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Objective To evaluate the impact of socioeconomic support on tuberculosis preventive therapy initiation in household contacts of tuberculosis patients and on treatment success in patients. Methods A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shanty towns in Peru. It included patients being treated for tuberculosis and their household contacts. Households were randomly assigned to either the standard of care provided by Peru's national tuberculosis programme (control arm) or the same standard of care plus socioeconomic support (intervention arm). Socioeconomic support comprised conditional cash transfers up to 230 United States dollars per household, community meetings and household visits. Rates of tuberculosis preventive therapy initiation and treatment success (i.e. cure or treatment completion) were compared in intervention and control arms. Findings Overall, 282 of 312 (90%) households agreed to participate: 135 in the intervention arm and 147 in the control arm. There were 410 contacts younger than 20 years: 43% in the intervention arm initiated tuberculosis preventive therapy versus 25% in the control arm (adjusted odds ratio, aOR:2.2; 95% confidence interval, CI: 1.1-4.1). An intention-to-treat analysis showed that treatment was successful in 64% (87/135) of patients in the intervention arm versus 53% (78/147) in the control arm (unadjusted OR: 1.6; 95% CI: 1.0-2.6). These improvements were equitable, being independent of household poverty. Conclusion A tuberculosis-specific, socioeconomic support intervention increased uptake of tuberculosis preventive therapy and tuberculosis treatment success and is being evaluated in the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project. Objectif Evaluer l'impact de l'accompagnement socioeconomique sur le commencement du traitement preventif contre la tuberculose par les contacts familiaux des patients atteints de la maladie et sur la reussite du traitement pour les patients. Methodes Une etude controlee, non aveugle, a repartition aleatoire des foyers a ete realisee entre fevrier 2014 et juin 2015 dans 32 bidonvilles du Perou. Elle portait sur des patients traites contre la tuberculose et leurs contacts familiaux. Les foyers ont ete choisis de fagon aleatoire pour recevoir soit les soins standards prevus par le programme national de lutte contre la tuberculose du Perou (groupe temoin), soit les memes soins standards plus un accompagnement socioeconomique (groupe experimental). L'accompagnement socioeconomique comprenait des transferts monetaires conditionnels pouvant atteindre 230 dollars des Etats-Unis par foyer, des visites a domicile et des reunions communautaires. Le taux de commencement du traitement preventif contre la tuberculose et le taux de reussite du traitement (guerison ou achevement du traitement) ont ete compares entre le groupe experimental et le groupe temoin. Resultats Au total, 282 foyers sur 312 (90%) ont accepte de participer: 135 dans le groupe experimental et 147 dans le groupe temoin. 410 contacts avaient moins de 20 ans: dans le groupe experimental, 43% ont commence un traitement preventif contre la tuberculose, contre 25% dans le groupe temoin (rapport des cotes ajuste (RC):2,2; intervalle de confiance (IC) de 95%: 1,1 -4,1). Une analyse par intention de traiter a montre la reussite du traitement chez 64% (87/135) des patients du groupe experimental contre 53% (78/147) du groupe temoin (RC non ajuste: 1,6; IC 95%: 1,0-2,6). Ces ameliorations etaient equitables et independantes de la pauvrete des foyers. Conclusion Une intervention d'accompagnement socioeconomique specifiquement axe sur la tuberculose a permis d'augmenter la prise d'un traitement preventif contre la tuberculose ainsi que la reussite du traitement contre cette maladie. Elle est actuellement evaluee dans le cadre du projet CRESIPT (Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB). Objetivo Evaluar el impacto del apoyo socioeconomico en la iniciacion a la terapia preventiva contra la tuberculosis en contactos domesticos de pacientes con tuberculosis, asi como en el exito del tratamiento para los pacientes. Metodos Entre febrero de 2014 y junio de 2015, se realizo un estudio controlado, aleatorizado, domestico y no cegado en 32 barrios bajos de Peru. En este estudio se incluyeron pacientes que estaban siendo tratados contra la tuberculosis y sus contactos domesticos. Los hogares se asignaron de forma aleatoria a la atencion estandar ofrecida por el programa nacional contra la tuberculosis de Peru (grupo de control) o bien a la misma atencion estandar pero con un apoyo socioeconomico (grupo de intervencion). El apoyo socioeconomico consisti'a en transferencias de efectivo condicionadas de hasta 230 dolares estadounidenses por hogar, visitas domesticas y reuniones comunitarias. Se compararon los grupos de control y de intervention en cuanto a las tasas de initiation a la terapia preventiva contra la tuberculosis y al exito del tratamiento (es decir, la cura o la finalizacion del tratamiento). Resultados En general, 282 de 312 (90%) hogares aceptaron participar: 135 en el grupo de intervention y 147 en el grupo de control. Habia 410 contactos menores de 20 anos: el 43% del grupo de intervention initio la terapia preventiva contra la tuberculosis, frente al 25% del grupo de control (coeficiente de posibilidades ajustado, CPa: 2,2; intervalo de confianza, IC, del 95%: 1,1 -4,1). Un analisis de intention de tratar mostro que el tratamiento tuvo exito en un 64% (87/135) de los pacientes del grupo de intervention, frente a un 53% (78/147) de los pacientes del grupo de control (CP no ajustado: 1,6; IC del 95%: 1,0-2,6). Estas mejoras fueron equitativas, independientemente de la pobreza del hogar. Conclusion Una intervention de apoyo socioeconomic especffica para la tuberculosis aumento la aceptacion de la terapia preventiva contra la tuberculosis y el exito del tratamiento, y se esta evaluando en el proyecto Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT--Evaluation Aleatoria Comunitaria de una Intervention Socioeconomica para Prevenir la TB)., Introduction An estimated one third of the world's population has latent tuberculosis infection and in 2015 10.4 million people developed tuberculosis disease. (1) Those at the highest risk of tuberculosis [...]

