Objectives: Chronic obstructive pulmonary disease is a large and increasing problem in low- and m... more Objectives: Chronic obstructive pulmonary disease is a large and increasing problem in low- and middle-income countries; Nepal is no exception. We aimed to obtain information on patient characteristics and the level of care provided to patients admitted for acute exacerbation of chronic obstructive pulmonary disease in two Nepalese hospitals and to compare the given care with the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods: This was a cross-sectional, observational, descriptive study. All patients admitted to two Nepalese hospitals due to acute exacerbation of chronic obstructive pulmonary disease between 18 February and 5 April 2019 were asked to participate. Results: In total, 108 patients with a median age of 70 years participated. Fifty-three (42.7%) were male, 80 (74.8%) were former smokers, and 46 (45.1%) were farmers. Using the Global Initiative for Chronic Obstructive Lung Disease A-D classification, 97 (90.6%) of the patients were classified i...
TB survey among Norwegian GPs survey questionnaire NOR: The survey questionnaire in Norwegian. (P... more TB survey among Norwegian GPs survey questionnaire NOR: The survey questionnaire in Norwegian. (PDF 208 kb)
TB survey among Norwegian GPs survey questionnaire ENG: The survey questionnaire in English. (PDF... more TB survey among Norwegian GPs survey questionnaire ENG: The survey questionnaire in English. (PDF 210 kb)
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005- June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening.
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Background: Tuberculosis (TB) is an enduring public health problem in Nepal. This study aimed to ... more Background: Tuberculosis (TB) is an enduring public health problem in Nepal. This study aimed to uncover the experiences and attitudes of health workers at Private medical colleges (PMCs) towards the National TB Control Programme (NTP). Methods: Strategic and convenience sampling were used to identify health personnel participating in TB care at PMCs affiliated to Kathmandu University. Three focus group interviews were held with 19 participants. Audio recordings of the discussions were transcribed, and thematic analysis was conducted. Results: The PMCs treat many TB patients and regularly refer patients to DOTS clinics for treatment, but the PMCs don't feel well integrated into the NTP. There are gaps between the NTP programmes/ guidelines and clinical realities, and the PMCs would like to participate in developing national guidelines and the NTP`s monitoring and evaluation initiatives. There is also a lack of communication within and between levels. Clear lines of management and responsibility, and more training of staff at all levels, are wanted. Conclusion: Increased involvement of PMCs in national TB control activities is important to improve TB care. Clearer guidelines from the government about the involvement of PMCs in TB control are also needed, as is better collaboration between the NTP and PMCs.
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
General aspects: This is a well written manuscript that addresses an important issue related to t... more General aspects: This is a well written manuscript that addresses an important issue related to tuberculosis (TB) care. The authors evaluate a " project " aimed at improving the collaboration between health care service providers at different levels (municipal vs. specialists) of the Norwegian health care system in the municipality of Trondheim. They assessed if improved collaboration resulted in increased frequency of patients who attended the first consultation at the specialist department (pulmonary outpatient dept., POPD) after being screened for TB. They also assessed the time from screening in the municipality to examination at the hospital for patients in the " project " vs. the " control " group as well as differences in the final attendance between both groups. The authors conclude that the " project " (i.e. increased collaboration between the municipal public health care and the POPD) improved the follow-up of TB screening, increased...
Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory fo... more Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory for adult asylum seekers who arrive in Norway. In 2005-2006, we included 823 asylum seekers in a study of the QuantiFERON-TB Gold test (QFT-G), and followed them for 23-32 months. Eight subjects with a positive and one with a negative QFT-G test were diagnosed with tuberculosis (TB). The positive (PPV) and negative predictive values (NPV) for TB were respectively 3.3% and 99.8%. The PPV was 2.3% and the NPV 99.1% for TST >or= 15 mm, and the NPV was 99.5% for TST >or= 6 mm in combination with a negative QFT-G.
About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence co... more About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries. There is a compulsory governmental tuberculosis screening programme for immigrants; immigrants with positive screening results are to be referred from municipal health care to the specialist health care for follow-up. Recent studies of the screening programme have shown inadequate follow-up. One of the main problems has been that patients referred for follow-up have not attended their appointment at the specialist health care.TB screening in the municipality of Trondheim is done by two different teams: the Refugee Healthcare Centre (RHC) screens refugees and the Vaccination and Infection Control Office (VICO) screens all the other groups. Patients with positive findings on screening are referred to the hospital's Pulmonary Out-patient Department (POPD). The municipal and referral level public health care initiated a project aiming to improve follow-up through closer collabor...
Objective: Prolonged exposure to adults with pulmonary tuberculosis is a risk factor for infectin... more Objective: Prolonged exposure to adults with pulmonary tuberculosis is a risk factor for infecting children. We have studied to what extent a brief exposure may increase the risk of being infected in children.
