Maria Eugênia Firmino Brunello

Retardo no diagnóstico da tuberculose em município da tríplice fronteira Brasil, Paraguai e Argentina

OBJETIVO: Identificar os aspectos relacionados aos doentes e aos servicos de saude no retardo do diagnostico da tuberculose. METODOS: Estudo epidemiologico em Foz do Iguacu, Parana, Brasil, realizado em 2009. Utilizou-se o instrumento The Primary Care Assessment Tool adaptado para a avaliacao da atencao a tuberculose. Empregaram-se tambem tecnicas de estatistica descritiva, como analise de frequencia, medidas de posicao (mediana e intervalos interquartis) e odds. RESULTADOS: Houve retardo na busca por servicos de saude entre aqueles na faixa etaria > 60 anos, sexo feminino, baixa escolaridade e conhecimento precario sobre a doenca. As variaveis clinicas caso novo e infeccao por HIV e as variaveis comportamentais uso de cigarros e bebidas alcoolicas nao estiveram relacionadas ao retardo no diagnostico. O tempo para o diagnostico atribuido ao doente e ao servico de saude foi de 30 e 10 dias (mediana), respectivamente. O Pronto Atendimento 24 Horas e a Atencao Primaria a Saude nao foram efetivos para a suspeicao de tuberculose e solicitacao de exames de apoio diagnostico, com alto percentual de encaminhamento para o ambulatorio do Programa de Controle da Tuberculose. CONCLUSOES: A procura pela Atencao Primaria a Saude para o diagnostico resultou em maior tempo ate a descoberta da doenca. O ambulatorio do Programa de Controle da Tubercu lose apresentou desempenho mais efetivo para o diagnostico da tuberculose devido ao preparo da equipe e ao acolhimento ordenado com oferta de exames de apoio diagnostico.

Vínculo doente-profissional de saúde na atenção a pacientes com tuberculose

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

Interaction between patient and health care professionals in the management of tuberculosis

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

O vínculo na atenção à saúde: revisão sistematizada na literatura, Brasil (1998-2007)

Objective: To review the Brazilian scientific literature on bond in health care. Methods: The review was limited to the period from 1998 to 2007. A literature search was conducted in the LILACS and SciELO databases using the following key words: primary health care, acceptance, tuberculosis (indexed), bond, adhesion, health, basic care, continuity, and abandon (not indexed). Initially 50 publications were selected and categorized. Results: The findings suggest a greater interest on the topic after 2004. There was a predominance of publications on primary health care in journals that value community health. Conclusions: Bond was found to be an important factor in primary health care and led to better understanding of the real problems of the population receiving care in those services. In addition, bond facilitated the interactions between clients and health care professionals.

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Early diagnosis of tuberculosis in the health services in different regions of Brazil

13 Objetivo: analisar o primeiro contato do doente com os servicos de saude para o diagnostico oportuno da tuberculose (TB), em diferentes regioes do Brasil. Metodo: trata-se de estudo de coorte transversal, em 6 municipios das Regioes Sudeste, Sul e Nordeste. Para a coleta utilizaram-se fontes secundarias e entrevista com os doentes. Os dados foram analisados por meio de tecnicas descritivas e analise fatorial de correspondencia multipla. Resultados: a Atencao Primaria a Saude apresentou maior tempo e menor proporcao de diagnosticos. Os servicos associados ao diagnostico, na primeira consulta, foram os servicos especializados e os Programas de Controle da TB, que oferecem consulta e exames no proprio local. Conclusao: faz-se necessaria a organizacao do trabalho de forma integrada, entre as equipes dos diferentes servicos, para as acoes de controle da TB. Na Atencao Primaria a Saude, e preciso ainda observar o grau de incorporacao e sustentabilidade na execucao dessas acoes a pratica diaria dos servicos.

