Tânia Maria Ribeiro Monteiro de Figueiredo

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.

Evolução da distribuição espacial dos casos novos de tuberculose no município de Patos (PB), 2001-2010

A tuberculose configura-se como problema de saude publica de relevância social e epidemiologica, presente na Agenda Estrategica da Secretaria de Vigilância em Saude (SVS), cujas acoes sao gerenciadas pelo Programa Nacional de Controle da Tuberculose (PNCT), que prioriza a descentralizacao das acoes de controle da doenca para Atencao Primaria a Saude. Este estudo teve como objetivo analisar a distribuicao espacial e a densidade de casos de tuberculose no periodo 2001 a 2010, na zona urbana do municipio de Patos (PB). O estudo, ecologico e descritivo, utilizou os casos novos de tuberculose notificados no Sistema de Informacao de Agravos de Notificacao, a tecnica de geoprocessamento para localizacao dos casos e o software ArcGis 10.0 para o processamento dos dados. Observou-se distribuicao da doenca com predominância em areas geograficas que apresentam carencia socioeconomica. No periodo de 2006 a 2010 houve maior distribuicao de abrangencia geografica da doenca, comparada com o periodo de 2001 a 2005. Acoes de saude e condicoes coletivas podem ter influenciado a distribuicao da doenca no territorio. Identificou-se areas geograficas prioritarias para o planejamento, o monitoramento e a avaliacao das acoes em saude que vislumbrem o combate a tuberculose.

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.

When is Tb-Aids Co-Infection Treatment Discontinued? an Analysis of the Situation in Brazil

Introduction: Brazil has high levels of TB-AIDS co-infection. Objective: To analyse differences and similarities, with respect to each State in Brazil and to the Federal District, concerning the stage at which TB-AIDS co-infection treatment is discontinued. The study period was 2008-13. Methods: Cross-sectional, quantitative study, using data from the Diseases and Notification Information System administered by the Brazilian Health Ministry. The data were analysed using the statistics program R, and the results are represented graphically by dotplots and dendrograms. Results: 58,704 cases of tuberculosis-AIDS co-infection were recorded. Rates of cure were under 30%. In the States of Paraiba and Pernambuco, treatment dropout was almost 50%.Mortality levels were high, at 70-90% in some States. Multiresistant TB was observed in less than 20%of cases. The rate of non-treated/non-resolved cases was 70% in Bahia. Transfer rates varied widely, with the highest level being recorded in Alagoas (80% of cases). Conclusion: Global goals are far from being met. There is considerable operational diversity in the public health policies of the different States. TB-AIDS co-infection should be monitored continuously and the epidemiological information system regularly updated in order to control this double epidemic.

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

Perfil Epidemiológico dos casos de Tuberculose Extrapulmonar em um município do estado da Paraíba, 2001-2010

INTRODUCTION: The extra-pulmonary form of tuberculosis is the one in which there is a compromising of other organs different from the lung.OBJECTIVE: To identify the profile of the cases of extra-pulmonary tuberculosis notified in the municipality of Campina Grande (PB), Brazil, from 2001 to 2010.METHOD: It is a retrospective, transversal study with quantitative approach. The data were submitted to the calculation of absolute and relative frequencies, incidences and application of χ2 test for association.RESULTS: The average incidence was of 5.3/100,000 inhabitants. The profile evidenced male (52,8%), age between 20 and 39 years old (48.4%), white race (44.4%) and with incomplete high school (39,3%), there was a strong association between indication to the Supervised Treatment and the variables schooling, accomplishment anti-VIH and presence of AIDS, the pleural and ganglionic peripheral attack the most prevalent among the cases.CONCLUSION: To know the profile and the clinical-epidemiological characteristics of the extra-pulmonary tuberculosis is important, because it can help the health services on the identification and follow-up of the population with bigger vulnerability to falling sick. Having in mind the gravity of the lesions and possible evolution to death, it must be diagnosed and treated as soon as possible.