Cinthia Midori Sassaki

Envolvimento de equipes da atenção básica à saúde no controle da tuberculose

This study was aimed at analyzing the involvement of Health Primary Care teams in the tuberculosis control actions in the perception of the Tuberculosis Control Program coordinators of nine priority municipalities of the State of São Paulo. It is a qualitative research whose data were collected in June of 2005 through semistructured interviews with nine coordinators. The content thematic modality was used for the analysis of the data. The results pointed out to difficulties in the implementation of the tuberculosis control actions in primary care related to quantitative and qualitative deficiencies of human resources and to a centralized and fragmented view regarding the organization of these actions in the health system. The integration of tuberculosis control activities in primary care is possible provided the system is organized according to primary care principles and a policy of human resources that ensures continuous education and capacity-building of health teams is elaborated/implemented.Este estudo objetivou analisar o envolvimento de equipes da Atencao Basica a Saude nas acoes de controle da tuberculose, ante a percepcao dos coordenadores do Programa de Controle da Tuberculose de nove municipios prioritarios do Estado de Sao Paulo. Trata-se de uma pesquisa qualitativa, cujos dados foram coletados em junho/2005 por meio de entrevista semi-estruturada com nove coordenadores e analisados pela tecnica de analise de conteudo-modalidade tematica. Os resultados apontaram dificuldades para incorporacao das acoes de controle da tuberculose, na atencao basica, relacionadas a debilidade quantitativa e qualitativa de recursos humanos e a visao centralizada e fragmentada da organizacao dessas acoes no sistema de saude. A integracao das atividades de controle da tuberculose na atencao basica sera possivel mediante organizacao do sistema de saude, seguindo os principios da atencao primaria e elaboracao/implementacao de uma politica de recursos humanos que garanta formacao e capacitacao continua das equipes de saude.

Time series of tuberculosis mortality in Brazil (1980-2001)

This descriptive study aimed to describe Tuberculosis-related mortality in Brazil between 1980 and 2001, through time series analysis of data from the DATASUS related to cases in which Tuberculosis was the basic cause of death. The mortality rates were calculated per 100,000 inhabitants according to gender and age. We found a decrease in Tuberculosis mortality of approximately 42% for men and 54% for women across the period analyzed. The International Classification of Diseases was used: ICD-9, for the period of 1980 to 1995; ICD-10 for 1996 to 2001. Deaths are related to late diagnosis, which is a problem of organization of the primary health care, as neither prevention actions nor case detections by active search for respiratory symptoms were incorporated into the health professionals’ practice which contributes to higher death rates in more vulnerable groups.

GEOPROCESSAMENTO APLICADO À ÁREA DA SAÚDE

The maps usage and the concerns about geographic distribution related with diseases are not a recent issue. A classical example is the John Snow survey -maps were used to locate choleras cases and related them with the water supplying. The spatial representation techniques are fewer used in health sectors due to troubles in managing such information. So, the aim of this survey was to establish the disease spatial distribution in Ribeirão Preto, 2002. Secondary data were used to elaborate this study. The spatial distribution of cases was realized by using the MapInfo 7.8 software. Although many cases were concentrated in the northeast region in the city, which consists the quarters of low economical income. The results contribute to show the Tb spatial distribution in Ribeirao Preto, they also reinforce the space category as a methodological alternative to manage, to monitor and to evaluate the health actions by directing interventions to decrease the iniquities.El uso de mapas y la preocupacion con la distribucion geografica de enfermedades se remonta a unpasado bastante distante. Un ejemplo clasico fue el trabajo realizado por John Snow, que utilizo el mapeamientopara localizar casos de colera. A pesar de su gran potencial, las tecnicas de representacion espacial aun sonrelativamente poco utilizadas en el area de la salud. El objetivo de este trabajo fue establecer la distribucionespacial de la enfermedad en Ribeirao Preto, 2002. Se utilizo la base de datos secundarios Epi-tb. Elgeorreferenciamiento de los casos fue realizado por el software MapInfo 7.8. Los casos estuvieron concentradosen una parte de la region nor-oeste del municipio. Los resultados contribuyen para el conocimiento de ladistribucion espacial de la Tb en de Ribeirao Preto, resaltando la importancia de la categoria espacio comoalternativa metodologica para auxiliar en el planeamiento, monitoramiento y evaluacion de las acciones ensalud, dirigiendo las intervenciones para disminuir las inequidades.DESCRIPTORES: tuberculosis; salud publica; sistemas de informacion geografica

