Institutional Violence Perpetrated against Transgender Individuals in Health Services: A Systematic Review of Qualitative Studies.

This review aims to analyze the evidence related to violence perpetrated against transgender individuals in health services based on their narratives. This is a systematic literature review of qualitative studies. A search was carried out in the Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and MEDLINE databases using the descriptors "transgender people", "violence", and "health services". The eligibility criteria included original qualitative articles addressing the research question, with fully available text, reporting violence specifically by health workers, involving trans individuals aged 18 and above, and published in Portuguese, English, or Spanish. In addition, studies were included that reported experiences of violence suffered by the trans population, through their narratives, in health services. A total of 3477 studies were found, of which 25 were included for analysis. The results highlighted situations such as refusal of service; resistance to the use of social names and pronouns; barriers to accessing health services; discrimination and stigma; insensitivity of health workers; lack of specialized care and professional preparedness; and a system focused on binarism. The analysis of the studies listed in this review highlights the multiple facets of institutional violence faced by the transgender population in health services. It is evident that the forms of violence often interlink and reinforce each other, creating a hostile environment for the transgender population in health services. Thus, there is an urgent need to create strategies that ensure access to dignified and respectful care for all individuals, regardless of their gender identity.

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Relatório final do fórum de regulação da prática de enfermagem na região das américas / Final report of the nursing practice regulation forum in the Americas region

Na Região das Américas existem aproximadamente 7 milhões de profissionais de enfermagem, que representam mais de 56% dos recursos humanos para a saúde. A regulação da prática profissional promove e protege a integridade profissional, garantindo profissionais competentes e bem qualificados. O Fórum de Regulação da Prática de Enfermagem na Região das Américas objetivou apresentar marcos regulatórios da prática profissional em saúde, particularmente em enfermagem; discutir ações estratégicas para fortalecer os sistemas regulatórios profissionais , apoiar o fortalecimento da capacidade de órgãos reguladores; analisar requisitos de licenciamento e renovação de licença; e compartilhar experiências de sucesso na regulamentação da enfermagem. O Fórum contou com a participação presencial de 83 pessoas, com representantes de 17 países da América Latina e Caribe. A plataforma COFENplay registrou a participação de 6.906 espectadores. A partir das discussões no evento, foram propostas as seguintes recomendações: promover discussão nacional com atores-chave, incluindo os Ministérios da Saúde, da Educação e do Trabalho e Emprego, para aprofundar a regulação nos países; recomendar a articulação intersetorial com o tema da regulação de Recursos Humanos em Saúde; gerar um banco comum para identificar informação sobre regulação; e ampliar a pesquisa no tema e a capacidade de gerar e analisar dados. (AU)

Integral health care for transgender adolescents: subsidies for nursing practice.

OBJECTIVE: to analyze the integral health care for transgender adolescents from the perspective of their guardians. METHOD: qualitative research based on the Social Network framework proposed by Lia Sanicola, developed with 22 guardians of transgender adolescents in Brazil through semi-structured individual online interviews. The empirical material was analyzed using the content analysis technique, thematic modality. RESULTS: lack of ambience was observed, in addition to technical unpreparedness of health professionals in relation to the theme at all levels of care, transphobia, centralization of care in scarce qualified services for transgender children and youth, absence of family support, lack of health promotion actions within the community, especially in the school environment, and the common support from non-governmental initiatives. CONCLUSION: the centralization of actions in scarce specialized services in the country, and the structural transphobia can compromise the integral health care for transgender adolescents. There is an urgent need for a network of care capable of assisting the joint action by multi and interdisciplinary teams, with greater proactivity of the nurse with the transgender adolescent and their guardians in individual and collective actions; ambience; health promotion in schools for visibility and support in Primary Health Care since childhood. HIGHLIGHTS: (1) Need for a network of care concerning integral health care for transgender adolescents.(2) Centralization and scarce qualified services for transgender children and youth.(3) Invisible families, lack of health promotion within the community.(4) Unpreparedness of health professionals and disarticulation of the health care network.(5) Need for qualification of nurses when caring for transgender people.

Advisory teams on the streets: A nurse's experience report.

OBJECTIVE: To report a nurse's work experience with the street medical consultation teams in the city of São Paulo/SP Brazil. METHOD: Descriptive, experience report study, which describes the care for homeless people, from a nurse's perspective and experience. RESULTS: Among the attributions of the nurses working with the street medical consultation teams, there are the accurate knowledge of the territory, the ability to build bonds, the performance of diagnoses of health and epidemiological conditions, the planning of the team's actions, the establishment of integration flows with the Health Care Network, the knowledge and understanding about the people ending up on the streets, the supervision of the actions of nursing assistants and community health agents. CONCLUSION: Acting as a nurse on the street medical consultation team is a new and challenging experience that requires dynamic, strategic, creative, and empathic actions. The presence of nurses in the Street Medical Consultation teams contributes to ensuring access to health services and comprehensive care, expanding the possibilities of early detection, treatment, monitoring, and healing of chronic and infectious diseases.

Temporal evolution and spatial distribution of leprosy in a municipality with low endemicity in São Paulo state, Brazil. / Evolução temporal e distribuição espacial da hanseníase em município de baixa endemicidade no estado de São Paulo.