Summary: This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance‐related behaviors or prevent overweight/obesity in children from families experiencing socio‐economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their heterogeneity and variability in internal and external validity, there was some evidence of beneficial impact of interventions on obesity risk (4/15), and associated behaviors, e.g.: breastfeeding (9/18), responsive feeding (11/16), diet (7/8), sedentary (1/3) and movement (4/7) behaviors, and sleep (1/2). The most effective interventions aimed at promoting breastfeeding commenced antenatally; this was similar for the prevention of obesity, provided the intervention continued for at least 2 years postnatally and was multi‐behavioral. Effective interventions were more likely to target first‐time mothers and involve professional delivery agents, multidisciplinary teams and peer groups. Among ethnic/racial minorities, interventions delivered by lay agents had some impact on dietary behavior but not weight outcomes. Co‐creation with stakeholders, including parents, and adherence to theoretical frameworks were additional ingredients for more pragmatic, inclusive, non‐judgmental, and effective programs. The growing body of evidence on obesity prevention interventions targeting families experiencing socio‐economic disadvantage is promising for reducing early inequalities in obesity risk. [ABSTRACT FROM AUTHOR]

Background Illness-related costs for patients with tuberculosis (TB) [greater than or equal to]20% of pre-illness annual household income predict adverse treatment outcomes and have been termed 'catastrophic.' Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a 'TB-specific' approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a 'TB-sensitive' approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. Methods and findings Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries' established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catastrophic costs in 4 out of 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $3.8 million (95% CI: $3.8 million-$3.8 million) and $75 million (95% CI: $50 million-$100 million) per country. If instead cash transfers were provided with a TB-sensitive approach, alone they would be insufficient to prevent DS TB-related catastrophic costs in any of the 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $298 million (95% CI: $219 million-$378 million) and $165,367 million (95% CI: $134,085 million-$196,425 million) per country. DR TB-related costs were catastrophic before and after TB-specific or TB-sensitive cash transfers in 1 out of 1 countries. Sensitivity analyses showed our findings to be robust to imputation of missing TB-related cost components, and use of 10% or 30% instead of 20% as the threshold for measuring catastrophic costs. Key limitations were using national average data and not considering other health and social benefits of cash transfers. Conclusions A TB-sensitive cash transfer approach to increase all poor households' income may have broad benefits by reducing poverty, but is unlikely to be as effective or affordable for preventing TB catastrophic costs as a TB-specific cash transfer approach to defray TB-related costs only in poor households with a confirmed TB diagnosis. Preventing DR TB-related catastrophic costs will require considerable additional investment whether a TB-sensitive or a TB-specific cash transfer approach is used., Author(s): William E. Rudgard 1,*, Carlton A. Evans 2,3,4, Sedona Sweeney 5, Tom Wingfield 6,7,8,9, Knut Lönnroth 9, Draurio Barreira 10, Delia Boccia 1 Introduction Tuberculosis (TB) disproportionately affects poor [...]

In July 2000, an outbreak of gastroenteritis occurred at a tourist resort in the Gulf of Taranto in southern Italy. Illness in 344 people, 69 of whom were staff members, [...]