Silvia Helena Figueiredo Vendramini

Tuberculose em município de porte médio do Sudeste do Brasil: indicadores de morbidade e mortalidade, de 1985 a 2003

BACKGROUND: Tuberculosis is a disease linked to poverty, unequal distribution of wealth, and urbanization, as well as the epidemics of acquired immunodeficiency syndrome epidemic and multidrug resistance. OBJECTIVE: To analyze indicators of tuberculosis morbidity and mortality in the city of Sao Jose do Rio Preto, Brazil from 1985 to 2003, compared with those in the state of Sao Paulo and in Brazil at large, and to determine the relationship between the risk of occurrence and socioeconomic level. METHOD: The following official information systems were utilized: the Sistema de Informacao de Mortalidade (SIM, Mortality database), the Notificacao de Tuberculose (Epi-Tb, Tuberculosis Notification database), the Sistema de Informacao de Agravos de Notificacao (SINAN, Case-registry database), the Departamento de Informacao e Informatica do Sistema Unico de Saude (DATASUS, Information Department of the Brazilian Health Ministry) and the Instituto Brasileiro de Geografia e Estatistica (IBGE, Brazilian Institute of Geography and Statistics database). New cases reported in 2003 in the urban area were georeferenced and analyzed. A map of the sectors, each classified as representing one of three socioeconomic classes, was drawn up, showing the respective tuberculosis incidence coefficients. RESULTS: Comparing Brazil as a whole to the state of Sao Paulo, total incidence coefficients and mortality rates were similar, as were gender-related values. In the city of Sao Jose do Rio Preto the rates were consistently lower. The proportion of cases presenting tuberculosis/human immunodeficiency virus coinfection varied from 29% to 37%. In 2002, 59% and 65% of tuberculosis-only and coinfected tuberculosis patients, respectively, were under supervised treatment, with a cure rate of 81% and a treatment-abandonment rate of 1%. The risk of developing active tuberculosis was three times higher in the area presenting the lowest socioeconomic levels. CONCLUSION: Identification of the areas with different levels of risks for tuberculosis enables the Municipal Health Department to deal with the peculiarities of each region and to prioritize those presenting higher incidences of the disease.

Poverty: socioeconomic characterization at tuberculosis

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the populations living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

Tratamento supervisionado no controle da tuberculose em uma unidade de saúde de Ribeirão Preto: a percepção do doente

The goal of this study was to analyze the perception of tuberculosis patients under direct observed treatment (DOT) in a District Health Unit in the City of Ribeirao Preto SP. A qualitative analysis was selected as the methodological approach. The study analized 6 tuberculosis patients participating in the Tuberculosis Control Program under the a regimen of supervised treatment. The patients’ medical records, the Epidemiological Form of Disease Notification and semi-structured interviews were used as instruments for data collection. The following were used as guiding questions: “the significance of tuberculosis” and “the supervised treatment in the patient’s life”. The Content Analysis technique Thematic Modality was used for data analysis. The main thematic unit “Supervised treatment in tuberculosis: the patient’s perception” was found from the following meaning units: the focus of ST as a therapeutic action (medication ingestion and the weaknesses and strengths of ST); and the Singularities of patients under supervised treatment (The perception of the disease, Living with the disease, The consequences of ST on the patient’s life). The following were perceived by patients as strengths in the disease and treatment process: the provision of free medication; the availability of other forms of incentive such funding basic alimentation and transportation vouchers; supervision through home visits. These factors were considered responsible for the link between health workers, the patients and their families. The perceived weaknesses of ST were perceived: the surveillance of medication ingestion and the dependence on the visiting hours for medication ingestion. The social actors involved in the treatment, such as the family and the health care team (in the visiting figure), were identified as factors responsible for adherence to the treatment.

