Sheylla Nadjane Batista Lacerda

Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review

Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control.Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control.

Chronic obstructive pulmonary disease and heart rate variability: a literature update

Background The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. Methods A search was performed in Medline database, using the link between the keywords: “autonomic nervous system”, “cardiovascular system”, “COPD” and “heart rate variability”. Results The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. Conclusion The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.

Incidence of Leptospirosis infection in the East Zone of Sao Paulo City, Brazil

Background Leptospirosis is a zoonosis which is spread through contamined running water. This contaminations is seriously affected by the flooding which occurs in the area surrounding the Aricanduva river. The transmission of the disease results mainly from the contact of water with soil contaminated by the urine of infected animals. We aimed to conduct an epidemiological survey on Leptospirosis cases in Sao Paulo East Zone area. Method The analysis conducted in this study was based on data collected from the health authorities of that region close the Aricanduva river between 2007 and 2008 years, which give the rates of confirmed cases, mortality and death from human Leptospirosis. Other information concerned with the relationships among rainfall index, points of flooding and incidence of Leptospirosis. Results We observed a direct and important water contamination. Records of flooding points and dates of the reported cases in the region showed a direct relationship from which the period of higher rainfall also recorded an increase in cases. The annual record of the city and the region and rainfall regions also presented correlation. Conclusion The association between the indices of flooding and Leptospirosis cases indicates that preventive measures are necessary to avoid exposing the community.

Patients’ perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study

BackgroundTuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients’ perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment.MethodsA qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP).ResultsA total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment.ConclusionsAccording to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.

Recommendations and effectiveness of chemoprophylaxis of latent infection by mycobacterium tuberculosis

Objective: identifying the recommendation and the effectiveness of the treatment of Latent Infection by Mycobacterium tuberculosis (LTBI) according to national and international studies. Method: a descriptive, exploratory study of a quantitative approach with predetermined stages, with searches in LILACS, MEDLINE and IBECS. Results: chemoprophylaxis is recommended in Brazil and other countries; however, in some countries, its achievement is not limited to the restricted use of isoniazid, as in Brazil, but isolated rifampin, or associating them with and in shorter treatment duration, usually three months. Conclusion: given so many favorable results to the use of anti-tuberculosis chemoprophylaxis does not justify the non-implementation of this therapy from the part of professionals tuberculosis service workers in Brazil, considering that there has been little reporting or record about this therapy in Brazilian Health Units. Descriptors: Primary Health Care; Chemoprophylaxis; Latent Tuberculosis. RESUMO Objetivo: identificar a recomendação e a efetividade do tratamento da Infecção Latente pelo Mycobacterium tuberculosis (ILTB) conforme estudos nacionais e internacionais. Método: estudo descritivo, exploratório com abordagem quantitativa, com etapas pré-determinadas, com buscas na LILACS, MEDLINE e IBECS. Resultados: a quimioprofilaxia é recomendada no Brasil e em outros países, contudo, em alguns países, sua realização não se limita ao uso restrito da isoniazida, como no Brasil, mas sim da rifampicina isolada, ou associando-as, e em menor tempo de duração de tratamento, geralmente três meses. Conclusão: diante de tantos resultados favoráveis ao uso da quimioprofilaxia antituberculose, não se justifica a não implementação desta terapêutica por parte dos profissionais trabalhadores de serviços de tuberculose no Brasil, tendo em vista que pouco se tem de relato ou de registro acerca desta terapêutica nas Unidades de Saúde brasileiras. Descritores: Atenção Primária à Saúde; Quimioprofilaxia; Tuberculose Latente. RESUMEN Objetivo: identificar la recomendación y la eficacia del tratamiento de la Infección Latente por el Mycobacterium tuberculosis (ITL) como estudios nacionales e internacionales. Método: este es un estudio descriptivo, exploratorio con enfoque cuantitativo con medidas predeterminadas, con búsquedas en LILACS, MEDLINE y IBECS. Resultados: la quimioprofilaxis se recomienda en Brasil y otros países, sin embargo, en algunos países, su logro no se limita al uso restringido de la isoniazida, como en Brasil, pero aislada rifampicina, o asociarse con, y más corto la duración del tratamiento, por lo general tres meses. Conclusión: en frente de tantos resultados favorables al uso de la quimioprofilaxis contra la tuberculosis no se justifica la no aplicación de esta terapia de la parte de los profesionales trabajadores de los servicios de la tuberculosis en Brasil, teniendo en cuenta que ha habido pocos informes o registro acerca de esta terapia en las Unidades de Salud de Brasil. Descriptores: Atención Primaria de Salud; Quimioprofilaxis; Tuberculosis Latente. Nurse, Master’s Student, Postgraduate Public Health Program/ PPGSP, State University of Paraíba/UEPB. Campina Grande (PB), Brazil. Email: rayrlacz@hotmail.com; Nurse, Master’s Student, Postgraduate Public Health Program/PPGSP, State University of Paraíba/UEPB. Campina Grande (PB), Brazil. Email: fernandarliane@hotmail.com; Degree in Sciences, Doctoral Student, Postgraduate Health Sciences Program/PPGCS, Medical School of the ACB/FMABC. São Paulo (SP), Brazil. Email: sheyllabatista@bol.com.br; Nurse, Master Teacher, Nursing Program, College Santa Maria/ FSM, Doctoral Student, Postgraduate Health Sciences Program/PPGCS, Medical School ACB/FMABC. São Paulo (SP), Brazil. Email: ankilmar@hotmail.com; Nurse, Master Teacher, Nursing Program, College Santa Maria/FSM, Doctoral Student, Postgraduate Health Promotion Program/PPGPS, University of Franca/UNIFRAN. Franca (SP), Brazil. Email: minualsa@hotmail.com; Nurse, Professor Post-Doc, State University of Paraíba/UEPB. Campina Grande (PB), Email: taniaribeiro_2@hotmail.com ORIGINAL ARTICLE Temoteo RCA de, Luna FDT de, Lacerda SNB et al. Recommendations and effectiveness of chemoprophylaxis...

