Ricardo Alexandre Arcêncio

Aspectos epidemiológicos da co-infecção tuberculose e vírus da imunodeficiência humana em Ribeirão Preto (SP), de 1998 a 2003

OBJETIVO: O estudo teve como proposito caracterizar o perfil epidemiologico dos casos de tuberculose notificados em Ribeirao Preto (SP), no periodo de 1998 a 2003, segundo a condicao sorologica para o virus da imunodeficiencia humana, sexo, faixa etaria e resultado do tratamento. METODOS: Trata-se de uma investigacao epidemiologica de cunho descritivo, que utilizou como instrumento de coleta de dados o banco de dados do Sistema de Informacao da Tuberculose. A populacao do estudo constituiu-se na totalidade dos casos de co-infeccao tuberculose e virus da imunodeficiencia humana, de residentes em Ribeirao Preto, notificados nos anos de 1998 a 2003. RESULTADOS: Nesse periodo foram notificados 1.273 casos de tuberculose, sendo que 377 apresentaram sorologia positiva para o virus da imunodeficiencia humana, o que significou taxa de co-infeccao igual a 30%. Em relacao ao sexo, observou-se neste grupo que 76% dos casos notificados foram de homens, havendo predominância na faixa etaria de 20 a 59 anos. Quanto ao resultado terapeutico, a media de cura alcancada foi de 52%, de abandono de 11% e de obito de 32%. A forma clinica predominante foi a pulmonar, com 58% dos casos. CONCLUSAO: Foi observada alta prevalencia da co-infeccao no municipio estudado, sendo nitido que a conclusao terapeutica desses casos reflete a necessidade de se adotar estrategias especiais de acompanhamento dessa clientela. Quanto ao sexo e faixa etaria, o acometimento foi equivalente ao de casos de tuberculose nao infectados pelo virus da imunodeficiencia humana.

A atencao primaria a saude na coordenacao das redes de atencao: uma revisao integrativa

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

A porta de entrada para o diagnóstico da tuberculose no sistema de saúde de Ribeirão Preto/SP

O primeiro contato do doente de tuberculose (TB) com o sistema de saude se da na porta de entrada, e e fundamental para o acesso ao diagnostico. Objetivou-se identificar e analisar a porta de entrada no sistema de saude de Ribeirao Preto para o diagnostico da TB. Baseou-se em um instrumento do Primary Care Assessment Tool, adaptado para a TB no Brasil. Realizou-se entrevista estruturada com 100 doentes de TB diagnosticados entre Junho de 2006 e Julho de 2007. Destes, 61% chegaram ao local de diagnostico por encaminhamento e apenas 29% se apresentaram espontaneamente; 66% procuraram por servicos de atencao primaria, 34% por servicos de nivel secundario e terciario. Ademais, 89% foram diagnosticados em servicos publicos e destes, 44% foram diagnosticados nos pronto-atendimentos. Alem disso, 88% foram diagnosticados fora de sua area de abrangencia. Apesar dos doentes terem procurado atendimento na atencao primaria e mais proximo de suas residencias, o diagnostico se deu na atencao secundaria e terciaria.

Accessibility to tuberculosis treatment: assessment of health service performance

El objetivo de este estudio fue analizar la accesibilidad de los pacientes al tratamiento de tuberculosis (TB) en Ribeirao Preto, ciudad del interior del estado de Sao Paulo. Se trata de un estudio de evaluacion de servicios de salud, con abordaje cuantitativo. Fueron entrevistados 100 pacientes que iniciaron el tratamiento de TB entre 2006-2007, utilizando un cuestionario estructurado basado en el Primary Care Assessment Tool (PCAT). Los datos fueron sometidos al analisis de varianza. Fueron observadas evaluaciones positivas en relacion a la accesibilidad organizacional, sin embargo, el desempeno de los servicios de salud fue poco satisfactorio en el ofrecimiento de ayuda de dislocamiento y en la necesidad de la utilizacion de transporte en el traslado hasta la unidad de salud, generando costos indirectos a los pacientes. Los servicios con mayor numero de enfermos atendidos fueron los que presentaban mayor irregularidad en la realizacion de visitas domiciliares, demostrando que la disponibilidad de recursos (humanos, materiales y tiempo) y la organizacion de la atencion pueden influir en la accesibilidad al tratamiento.Descriptores: Tuberculosis; Terapia por Observacion Directa; Evaluacion de Servicios de Salud; Accesibilidad a los Servicios de Salud.The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeirão Preto, countryside of São Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.

Cobertura do tratamento diretamente observado (DOTS) da Tuberculose no Estado de São Paulo (1998 a 2004)

The Supervised Treatment (ST) in the 36 priority municipalities for TB control of the State of Sao Paulo between 1998 and 2004 was analyzed with the aim of describing the coverage of the DOTS. This exploratory study used information from the State of Sao Paulos Health Secretarys EPI-TB data-base. An instrument of data collection was elaborated and the coverage of the ST was calculated. The data was put in the Excel program. In the municipalities that implemented the ST in 1998, coverage was under 20%. In 1999 half of the municipalities had coverage between 11% and 49%. In 2000, the implementation was 100%, but the maximum coverage was 61%. Between 2001 and 2002 the coverage increased in 69.44% of the municipalities. In 2003, coverage was below of 50% in 22 municipalities. In 2004 there was a trend to increasing coverage in 63.89% of the municipalities.The Supervised Treatment (ST) in the 36 priority municipalities for TB control of the State of São Paulo between 1998 and 2004 was analyzed with the aim of describing the coverage of the DOTS. This exploratory study used information from the State of São Paulos Health Secretarys EPI-TB database. An instrument of data collection was elaborated and the coverage of the ST was calculated. The data was put in the Excel program. In the municipalities that implemented the ST in 1998, coverage was under 20%. In 1999 half of the municipalities had coverage between 11% and 49%. In 2000, the implementation was 100%, but the maximum coverage was 61%. Between 2001 and 2002 the coverage increased in 69.44% of the municipalities. In 2003, coverage was below of 50% in 22 municipalities. In 2004 there was a trend to increasing coverage in 63.89% of the municipalities.