Tuberculose no idoso: análise do conceito

O estudo teve como objetivo definir o conceito de tuberculose no idoso, expresso pela literatura existente na decada de 80 e 90. Utilizou-se a analise de conceito, destacando-se os atributos essenciais, eventos antecedentes e consequentes do conceito a ser definido. A tuberculose no idoso e expressa como o recrudescimento de infeccao longamente inativa. O idoso esta mais predisposto a reinfeccao, tanto endogena (mais frequente) como exogena. Dentre os eventos antecedentes, identificou-se a moradia nas instituicoes para idosos como importante fonte de contagio da doenca. Os eventos consequentes mostraram a necessidade de enfoque diferenciado no diagnostico e tratamento da doenca no idoso, devido as carateristicas clinicas especificas que o diferenciam dos adultos jovens. Conclui-se a necessidade de realizar novas indagacoes sobre a analise do conceito desenvolvido, a fim de contribuir na construcao de conhecimentos que subsidiem no diagnostico, tratamento e cuidado do doente idoso.

Pobreza: caracterização socioeconômica da tuberculose

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the populations living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

Current epidemiological aspects of tuberculosis and the impact of the DOTS strategy in disease control

O artigo tem por objetivo apresentar a situacao atual da tuberculose e o impacto da estrategia DOTS (Directly Observed Treatment Short Course) nos Programas Nacionais de Controle da doenca no mundo, na America Latina e no Brasil. Os dados evidenciam tendencia de declinio lento da doenca no mundo (1%), em 2003. No Brasil, os dados indicam tendencia descendente constante na incidencia, com queda aproximada de 3% ao ano. A estrategia DOTS tem sido recomendada a todos os paises. O Brasil necessita melhorar a vigilância da doenca, principalmente em relacao a confirmacao da conversao da baciloscopia ao termino do tratamento.This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.

Aspectos epidemiológicos atuais da tuberculose e o impacto da estratégia DOTS no controle da doença

O artigo tem por objetivo apresentar a situacao atual da tuberculose e o impacto da estrategia DOTS (Directly Observed Treatment Short Course) nos Programas Nacionais de Controle da doenca no mundo, na America Latina e no Brasil. Os dados evidenciam tendencia de declinio lento da doenca no mundo (1%), em 2003. No Brasil, os dados indicam tendencia descendente constante na incidencia, com queda aproximada de 3% ao ano. A estrategia DOTS tem sido recomendada a todos os paises. O Brasil necessita melhorar a vigilância da doenca, principalmente em relacao a confirmacao da conversao da baciloscopia ao termino do tratamento.This article aims to present the current situation of tuberculosis and how the DOTS (Directly Observed Treatment Short Course) strategy has impacted national tuberculosis control programs worldwide, in Latin America and in Brazil. Data reveal a tendency towards a slow decline in disease rates (1%) around the world in 2003. In Brazil, data indicate a constant downward tendency of approximately 3% a year in incidence levels. The DOTS strategy has been recommended to all countries. Brazil needs to improve its tuberculosis surveillance efforts, particularly in terms of confirming negative sputum smear results at the end of treatment.

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.

Controle de comunicantes de tuberculose no Brasil: revisão de literatura (1984- 2004)

Este estudo tem como proposito identificar as medidas de controle de comunicantes de tuberculose (TB) no Brasil, inseridos nos planos de controle da TB. Trata-se de artigo de revisao da literatura referente ao periodo de 1984 a 2004, que tem como fonte os manuais de controle da TB do Ministerio da Saude e da Secretaria de Estado da Saude de Sao Paulo, e artigos localizados nas bases de dados Medline e Lilacs. RESULTADOS: identificou-se lacuna na normatizacao das medidas de controle durante a decada de 1984 a 1994. Conclui-se que faltou aos profissionais de saude incorporar as acoes de controle e prevencao de TB na perspectiva da vigilância em saude e monitoramento sistematico.This study aims to review plans for tuberculosis control through the analysis of measures for tuberculosis contact tracing in Brazil from 1984 to 2004. This article presents a literature review on tuberculosis control published in manuals of the Ministry of Health and the State Department of Health of Sao Paulo, and in Medline and Lilacs databases. There was a gap in the standardization of control measures in the decade from 1984 to 1994. It was concluded that health professionals need to incorporate TB control and prevention actions from the perspective of health surveillance and systematic monitoring.

Pobreza: caracterización socioeconómica de la tuberculosis

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the populations living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.