The International Journal of Tuberculosis and Lung Disease
Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory fo... more Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory for adult asylum seekers who arrive in Norway. In 2005-2006, we included 823 asylum seekers in a study of the QuantiFERON-TB Gold test (QFT-G), and followed them for 23-32 months. Eight subjects with a positive and one with a negative QFT-G test were diagnosed with tuberculosis (TB). The positive (PPV) and negative predictive values (NPV) for TB were respectively 3.3% and 99.8%. The PPV was 2.3% and the NPV 99.1% for TST >or= 15 mm, and the NPV was 99.5% for TST >or= 6 mm in combination with a negative QFT-G.
Abstract Background QuantiFERON®TB Gold (QFT) is a promising blood test for tuberculosis infectio... more Abstract Background QuantiFERON®TB Gold (QFT) is a promising blood test for tuberculosis infection but with few data so far from immigrant screening. The aim of this study was to compare results of QFT and tuberculin skin test (TST) among newly arrived asylum seekers in Norway and to assess the role of QFT in routine diagnostic screening for latent tuberculosis infection. Methods The 1000 asylum seekers (age ≥ 18 years) enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray. Results Among 912 asylum seekers with valid test results, 29% (264) had a positive QFT test whereas 50% (460) tested positive with TST (indurations ≥ 6 mm), indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST n...
Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of ... more Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of screening results at different healthcare levels in relation to demographics, screening results and organizational factors, and how this influenced treatment of latent tuberculosis. All asylum seekers >or=18 years with a Mantoux test >or=6 mm or positive x-ray findings who arrived at the National Reception Centre from January 2005 to June 2006, were included. Data were collected from public health authorities in the municipality where the asylum seekers had moved, and from internists in case they had been referred to a specialist. Specialists are responsible for treating latent tuberculosis. Individual subjects were matched with the National Tuberculosis Register to which everybody who had started treatment for latent tuberculosis was reported. Of 4,643 asylum seekers, 2,237 fulfilled the inclusion criteria. By May 2008, 30 persons had started treatment for latent TB, a median of 17 months (range 3-36) after arrival. A Mantoux test >or=15 mm on arrival was significantly associated with treatment. Demographic factors influenced follow-up in primary healthcare while screening results did not. Referral to specialist was related to screening results. Several specialists were reluctant to diagnose and treat latent tuberculosis and to treat persons without a permanent visa in particular. Just 1% of the study group received treatment for latent tuberculosis and with a long time delay. The reason for this may be organizational factors affecting follow-up and referral and specialists not following current guidelines.
Objectives: Chronic obstructive pulmonary disease is a large and increasing problem in low- and m... more Objectives: Chronic obstructive pulmonary disease is a large and increasing problem in low- and middle-income countries; Nepal is no exception. We aimed to obtain information on patient characteristics and the level of care provided to patients admitted for acute exacerbation of chronic obstructive pulmonary disease in two Nepalese hospitals and to compare the given care with the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods: This was a cross-sectional, observational, descriptive study. All patients admitted to two Nepalese hospitals due to acute exacerbation of chronic obstructive pulmonary disease between 18 February and 5 April 2019 were asked to participate. Results: In total, 108 patients with a median age of 70 years participated. Fifty-three (42.7%) were male, 80 (74.8%) were former smokers, and 46 (45.1%) were farmers. Using the Global Initiative for Chronic Obstructive Lung Disease A-D classification, 97 (90.6%) of the patients were classified i...
TB survey among Norwegian GPs survey questionnaire NOR: The survey questionnaire in Norwegian. (P... more TB survey among Norwegian GPs survey questionnaire NOR: The survey questionnaire in Norwegian. (PDF 208 kb)
TB survey among Norwegian GPs survey questionnaire ENG: The survey questionnaire in English. (PDF... more TB survey among Norwegian GPs survey questionnaire ENG: The survey questionnaire in English. (PDF 210 kb)
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005- June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening.
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Background: Tuberculosis (TB) is an enduring public health problem in Nepal. This study aimed to ... more Background: Tuberculosis (TB) is an enduring public health problem in Nepal. This study aimed to uncover the experiences and attitudes of health workers at Private medical colleges (PMCs) towards the National TB Control Programme (NTP). Methods: Strategic and convenience sampling were used to identify health personnel participating in TB care at PMCs affiliated to Kathmandu University. Three focus group interviews were held with 19 participants. Audio recordings of the discussions were transcribed, and thematic analysis was conducted. Results: The PMCs treat many TB patients and regularly refer patients to DOTS clinics for treatment, but the PMCs don't feel well integrated into the NTP. There are gaps between the NTP programmes/ guidelines and clinical realities, and the PMCs would like to participate in developing national guidelines and the NTP`s monitoring and evaluation initiatives. There is also a lack of communication within and between levels. Clear lines of management and responsibility, and more training of staff at all levels, are wanted. Conclusion: Increased involvement of PMCs in national TB control activities is important to improve TB care. Clearer guidelines from the government about the involvement of PMCs in TB control are also needed, as is better collaboration between the NTP and PMCs.