Geoprocessing in health area

The maps usage and the concerns about geographic distribution related with diseases are not a recent issue. A classical example is the John Snow survey -maps were used to locate choleras cases and related them with the water supplying. The spatial representation techniques are fewer used in health sectors due to troubles in managing such information. So, the aim of this survey was to establish the disease spatial distribution in Ribeirão Preto, 2002. Secondary data were used to elaborate this study. The spatial distribution of cases was realized by using the MapInfo 7.8 software. Although many cases were concentrated in the northeast region in the city, which consists the quarters of low economical income. The results contribute to show the Tb spatial distribution in Ribeirao Preto, they also reinforce the space category as a methodological alternative to manage, to monitor and to evaluate the health actions by directing interventions to decrease the iniquities.El uso de mapas y la preocupacion con la distribucion geografica de enfermedades se remonta a unpasado bastante distante. Un ejemplo clasico fue el trabajo realizado por John Snow, que utilizo el mapeamientopara localizar casos de colera. A pesar de su gran potencial, las tecnicas de representacion espacial aun sonrelativamente poco utilizadas en el area de la salud. El objetivo de este trabajo fue establecer la distribucionespacial de la enfermedad en Ribeirao Preto, 2002. Se utilizo la base de datos secundarios Epi-tb. Elgeorreferenciamiento de los casos fue realizado por el software MapInfo 7.8. Los casos estuvieron concentradosen una parte de la region nor-oeste del municipio. Los resultados contribuyen para el conocimiento de ladistribucion espacial de la Tb en de Ribeirao Preto, resaltando la importancia de la categoria espacio comoalternativa metodologica para auxiliar en el planeamiento, monitoramiento y evaluacion de las acciones ensalud, dirigiendo las intervenciones para disminuir las inequidades.DESCRIPTORES: tuberculosis; salud publica; sistemas de informacion geografica

Involvement of health primary care teams in the control of tuberculosis

This study was aimed at analyzing the involvement of Health Primary Care teams in the tuberculosis control actions in the perception of the Tuberculosis Control Program coordinators of nine priority municipalities of the State of São Paulo. It is a qualitative research whose data were collected in June of 2005 through semistructured interviews with nine coordinators. The content thematic modality was used for the analysis of the data. The results pointed out to difficulties in the implementation of the tuberculosis control actions in primary care related to quantitative and qualitative deficiencies of human resources and to a centralized and fragmented view regarding the organization of these actions in the health system. The integration of tuberculosis control activities in primary care is possible provided the system is organized according to primary care principles and a policy of human resources that ensures continuous education and capacity-building of health teams is elaborated/implemented.Este estudo objetivou analisar o envolvimento de equipes da Atencao Basica a Saude nas acoes de controle da tuberculose, ante a percepcao dos coordenadores do Programa de Controle da Tuberculose de nove municipios prioritarios do Estado de Sao Paulo. Trata-se de uma pesquisa qualitativa, cujos dados foram coletados em junho/2005 por meio de entrevista semi-estruturada com nove coordenadores e analisados pela tecnica de analise de conteudo-modalidade tematica. Os resultados apontaram dificuldades para incorporacao das acoes de controle da tuberculose, na atencao basica, relacionadas a debilidade quantitativa e qualitativa de recursos humanos e a visao centralizada e fragmentada da organizacao dessas acoes no sistema de saude. A integracao das atividades de controle da tuberculose na atencao basica sera possivel mediante organizacao do sistema de saude, seguindo os principios da atencao primaria e elaboracao/implementacao de uma politica de recursos humanos que garanta formacao e capacitacao continua das equipes de saude.

Suporte social para portador de tuberculose no serviço de saúde e na comunidade

Summary Descriptive study with the aim to identify the types of existing social supports (emotional, instrumental, or informational) offered by the Tuberculosis Control Pr ogram (TCP) to the patients undergoing Supervised Treatment (ST). This was carried out at a TCP of the Public Health Department of the City of Ribeirao Preto, Sao Paulo State. The studyis population consisted of patients enrolled in the ST of the NGA-59 TCP, in July 2002. Information regarding the ST patients were pr ovided by key-informers , such as doctors, nurses and sanitary visitors working directly in the TCP, social workers from the Cityis Health and Social Service Departments, representatives from social support institutions, and TCP coordinators. Also, data was collected through observations done before and after nursing appointments and home visits, application of forms to collect information using patientsi files and TCPis r ecords r egarding types of incentives and social supports offered during tuberculosis treatment, as well as by the search for governmental and non- governmental institutions that offer social support to tuberculosis patients. Two types of incentives and benefits were identified: specific benefits for tuberculosis patients (offered by the NGA-59 TCP): basket of essential provisions (monthly), milk - 1 liter (weekly), and the Ana Diederichsen Shelter; and general benefits that were available to tuberculosis patients: financial aid for illnesses, school, and kitchen gas, LOAS n social support for the elderly and handicapped, and unemployment insurance. Key wor ds: tuberculosis, social support, intersectoria l action.