The comorbidity tuberculosis and diabetes mellitus

ABSTRACT Objective: investigating the characteristics of tuberculosis patients who had as aggravation associated with diabetes mellitus and the effect of comorbidity in the closing situation (cure, abandonment, relapse and death). Method: an epidemiological study, transversal, with a quantitative approach, accomplished with tuberculosis patients who had as associated aggravation diabetes mellitus. Data were analyzed by calculating absolute and relative frequencies and indicators of the National Program for Tuberculosis Control. The research project was approved by the Research Ethics Committee, CAEE: 30840614.4.0000.5187. Results: the frequency of diabetes mellitus in patients with tuberculosis was of 61 (3,8%) cases. There was a male predominance (85%), aged between 40-59 years old (75%) and with no schooling (35%). 70% showed less adverse reactions to TB drugs. 100% of the patients achieved the cure. Conclusion: there was a significant incidence of association between the diseases in the city. The socio-clinical and epidemiological knowledge of this comorbidity is of great relevance to public health, because it generates benefits and effective strategies to control both diseases. Descriptors: Comorbidity; Diabetes Mellitus; Treatment; Tuberculosis. RESUMO Objetivo : investigar as caracteristicas de doentes com tuberculose que possuiam como agravo associado o diabetes mellitus e o efeito da comorbidade na situacao de encerramento (cura, abandono, recidiva e obito). Metodo : estudo epidemiologico, transversal, com abordagem quantitativa, realizado com doentes de tuberculose que possuiam como agravo associado o diabetes mellitus. Os dados foram analisados pelo calculo de frequencias absolutas e relativas, e indicadores do Programa Nacional de Controle da Tuberculose. O projeto de pesquisa foi aprovado pelo Comite de Etica em Pesquisa, CAEE: 30840614.4.0000.5187. Resultados : a frequencia do diabetes mellitus em doentes com tuberculose foi de 61 (3,8%) casos. Houve predominio de sexo masculino (85%), faixa etaria entre 40-59 anos (75%) e sem escolaridade (35%). 70% apresentaram reacoes adversas menores aos tuberculostaticos. 100% dos casos alcancaram a cura. Conclusao: verificou-se incidencia significante da associacao entre as doencas no municipio. O conhecimento socio-clinico-epidemiologico desta comorbidade e de grande relevância para a saude publica, pois gera subsidios e estrategias efetivas para controle de ambas as enfermidades. Descritores : Comorbidade; Diabetes Mellitus; Tratamento; Tuberculose. RESUMEN Objetivo: investigar las caracteristicas de los pacientes con tuberculosis que tenian como agravamiento asociado con la diabetes mellitus y el efecto de la comorbilidad en la situacion de cierre (curacion, el abandono, la recaida y muerte). Metodo: un estudio epidemiologico, transversal, con enfoque cuantitativo, realizado con pacientes con tuberculosis que tenian como la diabetes mellitus asociada agravacion. Los datos se analizaron mediante el calculo de frecuencias absolutas y relativas, y los indicadores del Programa Nacional para el Control de la Tuberculosis. El proyecto de investigacion fue aprobado por el Comite de Etica en la Investigacion, CAEE: 30840614.4.0000.5187. Resultados: la frecuencia de la diabetes mellitus en pacientes con tuberculosis fue de 61 (3,8%) casos. Hubo un predominio masculino (85%), con edades comprendidas entre 40-59 anos (75%) y sin escolaridad (35%). 70% tuvo reacciones adversas de menor importancia a los medicamentos antituberculosos. 100% de los pacientes logro una cura. Conclusion: hubo asociacion significativa entre la incidencia de enfermedades en la ciudad. El conocimiento socio-clinico y epidemiologico de esta comorbilidad es de gran relevancia para la salud publica, ya que genera beneficios y estrategias eficaces para el control de ambas enfermedades. Descriptores: Comorbilidad; Diabetes Mellitus; Tratamiento; Tuberculosis. Normal 0 21 false false false PT-BR X-NONE X-NONE

