Natália Sperli Geraldes Marin dos Santos

Análise espacial da co-infecção tuberculose/HIV: relação com níveis socioeconômicos em município do sudeste do Brasil

INTRODUCTION Spatial analysis of the distribution of tuberculosis/HIV coinfection was performed and associated with socioeconomic indicators in São José do Rio Preto, from 1998 to 2006. METHODS New TB/HIV coinfection cases were georeferenced and incidence coefficients were calculated for spatial units. Morans index was used to evaluate spatial associations of incidences. Multiple regressions selected variables that could best explain the spatial association of incidences. The local indicator of spatial association was used to identify significant spatial groupings. RESULTS Morans index was 0.0635 (p=0.0000) indicating that the incidence association occurred. The variable that best explained the spatial association of incidence was the percentage of heads of families with up to three years of education. The LISA cluster map for TB/HIV coinfection incidence coefficients showed groups with high incidence rates in the North and low incidence in the South and West regions of the municipality. CONCLUSIONS The study elucidated the spatial geographic distribution of TB/HIV coinfection and determined its association with socioeconomic variables, thus providing data for oriented planning, prioritizing socially disadvantaged regions that present a higher incidence of the disease.

A GERÊNCIA DAS AÇÕES DE CONTROLE DA TUBERCULOSE EM MUNICÍPIOS PRIORITÁRIOS DO INTERIOR PAULISTA

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

The epidemiological dimension of TB/HIV co-infection

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the citys Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.El objetivo fue analizar los indicadores epidemiologicos de la coinfeccion tuberculosis y virus de la inmunodeficiencia humana (TB/VIH) en el municipio de Sao Jose del Rio Preto, Sao Paulo, Brasil, en el periodo de 1.998 a 2.006. Los datos de los casos nuevos de TB, que iniciaron el tratamiento entre enero de 1.998 y diciembre de 2.006, fueron recolectados del Sistema de Notificacion de la TB (EPI-TB). Fueron notificados 306 casos. El coeficiente de incidencia fue de 5,1/100.000 hab, en 2006. Hubo predominio de personas del sexo masculino (72,5%), en el intervalo de edad de 20 a 59 anos (96,4%). La mayoria (51%) no poseia la ensenanza fundamental completa. La forma clinica pulmonar fue relevante (52,9%) y recibieron tratamiento supervisado 46,1% enfermos. En 2.006, la tasa de cura fue de 33,3%, de muertes 14,3%, y no hubo ningun caso de abandono. Entre los casos, 60% fueron diagnosticados en el hospital. Los datos reflejan la necesidad de tener una mayor articulacion entre el Programa Municipal de Control de la Tuberculosis y el Programa Municipal de DST/SIDA.

A dimensão epidemiológica da coinfecção TB/HIV

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the citys Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.El objetivo fue analizar los indicadores epidemiologicos de la coinfeccion tuberculosis y virus de la inmunodeficiencia humana (TB/VIH) en el municipio de Sao Jose del Rio Preto, Sao Paulo, Brasil, en el periodo de 1.998 a 2.006. Los datos de los casos nuevos de TB, que iniciaron el tratamiento entre enero de 1.998 y diciembre de 2.006, fueron recolectados del Sistema de Notificacion de la TB (EPI-TB). Fueron notificados 306 casos. El coeficiente de incidencia fue de 5,1/100.000 hab, en 2006. Hubo predominio de personas del sexo masculino (72,5%), en el intervalo de edad de 20 a 59 anos (96,4%). La mayoria (51%) no poseia la ensenanza fundamental completa. La forma clinica pulmonar fue relevante (52,9%) y recibieron tratamiento supervisado 46,1% enfermos. En 2.006, la tasa de cura fue de 33,3%, de muertes 14,3%, y no hubo ningun caso de abandono. Entre los casos, 60% fueron diagnosticados en el hospital. Los datos reflejan la necesidad de tener una mayor articulacion entre el Programa Municipal de Control de la Tuberculosis y el Programa Municipal de DST/SIDA.

Puerperae bonding with their children and labor experiences

OBJECTIVES To analyze the degree of bonding of puerperae with their babies, both in isolation and associated with experiences during and after labor. METHODS A cross-sectional study carried out among 200 puerperae in São José do Rio Preto, Brazil. To evaluate the mother-child bond, we used the Mother-to-Infant Bonding Scale (MIBS). RESULTS The mean age of puerperae was 26.4 years; most women were white (60.0%), were married (87.5%), and had an elementary education (51.5%). Most deliveries were cesarean (80.0% of cases); 68.0% of women had no pain during labor, and only 54% had skin-to-skin contact immediately after delivery. Type of labor and pain did not significantly change the maternal bond, and the lack of skin-to-skin contact negatively influenced the bond. CONCLUSIONS Pueperae participants had a high degree of bonding with their babies that is mainly related to history of skin-to-skin contact. Nurses must promote strategies that encourage skin-to-skin contact between mother and newborn in the delivery room.

Gestión de programas de control de la tuberculosis en municipios del interior del Estado de São Paulo

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

Tuberculosis control program management in major counties of the interior of São Paulo State

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

La dimensión epidemiológica de la coinfección TB/VIH

This study aimed to analyze the epidemiological indicators of TB/HIV co-infection in São José do Rio Preto, São Paulo, Brazil from 1998 to 2006. Data of new TB cases that initiated treatment between January 1998 and December 2006 were obtained from the TB Notification System (EPI-TB) and 306 cases were reported. The incidence rate was 5.1/100,000 inhabitants in 2006. Most cases were men (72.5%) with ages ranging between 20 and 59 years (96.4 %). The majority (51%) had incomplete primary education. Pulmonary TB was the most common type (52.9%) and 46.1% of the patients received supervised treatment. In 2006, the cure rate was 33.3%, 14.3% death rate and no patient abandoned the treatment. Diagnosis occurred at the hospital in 60% of the cases. Results show the need of improved coordination between the citys Tuberculosis Control Program and the Sexually Transmitted Diseases and HIV Program.El objetivo fue analizar los indicadores epidemiologicos de la coinfeccion tuberculosis y virus de la inmunodeficiencia humana (TB/VIH) en el municipio de Sao Jose del Rio Preto, Sao Paulo, Brasil, en el periodo de 1.998 a 2.006. Los datos de los casos nuevos de TB, que iniciaron el tratamiento entre enero de 1.998 y diciembre de 2.006, fueron recolectados del Sistema de Notificacion de la TB (EPI-TB). Fueron notificados 306 casos. El coeficiente de incidencia fue de 5,1/100.000 hab, en 2006. Hubo predominio de personas del sexo masculino (72,5%), en el intervalo de edad de 20 a 59 anos (96,4%). La mayoria (51%) no poseia la ensenanza fundamental completa. La forma clinica pulmonar fue relevante (52,9%) y recibieron tratamiento supervisado 46,1% enfermos. En 2.006, la tasa de cura fue de 33,3%, de muertes 14,3%, y no hubo ningun caso de abandono. Entre los casos, 60% fueron diagnosticados en el hospital. Los datos reflejan la necesidad de tener una mayor articulacion entre el Programa Municipal de Control de la Tuberculosis y el Programa Municipal de DST/SIDA.