report on socioeconomic attributes and gender inequality in Kondh-dominated villages: A comparative analysis of tribals and non-tribals in the Phulbani district, Orissa, India

Reports on results of a survey, completed in 2000, of wives in three villages in the Phulbani district, Orissa, India. These villages are dominated by the Kondh scheduled tribe but some also contain members of the scheduled caste, called Dombs in Orissa. The article reports on the total responses and comparative responses of these groups to a structured questionnaire. The article provides background information for the villages surveyed, and reports information in relation to wives and their families about property rights, assets and incomes, economic conditions and survival strategies, aspects of credit, production and marketing, social dynamics and eduction. In addition, children’s affairs, including the treatment and entitlements of female and male children, are considered as well as additional aspects of the socioeconomic status of wives.

Family size, economics and child gender preference: A case study in the Nyeri district of Kenya

Kenyan women have more children, especially in rural areas, than in most developing nations. This is widely believed to be an impediment to Kenya’s economic development. Thus, factors influencing family size in the Kenyan context are important for its future. A brief review of economic theories of fertility leads to the conclusion that both economics and social/cultural factors must be considered simultaneously when examining factors that determine the number of children in a family. The need to do this is borne out in Kenya’s situation by utilising responses from a random sample of rural households in the Nyeri district of Kenya. Economic and social/cultural factors intertwine to influence family sizes in this district. After providing a summary of the main statistical results from the survey, we use multiple regression analysis to explore the influences of a woman’s age, level of education, whether she has outside employment, whether the family keeps livestock, whether she expresses a preference for more boys than girls, whether the family uses only family labour (including child labour) and the size of the farm, which is used as a proxy for family income. It was found that preference for male children has an important positive influence on family size in this district. Women were found to have greater preference for male children than their male counterparts possibly because of their fear of being disinherited if they do not produce an heir for their husbands. Preference for sons was also found in allocation of human capital resources at the household level in that the female respondents were found to have lower levels of education than their male counterparts. Various long-term policies are outlined that may help to reduce the number of offspring of women in Kenya.

Factors affecting cane yield and commercial cane sugar in the Tully district

The Tully Sugar Mill has collected information about sugarcane supplied for crushing from every block in the mill district from 1970 to 1999. Data from 1988 to 1999 were analysed to understand the extent of the variation in cane yield per hectare and commercial cane sugar in the Tully mill area. The key factors influencing the variation in cane yield and commercial cane sugar in this commercial environment were identified and the variance components computed using a restricted maximum likelihood methodology. Cane yield was predominantly influenced by the year in which it was harvested, the month when the crop was ratooned (month of harvest in the previous year) and the farm of origin. These variables were relatively more important than variety, age of crop or crop class (plant crop, first ratoon through to fourth or older ratoons) and fallowing practice (fallow or ploughout-replant). The month-of-ratooning effect was relatively stable from year-to-year. Commercial cane sugar was influenced by the year of harvest, the month of harvest and their interaction, in that the influence of the month of harvest varied from year to year. Variety and farm differences were also significant but accounted for a much lower portion of the variation in commercial cane sugar. An empirical model was constructed from the key factors that influenced commercial cane sugar and cane yield to quantify their combined influence on sugar yield (t/ha). This may be used to assist mill personnel to predict their activities more accurately, for example to calculate the impact of a late finish to the current harvest season on the following year's crop.

Tourism impacts of a portuguese world heritage historic center: residents’ perspectives

The aim of this study is twofold. First, the study analyzes local community perspectives of the importance of the WHS classification of the historic center of Évora. Second, the study analyzes local residents’ perceived tourism impacts on the municipality of Évora. The methodology comprises quantitative research based on a self-administered survey applied to convenience samples of local residents of Évora in the beginning of 2014. The main results reveal that local residents have a strongly positive perception of the WHS designation. With regard to the perceived tourism impacts, a principal component factor analysis delineated three positive and three negative tourism impacts. The comparison of the mean scores of these factors across residents that live near and far from the historic center reveals that the most valued and least valued factors are common to all groups of residents. Nevertheless, in terms of positive impacts, the residents that live near the historic center revealed higher means than the residents that live far from it, whereas in terms of negative impacts, the latter group revealed higher means than former group.

