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Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal

2023-12-05Journal article Open access
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dc.contributor.authorde Morais, Margarida
dc.contributor.authorSousa, Sofia
dc.contributor.authorMarques, Jéssica
dc.contributor.authorMoniz, Marta
dc.contributor.authorDuarte, Raquel
dc.contributor.authorLeite, Andreia
dc.contributor.authorSoares, Patricia
dc.contributor.authorCarreira, Mário
dc.contributor.authorPereira, Sofia
dc.contributor.authorAlves, Catarina
dc.contributor.authorAlves, Filipe
dc.contributor.authorRodrigues, Ana
dc.contributor.authorMoreira, Ana
dc.contributor.authorCardoso, Márcia
dc.contributor.authorMota, Sandra
dc.contributor.authorGomes, Ana
dc.contributor.authorFerreira, Liliana
dc.contributor.authorLopes, Marta
dc.contributor.authorCorreia, Isabel
dc.contributor.authorRachadell, Juan
dc.contributor.authorGameiro, Maria
dc.contributor.authorDias, Ângela
dc.contributor.authorPereira, Manuel
dc.contributor.authorGonçalves, Jorge
dc.contributor.authorGonçalves, Maria
dc.contributor.authorTaveira, Adriana
dc.contributor.authorNeves, Celene
dc.contributor.authorSilva, Lucinda
dc.contributor.authorMendes, Maria
dc.contributor.authorTeixeira, Maria
dc.contributor.authorPereira, Maria
dc.contributor.authorPiedade, Milena
dc.contributor.authorTeixeira, Antónia
dc.contributor.authorCarvalho, Carlos
dc.date.accessioned2024-01-18T13:13:41Z
dc.date.available2024-01-18T13:13:41Z
dc.date.issued2023-12-05
dc.descriptionURBANTB group: Patrícia Soares (Representative of the consortium), Mário Carreira, Sofia Pereira, Catarina Alves, Filipe Alves, Ana Rodrigues, Ana Moreira, Márcia Cardoso, Sandra Mota, Ana Gomes, Liliana Ferreira, Marta Lopes, Isabel Correia, Juan Rachadell, Maria Gameiro, Ângela Dias, Manuel Pereira, Jorge Gonçalves, Maria Gonçalves, Adriana Taveira, Celene Neves, Lucinda Silva, Maria Mendes, Maria Teixeira, Maria Pereira, Milena Piedade, Antónia Teixeira & Carlos Carvalho.pt_PT
dc.description.abstractBackground: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. Methods: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). Results: The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. Conclusions: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.pt_PT
dc.description.sponsorshipThis work was supported by the Fundação para a Ciência e Tecnologia (FCT, Portugal) [Grant: PTDC/SAU-PUB/31346/2017]. The present publication was funded by Fundação para a Ciência e Tecnologia (FCT, Portugal) national support through Comprehensive Health Research Centre (CHRC) [UIDP/04923/2020].pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBMC Public Health. 2023 Dec 5;23(1):2421. doi: 10.1186/s12889-023-17319-7pt_PT
dc.identifier.doi10.1186/s12889-023-17319-7pt_PT
dc.identifier.issn1471-2458
dc.identifier.urihttp://hdl.handle.net/10400.18/8926
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMCpt_PT
dc.relationComprehensive Health Research Center - Research, Education, Training and Innovation in Clinical research and Public Health
dc.relation.publisherversionhttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-17319-7pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectDelayed Diagnosispt_PT
dc.subjectHelp-seeking Behaviourpt_PT
dc.subjectPatient Delaypt_PT
dc.subjectSymptom Perceptionpt_PT
dc.subjectSymptom Valorisationpt_PT
dc.subjectTuberculosispt_PT
dc.subjectDoenças Infeciosaspt_PT
dc.subjectInfecções Respiratóriaspt_PT
dc.subjectEstados de Saúde e de Doençapt_PT
dc.subjectPortugalpt_PT
dc.titleInvestigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugalpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleComprehensive Health Research Center - Research, Education, Training and Innovation in Clinical research and Public Health
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/Concurso para Financiamento de Projetos de Investigação Científica e Desenvolvimento Tecnológico em Todos os Domínios Científicos - 2017/PTDC%2FSAU-PUB%2F31346%2F2017/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDP%2F04923%2F2020/PT
oaire.citation.issue1pt_PT
oaire.citation.startPage2421pt_PT
oaire.citation.titleBMC Public Healthpt_PT
oaire.citation.volume23pt_PT
oaire.fundingStreamConcurso para Financiamento de Projetos de Investigação Científica e Desenvolvimento Tecnológico em Todos os Domínios Científicos - 2017
oaire.fundingStream6817 - DCRRNI ID
person.familyNameLeite
person.familyNameSoares
person.givenNameAndreia
person.givenNamePatricia
person.identifier1052436
person.identifier1050496
person.identifier.ciencia-id2F10-F9A9-E8A7
person.identifier.ciencia-id0415-632D-8609
person.identifier.orcid0000-0003-0843-0630
person.identifier.orcid0000-0001-5033-9115
person.identifier.scopus-author-id57109931300
person.identifier.scopus-author-id52063758300
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication838ff85b-16c9-4992-b13f-e3099f916717
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