Tuberculosis sanatorium treatment at the advent of the chemotherapy era
Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments chan...
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ftdoajarticles:oai:doaj.org/article:42313351bb3a4efda3608ecbbd12e6b5 2023-05-15T16:17:08+02:00 Tuberculosis sanatorium treatment at the advent of the chemotherapy era Erin D. Zwick Caitlin S. Pepperell 2020-11-01T00:00:00Z https://doi.org/10.1186/s12879-020-05539-w https://doaj.org/article/42313351bb3a4efda3608ecbbd12e6b5 EN eng BMC http://link.springer.com/article/10.1186/s12879-020-05539-w https://doaj.org/toc/1471-2334 doi:10.1186/s12879-020-05539-w 1471-2334 https://doaj.org/article/42313351bb3a4efda3608ecbbd12e6b5 BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-11 (2020) Tuberculosis Sanatorium Length of treatment Tuberculosis treatment Infectious and parasitic diseases RC109-216 article 2020 ftdoajarticles https://doi.org/10.1186/s12879-020-05539-w 2022-12-31T15:51:27Z Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Methods Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. Results First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from ... Article in Journal/Newspaper First Nations Directory of Open Access Journals: DOAJ Articles Canada BMC Infectious Diseases 20 1 |
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Tuberculosis Sanatorium Length of treatment Tuberculosis treatment Infectious and parasitic diseases RC109-216 |
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Tuberculosis Sanatorium Length of treatment Tuberculosis treatment Infectious and parasitic diseases RC109-216 Erin D. Zwick Caitlin S. Pepperell Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
topic_facet |
Tuberculosis Sanatorium Length of treatment Tuberculosis treatment Infectious and parasitic diseases RC109-216 |
description |
Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Methods Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. Results First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from ... |
format |
Article in Journal/Newspaper |
author |
Erin D. Zwick Caitlin S. Pepperell |
author_facet |
Erin D. Zwick Caitlin S. Pepperell |
author_sort |
Erin D. Zwick |
title |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_short |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_full |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_fullStr |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_full_unstemmed |
Tuberculosis sanatorium treatment at the advent of the chemotherapy era |
title_sort |
tuberculosis sanatorium treatment at the advent of the chemotherapy era |
publisher |
BMC |
publishDate |
2020 |
url |
https://doi.org/10.1186/s12879-020-05539-w https://doaj.org/article/42313351bb3a4efda3608ecbbd12e6b5 |
geographic |
Canada |
geographic_facet |
Canada |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
BMC Infectious Diseases, Vol 20, Iss 1, Pp 1-11 (2020) |
op_relation |
http://link.springer.com/article/10.1186/s12879-020-05539-w https://doaj.org/toc/1471-2334 doi:10.1186/s12879-020-05539-w 1471-2334 https://doaj.org/article/42313351bb3a4efda3608ecbbd12e6b5 |
op_doi |
https://doi.org/10.1186/s12879-020-05539-w |
container_title |
BMC Infectious Diseases |
container_volume |
20 |
container_issue |
1 |
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1766002972626518016 |