Predictors of favorable results in pulmonary tuberculosis treatment (Recife, Pernambuco, Brazil, 2001-2004)

Partindo de dados disponiveis no Sistema de Informacao de Agravos de Notificacao, identificaram-se e analisaram-se fatores preditivos ao resultado favoravel de tratamento dos casos de tuberculose pulmonar, diagnosticados no periodo de 2001-2004, residentes em Recife-PE. Utilizaram-se metodos estatisticos uni e multivariado de regressao logistica. No multivariado permaneceram: Idade (anos), 0 a 9 (OR=4,27; p=0,001) e 10 a 19 (OR=1,78; p=0,011), maior chance de cura que mais de 60; Escolaridade (anos), 8 a 11 (OR=1,52; p=0,049), maior chance de cura que nenhuma escolaridade; Tipo de entrada, casos novos (OR=3,31; p<0,001) e recidiva (OR=3,32; p<0,001), maiores chances de cura que reingresso pos-abandono; Tempo (meses) 2, 5 -|6 (OR=9,15; p<0,001); 6 -| 9 (OR= 27,28; p<0,001) e Mais de 9 (OR=24,78; p<0,001), maiores chances de cura que menor que 5; Distrito da Unidade de Saude, DS I (OR=1,60; p=0,018) e DS IV (OR=2,87; p<0,001), maiores chances de cura que DS VI.Based on data available in the Information System for Notifiable Diseases, predictive factors of favorable results were identified in the treatment of pulmonary tuberculosis, diagnosed between 2001 and 2004 and living in Recife-PE, Brazil. Uni- and multivariate logistic regression methods were used. In multivariate analysis, the following factors remained: Age (years), 0 to 9 (OR = 4.27; p = 0.001) and 10 to 19 (OR = 1.78; p = 0.011), greater chance of cure than over 60; Education (years), 8 to 11 (OR = 1.52; p = 0.049), greater chance of cure than no education; Type of entry, ne wcase s (OR = 3.31; p < 0.001) and relapse (OR = 3.32; p < 0.001), greater chances of cure than restart after abandonment; Time (months) 2, 5--6 (OR = 9.15; p < 0.001); 6--9 (OR = 27.28; p < 0.001) and More than 9 (OR = 24.78; p < 0.001), greater chances of cure than less than 5; Health Unit District, DSII (OR = 1.60; p = 0.018) and DSIIV (OR = 2.87; p < 0.001), greater chance sof cure than DS II.

Tempo de tratamento de pacientes inscritos no Programa de Controle da Tuberculose. Ribeirão Preto-SP (1998-1999)

Trata-se de um estudo exploratorio descritivo que busca analisar o tempo de tratamento da tuberculose de pacientes inscritos no PCT de um servico de saude do municipio de Ribeirao Preto-SP, nos anos de 1998 e 1999. Os dados foram obtidos atraves de livros de registro e prontuarios. Utilizou-se o programa Epi-Info, versao 6.04d para o cadastramento, tabulacao e analise. Observou-se que dos 140 pacientes em estudo, 105 (75%) curaram, 20 (14,29%) foram transferidos, 05 (3,57%) tiveram mudanca de diagnostico, 05 (3,57%) abandonaram e 05 (3,57%) foram a obito. Em relacao a cura, 39,05% curaram em ate 6 meses; 39,05% entre 6,1 9 meses; 20% em mais de 9 meses e 1,9% foi ignorado. Identificou-se que a historia de tratamento anterior, intercorrencias patologicas, aids e alcoolismo contribuiram para o nao cumprimento correto da terapeutica, prolongando o tempo de tratamento entre os individuos curados. Quanto ao tempo de tratamento dos pacientes que nao evoluiram para a cura, 09 (25,71%) nao curaram apos 6 meses de tratamento (03 abandonos, 03 obitos, 02 mudancas de diagnostico e 01 transferencia). Verificou-se que as intercorrencias podem acontecer ao longo do tratamento, ocasionando desvios como o nao cumprimento do esquema terapeutico, aumentando o tempo de tratamento, o risco de abandono e ate mesmo o obito. Destacam-se, neste estudo, falhas no preenchimento dos prontuarios e fichas de notificacao.

Gerenciamento de caso: um novo enfoque no cuidado à saúde

The study is a literature review and has the goal to present a new modality of health care delivery called case management. Authors emphasize essential aspects related to this modality of care: care methodology, history, goals, practice areas. It is considered the use of case management in the Brazilian reality.Trata-se de um artigo de revisao e tem como objetivo apresentar uma nova modalidade de prestacao de servico de saude conhecido como gerenciamento de caso. Nessa modalidade, destacam-se aspectos basicos, tais como: metodologia de atencao; historico; objetivos; locais e areas de pratica. Considera-se sua utilizacao na realidade brasileira.

Factors predicting unfavorable results in tuberculosis treatment: an integrative literature review ( 2001-2005)

This integrative literature review aimed to survey Brazilian and international publications related to factors predicting unfavorable results in tuberculosis treatment. Consulting LILACS, MEDLINE, PORTAL CAPES, operational and epidemiological articles published between 2001 and 2005 were surveyed. The articles were categorized according to: year, journal, place, type, nature, treatment results and predictive factors. In LILACS, 07 articles were found, 03 of which mentioned only treatment abandonment. The predictive factors were: extreme poverty, non adherence and male gender. In MEDLINE, 14 articles were surveyed, 04 of which mentioned only multidrug resistance. The predictive factors were: alcoholism, non supervision and male gender. In Brazilian publications, the greatest concern referred to the non continuity of treatment. These indicated the lack of supervision as an aggravating factor. In international publications, multidrug resistance was appointed as the main problem. Clinical, social and operational factors strongly contributed to the unfavorable result.