Incidence of Violence Among the Elderly in a Family Health Center

Introduction: Violence is not considered a stigma of contemporary society, as it accompanies the man since ancient times and manifests itself in different ways and circumstances in each period. It is a socio-historical phenomenon that accompanies the whole mankind experience, although this has never been accepted as something intrinsic to the human condition. Objective : Verify the incidence of violence among the elderly in Brazil. Methods : Exploratory and descriptive field research, with a quantitative approach, conducted in a Family Health Center in Cajazeiras, Paraiba, Brazil. Data was collected in March and April 2014, using an instrument validated by the multicenter study Health, Well-Being, and Aging (SABE). This study was approved by the Ethics Committee of Research from University Santa Maria (FSM), under the Certificate of Submission for Ethical Appraisal (CAAE) n. 24982213.7.0000.5180. Results : the sample presented a mean age of 73.68 years old, with a predominance of women (69.9%). We analyzed demographic data relative to age, gender, marital status, educational level, income, and hostility. The data on the prevalence of violence among the elderly indicate that the most frequent cases of mistreatment were those involving psychological or verbal violence (23.0%), followed by financial violence (10.6%), and physical violence (4.4%). Conclusion : It was found that any elderly individual may be victim of violence, especially when taking into account that this population group has been neglected both by the State and civil society. Descriptors : aging; Family Health Strategy; violence against the elderly.

Profile of Oral Health and susceptibility to Oral Candidiasis in Patients of Primary Health Care

Introduction: The yeasts of the genus Candida are fungi that can cause an infection called oral candidiasis, when there are conditions that favor their proliferation, as the example of immunosuppression and the bad habits of oral hygiene. Objective : Profile oral health of patients seen in the Dental Office of the Family Health Strategy in Sao Bentinho–PB; and its relation with the susceptibility for oral candidiasis. Method: The study is exploratory, descriptive, quantitative type, held from May to July 2014, with 152 patients of both genders, dental service users for monitoring/dental treatment. The data were collected in an interview guided by structured script. For treatment of the data SPSS was used, in order to provide the descriptive and analytical statistics; with the application of the X 2 test there were correlated variables: age, gender, schooling and oral hygiene habits. Results: Statistical dependence has been identified between the age and educational level ( p = 0.003), age and gender ( p = 0.002), age and brushing/day ( p = 0.035) and education and brushing/day ( p = 0.001); the average age of the participants was 30.29 (± 13.83), the majority were female (77.6%), in oral hygiene conditions evaluated on regular and disabled (86.8%); 82.2% presented caries; most (77.6%) had no use of mouthwash; 4.6% presented signs of oral candidiasis. Conclusion: The sample investigated was exposed to several predisposing factors to Candida infections and, therefore, needs to be intensified the educational actions and oral health promotion aimed at this target population.