Internações por tuberculose pulmonar no Estado de São Paulo no ano de 2004

A TB permanece como um principal desafio para a saude publica e para a Atencao Primaria a Saude. Objetivo: analisar as internacoes por TB pulmonar no Estado de Sao Paulo no ano de 2004. Metodologia: foram coletados dados referentes a: numero de internacoes por tuberculose pulmonar segundo sexo e faixa etaria; media de permanencia de internacao; obitos ocorridos durante a internacao e custos da internacao para o SUS. Dados coletados atraves do DATASUS. Resultados: no ano de 2004 observaram-se 4.859 internacoes por tuberculose pulmonar no Estado de Sao Paulo, verificando-se maior numero de internacoes no sexo masculino - 4.079 (84%); a media geral de permanencia no hospital foi de 26,2 dias, 202 (4,53%) pacientes foram a obito, sendo que destes 155 eram do sexo masculino; verificaram-se maiores custos nas idades menores de 14 anos. Conclusao: entende-se que o diagnostico precoce seja um ponto fundamental na identificacao do quadro de TB, a fim de amenizar o numero de internacoes por TB; entretanto, faz-se necessario uma Atencao Primaria a Saude que seja capaz de contemplar tais acoes.

Performance indicators of DOT at home for tuberculosis control in a large city, SP, Brazil

The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.

Indicadores de desempenho do DOT no domicílio para o controle da tuberculose em município de grande porte, SP, Brasil

The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.The study had the objective to analyze the performance of the health services that implement the Directly Observed Therapy at home for tuberculosis control. This study analyzed four Tuberculosis Control Programs, referred to as A, B, C, and D, using the following indicators: Resource use; Performance quickness; Monitoring medication administration; Time spent per home visit. Data were collected during visits to 47 patients receiving DOT at home. Resource use was higher in program B (91.3%); program A showed quicker performance (5.8) and more visits during which medication administration was monitored (77.4%); program C had the longest time spent per home visit (14.7 minutes) and program A the shortest (10.4 minutes). The best or worst performance numerically expresses how resources are being used and whether the observation of medication intake is being achieved.

Spatial analysis of deaths from pulmonary tuberculosis in the city of São Luís, Brazil

OBJECTIVE: To characterize deaths from pulmonary tuberculosis, according to sociodemographic and operational variables, in the city of São Luís, Brazil, and to describe their spatial distribution. METHODS: This was an exploratory ecological study based on secondary data from death certificates, obtained from the Brazilian Mortality Database, related to deaths from pulmonary tuberculosis. We included all deaths attributed to pulmonary tuberculosis that occurred in the urban area of São Luís between 2008 and 2012. We performed univariate and bivariate analyses of the sociodemographic and operational variables of the deaths investigated, as well as evaluating the spatial distribution of the events by kernel density estimation. RESULTS: During the study period, there were 193 deaths from pulmonary tuberculosis in São Luís. The median age of the affected individuals was 52 years. Of the 193 individuals who died, 142 (73.60%) were male, 133 (68.91%) were Mulatto, 102 (53.13%) were single, and 64 (33.16%) had completed middle school. There was a significant positive association between not having received medical care prior to death and an autopsy having been performed (p = 0.001). A thematic map by density of points showed that the spatial distribution of those deaths was heterogeneous and that the density was as high as 8.12 deaths/km2. CONCLUSIONS: The sociodemographic and operational characteristics of the deaths from pulmonary tuberculosis evaluated in this study, as well as the identification of priority areas for control and surveillance of the disease, could promote public health policies aimed at reducing health inequities, allowing the optimization of resources, as well as informing decisions regarding the selection of strategies and specific interventions targeting the most vulnerable populations.

Perfil clínico e epidemiológico e prevalência da coinfecção tuberculose/HIV em uma regional de saúde no Maranhão

OBJECTIVE: To describe the clinical and epidemiological profile, as well as the prevalence, of tuberculosis/HIV co-infection in the Regional Health District of Tocantins, which serves 14 cities in the state of Maranhao, Brazil. METHODS: This was a descriptive epidemiological study based on secondary data obtained from individual tuberculosis reporting forms in the Brazilian Case Registry Database. We included all reported cases of tuberculosis/HIV co-infection, by city, between January of 2001 and December of 2010. RESULTS: In the district, 1,746 cases of tuberculosis were reported. Of those tested for HIV, 100 had positive results, which corresponded to a tuberculosis/HIV co-infection prevalence of 39%. Of the co-infected patients, 79% were male, 42% were Mulatto, and 64% were in the 20- to 40-year age bracket, 31% had had < 4 years of schooling, and 88% resided in the city of Imperatriz. Cases of pulmonary tuberculosis and new cases of tuberculosis predominated (in 87% and 73%, respectively). Of the co-infected patients, 27% had positive sputum smear microscopy results, and 89% had chest X-ray findings suggestive of tuberculosis. Sputum culture was performed in only 7% of the cases. CONCLUSIONS: Our results show that, because of its clinical and epidemiological profile, tuberculosis/HIV co-infection is still a major public health problem in the southwestern region of Maranhao. This situation calls for better coordination between tuberculosis and sexually transmitted disease/AIDS control programs, as well as a political commitment and greater involvement on the part of administrators and health care professionals in the planning of interventions and the functioning of health care facilities.