Residents’ perspectives on tourism impacts of portuguese world heritage historic centers: Angra do Heroísmo and Évora

The aim of this study is twofold. First, the study analyzes local community perspectives of the importance of the World Heritage Site (WHS) classification of the historic centers of Angra do Heroísmo and Évora. Second, the study analyzes local residents’ perceived tourism impacts on the municipalities of Angra do Heroísmo and Évora. The methodology comprises quantitative research based on a self-administered survey applied to convenience samples of local residents of the two Portuguese municipalities in 2014. The main results reveal that local residents have a strongly positive perception of the WHS designation in both municipalities. With regard to the perceived tourism impacts, residents from Angra do Heroísmo have a stronger agreement about the impacts of tourism on their city than the residents of Évora, except for the negative social and cultural impacts. The comparison of the mean scores of these impacts across residents that live near and far from the historic centers reveals that the most valued and least valued impacts in the three categories of impacts (economic, social and cultural, and environmental) are common to all groups of residents. Nevertheless, residents living in or near the historic center of Angra do Heroísmo have higher means in the majority of tourism impacts (in all categories), with only one negative impact to concern the majority of respondents. Among the residents from Évora, residents living in or near the historic center have higher means in the majority of economic impacts but lower means in almost social and cultural impacts. With regard to the environmental impacts, residents living in or near the historic center have higher means scores in the positive impacts and lower means scores in the negative environmental impacts.

Reabilitação de edifícios de habitação no Bairro da Mouraria em Lisboa

A Reabilitação Urbana é uma preocupação que afeta a maioria dos municípios portugueses. A degradação nosso património edificado da nossa memória, principalmente nos centros históricos, tornou-se um problema que urge resolver rapidamente. Na conjuntura que o país atravessa, com o excesso de construção nova que nos últimos anos inundou o mercado, a reabilitação assume-se como uma opção para a indústria da construção civil. No caso do Bairro da Mouraria, o esforço que o município tem vindo a desenvolver, que implica grandes investimentos e grande esforço financeiro, no difícil contexto económico do país, assume maior relevância. Esta dissertação debruça-se sobre o caminho percorrido, as condicionantes das soluções de projeto e do investimento na reabilitação no Bairro da Mouraria. E sobre os aspetos que envolvem esta atividade e conferem à recuperação do edificado um carácter especial, pois trata-se de um tipo de obra que se reveste de alguma imprevisibilidade, que pode mesmo levar a custos adicionais e à inviabilidade dos investimentos. O que justifica que para este tipo de obras tenha de haver uma atenção redobrada desde a fase do levantamento do edificado, das suas patologias, das obras a realizar, das soluções arquitetónicas e técnicas a adotar, passando pela fase de licenciamento do projeto, até à recuperação física dos edifícios. Pretende-se, também, apresentar algumas situações típicas de reabilitação de edifícios antigos, aprofundando-se as questões técnicas sobre as patologias mais correntes, a viabilidade económica das operações e enquadrando os principais fatores que têm retardado o processo.

Evaluation of atmospheric deposition and patterns of polycyclic aromatic hydrocarbons in façades of historic monuments of Oporto (Portugal)

Atmospheric pollution by motor vehicles is considered a relevant source of damage to architectural heritage. Thus the aim of this work was to assess the atmospheric depositions and patterns of polycyclic aromatic hydrocarbons (PAHs) in façades of historical monuments. Eighteen PAHs (16 PAHs considered by US EPA as priority pollutants, dibenzo[a,l]pyrene and benzo[j]fluoranthene) were determined in thin black layers collected from façades of two historical monuments: Hospital Santo António and Lapa Church (Oporto, Portugal). Scanning electron microscopy (SEM) was used for morphological and elemental characterisation of thin black layers; PAHs were quantified by microwave-assisted extraction combined with liquid chromatography (MAE-LC). The thickness of thin black layers were 80–110 μm and they contained significant levels of iron, sulfur, calcium and phosphorus. Total concentrations of 18 PAHs ranged from 7.74 to 147.92 ng/g (mean of 45.52 ng/g) in thin black layers of Hospital Santo António, giving a range three times lower than at Lapa Church (5.44– 429.26 ng/g; mean of 110.25 ng/g); four to six rings compounds accounted at both monuments approximately for 80–85% of ΣPAHs. The diagnostic ratios showed that traffic emissions were significant source of PAHs in thin black layers. Composition profiles of PAHs in thin black layers of both monuments were similar to those of ambient air, thus showing that air pollution has a significant impact on the conditions and stone decay of historical building façades. The obtained results confirm that historical monuments in urban areas act as passive repositories for air pollutants present in the surrounding atmosphere.