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
Background: Most new cases of active tuberculosis in Norway are presently caused by imported stra... more Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
General aspects: This is a well written manuscript that addresses an important issue related to t... more General aspects: This is a well written manuscript that addresses an important issue related to tuberculosis (TB) care. The authors evaluate a " project " aimed at improving the collaboration between health care service providers at different levels (municipal vs. specialists) of the Norwegian health care system in the municipality of Trondheim. They assessed if improved collaboration resulted in increased frequency of patients who attended the first consultation at the specialist department (pulmonary outpatient dept., POPD) after being screened for TB. They also assessed the time from screening in the municipality to examination at the hospital for patients in the " project " vs. the " control " group as well as differences in the final attendance between both groups. The authors conclude that the " project " (i.e. increased collaboration between the municipal public health care and the POPD) improved the follow-up of TB screening, increased...
Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory fo... more Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory for adult asylum seekers who arrive in Norway. In 2005-2006, we included 823 asylum seekers in a study of the QuantiFERON-TB Gold test (QFT-G), and followed them for 23-32 months. Eight subjects with a positive and one with a negative QFT-G test were diagnosed with tuberculosis (TB). The positive (PPV) and negative predictive values (NPV) for TB were respectively 3.3% and 99.8%. The PPV was 2.3% and the NPV 99.1% for TST >or= 15 mm, and the NPV was 99.5% for TST >or= 6 mm in combination with a negative QFT-G.
About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence co... more About 90% of new tuberculosis (TB) cases in Norway appear among immigrants from high incidence countries. There is a compulsory governmental tuberculosis screening programme for immigrants; immigrants with positive screening results are to be referred from municipal health care to the specialist health care for follow-up. Recent studies of the screening programme have shown inadequate follow-up. One of the main problems has been that patients referred for follow-up have not attended their appointment at the specialist health care.TB screening in the municipality of Trondheim is done by two different teams: the Refugee Healthcare Centre (RHC) screens refugees and the Vaccination and Infection Control Office (VICO) screens all the other groups. Patients with positive findings on screening are referred to the hospital's Pulmonary Out-patient Department (POPD). The municipal and referral level public health care initiated a project aiming to improve follow-up through closer collabor...
Objective: Prolonged exposure to adults with pulmonary tuberculosis is a risk factor for infectin... more Objective: Prolonged exposure to adults with pulmonary tuberculosis is a risk factor for infecting children. We have studied to what extent a brief exposure may increase the risk of being infected in children.
The International Journal of Tuberculosis and Lung Disease
Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory fo... more Screening with chest X-ray and the Mantoux test (the tuberculin skin test [TST]) is compulsory for adult asylum seekers who arrive in Norway. In 2005-2006, we included 823 asylum seekers in a study of the QuantiFERON-TB Gold test (QFT-G), and followed them for 23-32 months. Eight subjects with a positive and one with a negative QFT-G test were diagnosed with tuberculosis (TB). The positive (PPV) and negative predictive values (NPV) for TB were respectively 3.3% and 99.8%. The PPV was 2.3% and the NPV 99.1% for TST >or= 15 mm, and the NPV was 99.5% for TST >or= 6 mm in combination with a negative QFT-G.
Abstract Background QuantiFERON®TB Gold (QFT) is a promising blood test for tuberculosis infectio... more Abstract Background QuantiFERON®TB Gold (QFT) is a promising blood test for tuberculosis infection but with few data so far from immigrant screening. The aim of this study was to compare results of QFT and tuberculin skin test (TST) among newly arrived asylum seekers in Norway and to assess the role of QFT in routine diagnostic screening for latent tuberculosis infection. Methods The 1000 asylum seekers (age ≥ 18 years) enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray. Results Among 912 asylum seekers with valid test results, 29% (264) had a positive QFT test whereas 50% (460) tested positive with TST (indurations ≥ 6 mm), indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST n...
Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of ... more Asylum seekers are screened for tuberculosis at entry to Norway. We aimed to assess follow-up of screening results at different healthcare levels in relation to demographics, screening results and organizational factors, and how this influenced treatment of latent tuberculosis. All asylum seekers >or=18 years with a Mantoux test >or=6 mm or positive x-ray findings who arrived at the National Reception Centre from January 2005 to June 2006, were included. Data were collected from public health authorities in the municipality where the asylum seekers had moved, and from internists in case they had been referred to a specialist. Specialists are responsible for treating latent tuberculosis. Individual subjects were matched with the National Tuberculosis Register to which everybody who had started treatment for latent tuberculosis was reported. Of 4,643 asylum seekers, 2,237 fulfilled the inclusion criteria. By May 2008, 30 persons had started treatment for latent TB, a median of 17 months (range 3-36) after arrival. A Mantoux test >or=15 mm on arrival was significantly associated with treatment. Demographic factors influenced follow-up in primary healthcare while screening results did not. Referral to specialist was related to screening results. Several specialists were reluctant to diagnose and treat latent tuberculosis and to treat persons without a permanent visa in particular. Just 1% of the study group received treatment for latent tuberculosis and with a long time delay. The reason for this may be organizational factors affecting follow-up and referral and specialists not following current guidelines.
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