The burden of alcohol, tobacco and others drugs among incarcerated population diagnosed with tuberculosis: time trends and spatial determinants in Southern Brazil.

BACKGROUND: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with TB and the spatial determinants and time trends of the phenomenon in southern Brazil. METHODS: A cross-sectional study using data from the Brazilian Notifiable Diseases Information System was carried out. TB cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and the risk areas were identified using spatial scan statistics. RESULTS: A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stood out. An ascending trend was found for the consumption of alcohol (+ 19.4%/mo. (95%CI: 12.20-23.03)), tobacco (+ 20.2%/mo. (95%CI: 12.20-28.82)), and illegal drugs (+ 62.2%/mo. (95%CI: 44.54-81.97)). Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. CONCLUSIONS: This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with TB in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located.

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.

INTRODUCTION: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. CONCLUSIONS: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

Cambios en la vida sexual de la persona con lesión medular / Changes in the sexual life of people with spine cord lesion

La sexualidad es parte integral del ser humano y de sus actividades de vida. Debido a la limitación consecuentede la lesión, el lesionado enfrenta cambios significativos en su vida sexual. Este estudio describe las alteraciones evidenciadas y las dificultades enfrentadas por el lesionado en la relación sexual. Participaron de la investigación diez personas con paraplejía y tetraplejía de por lo menos seis meses, de ambos sexos. Para recolectar los datos se realizó una entrevista estructurada. Los hallazgos indican que las alteraciones causadas en la función sexual dependen del nivel y del grado de la lesión medular. Se observó reducción en la sensibilidad, dificultad en conseguir o mantener la erección, y eyaculación impedida o retrógrada, reducción del número de espermas, lubricación disminuida, entre otros. Lamovilidad alterada es uno de los factores que más perjudica al portador de lesión medular en el desempeño del acto sexual.

Sexuality is an integral part of a human being’s life and it is a driving part in many of his or her everyday life activities. Given the limitations resulting from a lesion, patients with a spinal cord lesion face significant changes in their sexual life. This study provides an objective description of the evident alterations and difficulties a patient deals with during sexual intercourses, given spinal lesions. Ten paraplegic or tetraplegic patients, both men and women, with an at-least six month lesion participated in the research. Data were gathered by conducting structured interviews. The findings show that alterations in the sexual function depend on the level and degree of the spinal cord lesion. Reduced sensitivity was observed, as well as problems to obtain and maintain an erection, retrograde or delayed ejaculation, sperm count reduction; diminished lubrication; among other alterations. Mobility impairment is one of the factors that harm spinal cord patient’s sexual performance the most.