Areas of vulnerability to HIV/ TB co-infection in Southeastern Brazil

OBJETIVO: Identificar areas de vulnerabilidade para os casos novos de co-infeccao HIV/tuberculose (TB). METODOS: Estudo descritivo ecologico realizado por meio do georreferenciamento dos casos novos de HIV/TB notificados em Ribeirao Preto, SP, em 2006. Os dados foram obtidos do sistema de informacao estadual paulista de notificacao de TB. Os casos novos de co-infeccao HIV/TB foram analisados conforme caracteristicas sociodemograficas e clinicas e, posteriormente, georreferenciados na base cartografica do municipio segundo endereco residencial. Os setores do municipio foram categorizados em tres niveis socioeconomicos: inferior, intermediario e superior, com base na analise de componentes principais das variaveis do censo demografico de 2000 (renda, instrucao e percentagem de domicilios com cinco ou mais moradores). Foi calculada a incidencia da co-infeccao HIV/TB para cada nivel socioeconomico. RESULTADOS: A co-infeccao HIV/TB acometeu mais adultos do sexo masculino em idade economicamente ativa e a forma pulmonar da TB foi a mais comum. A distribuicao espacial mostrou que as incidencias nas areas com niveis socioeconomicos intermediarios e inferiores (8,3 e 11,5 casos por 100 mil habitantes, respectivamente) foram superiores aquela (4,8 casos por 100 mil habitantes) de nivel socioeconomico superior. CONCLUSOES: A taxa de incidencia de co-infeccao HIV/TB analisada por niveis socioeconomicos mostrou padraÞo espacial de distribuicaÞo nao homogeneo e apresentou valores mais altos em areas de maior vulnerabilidade social. O estudo diagnosticou aireas geograificas prioritairias para o controle da co-infeccao e a tecnologia do sistema de informacao geografica pode ser empregada no planejamento das acoes em saude pelos gestores municipais.OBJECTIVE To identify areas of vulnerability to new cases of HIV/tuberculosis (TB) co-infection. METHODS An ecological descriptive study was conducted by georeferencing new HIV/TB cases reported in the city of Ribeirão Preto, Southeastern Brazil, in 2006. Data were obtained from the São Paulo state information system for TB notification (TB-WEB) database. New cases of HIV/TB co-infection were analyzed according to sociodemographic and clinical characteristics and, subsequently, georeferenced in the citys cartographic basis, based on home addresses. City sectors were categorized into three socioeconomic levels: lower, average and upper levels, based on the analysis of the main components of the 2000 Demographic Census variables (income, level of education and percentage of households with five or more residents). The incidence of HIV/TB co-infection was calculated for each socioeconomic level. RESULTS HIV/TB co-infection affected a higher number of economically active adult males and the pulmonary form of TB was the most frequent. Spatial distribution showed that the incidences in areas with average and lower socioeconomic levels (8.3 and 11.5 cases per 100,000 inhabitants, respectively) were higher than that with a higher socioeconomic level (4.8 cases per 100,000 inhabitants). CONCLUSIONS The incidence rate of HIV/TB co-infection, analyzed according to socioeconomic levels, showed a non-homogeneous spatial pattern of distribution and higher values in more socially vulnerable areas. The present study identified priority geographical areas to control co-infection and revealed that the geographical information system technology can be used by city managers to plan health actions.

Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study.

Background Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management. Objective To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto—SP, Brazil. Methods Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed. Results Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified. Conclusions There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.

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.

Bond in health care: a systematic review of literature in Brazil (1998-2007)

Objective: To review the Brazilian scientific literature on bond in health care. Methods: The review was limited to the period from 1998 to 2007. A literature search was conducted in the LILACS and SciELO databases using the following key words: primary health care, acceptance, tuberculosis (indexed), bond, adhesion, health, basic care, continuity, and abandon (not indexed). Initially 50 publications were selected and categorized. Results: The findings suggest a greater interest on the topic after 2004. There was a predominance of publications on primary health care in journals that value community health. Conclusions: Bond was found to be an important factor in primary health care and led to better understanding of the real problems of the population receiving care in those services. In addition, bond facilitated the interactions between clients and health care professionals.