Factors Related to Depressive Complaints on Climacteric: a Cross-Sectional Study

Introduction: Climacterium is a period of a womans life, between 35 and 65 years old, marked by hormonal and biopsychosocial changes that can lead to the onset of depressive symptoms. The aim was to identify the prevalence of and factors associated with depressive symptoms in climacteric women. Method : An exploratory study, of cross-sectional type research, was carried out in Cajazeiras, Paraiba, Brazil, from January 2013 to March 2014. The sample included 411 women aged 40 to 60. Data collection was done by interviews using a structured script. Mean and standard deviation of age variables and per capita income were identified. For correlation between the variables, we used odds ratios (CI 95%), the X² and Fishers Exact Test, with a significance level of 5%. Results: The average age of women was 49.73 (± 5.799) years. Depressive complaints prevailed in 68.1%, associated with advanced age ( p = 0.009; OR: 1693 [CI 1113–2577]), low education ( p = 0.022; OR: 1568 [CI 1032–2382]), lower per capita income ( p = 0.043; OR: 1553 [CI 1012–2384]), unpaid labor activity ( p = 0.013; OR: 1641 [CI 1079–2495]), menopausal/postmenopausal ( p = 0.011; OR: 1667 [CI 1092–2545]), sexual activity with complaint ( p < 0.001 [OR: 2.777; [CI 1628–4737]) and the presence of at least one disease ( p < 0.001; OR: 2230 [CI 1445–3440]). Conclusion: Understanding and addressing the factors related to depressive complaints during climacterium supports the importance of conducting disease prevention programmes, thus delaying the onset of morbidity and improving quality of life.

Vulnerability Aspects That Hinder Tuberculosis Healing According to the Perspective of Patients and Healthcare Managers.

Introduction : Tuberculosis is a major public health condition worldwide. The partnership between Healthcare Services and the patient is the gold standard for a successful healing outcome and a reduction in the harm the disease causes to patients and society in general. Objective : To analyze the vulnerability aspects that make tuberculosis healing difficult according to the perspective of patients and public healthcare managers. Method : This is a descriptive study conducted in the year 2013 in Cajazeiras, a town located in the state of Paraiba in the northeastern region of Brazil. The study population was composed of 4 healthcare managers and 29 patients with confirmed tuberculosis diagnosis. In order to gather the sample of tuberculosis patients, a search on the Information System on Diseases of Compulsory Declaration (SINAN, in the Portuguese abbreviation) was run. Results : All patients had fixed addresses. Among these individuals, a total of 12 were of the male sex, 13.6% were smokers, 77.3% were alcohol-free and 13.6% were frequent alcohol consumers. In addition to that, 72.7% of the patients received no public financial support of any sort. As to coping with the disease, 54.5% declared no difficulty at all, 22.7% found it very difficult, 18.2% reported it was somewhat difficult and 4.5% stated it was extremely difficult. Concerning family income, 68.0% lived on up to two minimum wages. Final considerations : The findings in the current study revealed the vulnerability condition upon which tuberculosis patients live, highlighting the social exclusion of this population with their low educational level, their low-income status, their poverty condition and their difficulty in understanding their basic needs, such as the necessity of a well-balanced diet to prevent the adverse effects caused by the drugs during the treatment. Managers identified social stigma, prejudice, denial of the disease with a resultant resistance to treatment, street-dwelling individuals and drinking and smoking habits as major difficulties for tuberculosis control in the city. It is quite clear that the managers approach the universe of vulnerability within its three inseparable dimensions: individual, social and programmatic. A better understanding of the real needs of tuberculosis patients as well as the prioritization of the disease are of utmost importance in the municipal public health agenda, which is based on a higher involvement of managers in the participation, discussion and definition of the application of resources for the disease control and a public health policy that encompasses tuberculosis social issues.