OBJECTIVE: To analyze the spatial and temporal distribution of leprosy in a scenario of low endemicity in the state of São Paulo, Brazil. METHODS: Ecological study with leprosy cases in Ribeirão Preto, between 2006 to 2016. The temporal trend of leprosy detection was verified through the decomposition of time series and identified areas of high and low occurrence of the disease using the Getis-Ord Gi* technique. RESULTS: There were 890 cases, and the detection rate showed an increasing trend in the period from 2011 to 2015, with an average growth of 1% per month. Areas of high occurrence of the disease were identified in the northern region of the city (99% and 95% confidence). CONCLUSION: The temporal analysis showed that the rate of detection of leprosy presented an increasing trend, and the spatial analysis showed that the region of the municipality with the highest occurrence of the disease is characterized by presenting the greatest social inequalities.

Advisory teams on the streets: A nurse's experience report / Equipos de consultorio en la calle: relato de experiencia de una enfermera / Equipes de consultório na rua: relato de experiência de uma enfermeira

ABSTRACT Objective: To report a nurse's work experience with the street medical consultation teams in the city of São Paulo/SP Brazil. Method: Descriptive, experience report study, which describes the care for homeless people, from a nurse's perspective and experience. Results: Among the attributions of the nurses working with the street medical consultation teams, there are the accurate knowledge of the territory, the ability to build bonds, the performance of diagnoses of health and epidemiological conditions, the planning of the team's actions, the establishment of integration flows with the Health Care Network, the knowledge and understanding about the people ending up on the streets, the supervision of the actions of nursing assistants and community health agents. Conclusion: Acting as a nurse on the street medical consultation team is a new and challenging experience that requires dynamic, strategic, creative, and empathic actions. The presence of nurses in the Street Medical Consultation teams contributes to ensuring access to health services and comprehensive care, expanding the possibilities of early detection, treatment, monitoring, and healing of chronic and infectious diseases.

RESUMEN Objetivo: Relatar la experiencia acerca de la actuación de la/del enfermera/o con los equipos de consultorio en la calle en el municipio de São Paulo/SP, Brasil. Método: Estudio descriptivo, del tipo relato de experiencia que describe el cuidado a las personas que viven en la calle desde el punto de vista y de la vivencia de una enfermera. Resultados: Entre las atribuciones de las/de los enfermeras/os que actuaban con los equipos de consultorio en la calle se destacaban el profundo conocimiento del territorio, habilidad para construcción de vínculos, realización de diagnósticos de las condiciones de salud y epidemiológico, planificación de las acciones del equipo, establecimiento de flujos de integración con la Red de Asistencia a la Salud, conocimiento y comprensión sobre la llegada de personas a la calle, supervisión de las acciones de los auxiliares de enfermería y agentes de salud comunitaria. Conclusión: Actuar como enfermera/o en el equipo de consultorio en la calle es una experiencia nueva y retadora que requiere de los profesionales acciones dinámicas, estratégicas, creativas y empáticas. La presencia de enfermeras/os en los equipos de Consultorio en la calle contribuye para garantizar el acceso a los servicios de salud y cuidado integral, amplía las posibilidades de detección precoz, tratamiento, acompañamiento y la cura de agravios crónicos e infectocontagiosas.

RESUMO Objetivo: Relatar a experiência acerca da atuação da/o enfermeira/o junto às equipes de consultório na rua no município de São Paulo/SP Brasil. Método: Estudo descritivo, do tipo relato de experiência, que descreve o cuidado às pessoas em situação de rua, a partir do olhar e da vivência de uma enfermeira. Resultados: Dentre as atribuições das/os enfermeiras/os que atuavam junto às equipes de consultório na rua, destacavam-se o conhecimento acurado do território, habilidade para construção de vínculos, realização de diagnósticos das condições de saúde e epidemiológico, planejamento das ações da equipe, estabelecimento de fluxos de integração junto à Rede de Assistência à Saúde, conhecimento e compreensão sobre a chegada das pessoas às ruas, supervisão das ações dos auxiliares de enfermagem e agentes comunitários de saúde. Conclusão: Atuar como enfermeira/o na equipe de consultório na rua é uma experiência nova e desafiadora que requer dos profissionais ações dinâmicas, estratégicas, criativas e empáticas. A presença de enfermeiras/os nas equipes de Consultório na Rua contribui para a garantia do acesso aos serviços de saúde e cuidado integral, amplia as possibilidades de detecção precoce, tratamento, acompanhamento e a cura de agravos crônicos e infectocontagiosos.

Integral health care for transgender adolescents: subsidies for nursing practice / Atenção integral à saúde dos adolescentes transgêneros: subsídios para a prática da Enfermagem / Atención integral a la salud de los adolescentes transgénero: subsidios para la práctica de la Enfermería

Abstract Objective: to analyze the integral health care for transgender adolescents from the perspective of their guardians. Method: qualitative research based on the Social Network framework proposed by Lia Sanicola, developed with 22 guardians of transgender adolescents in Brazil through semi-structured individual online interviews. The empirical material was analyzed using the content analysis technique, thematic modality. Results: lack of ambience was observed, in addition to technical unpreparedness of health professionals in relation to the theme at all levels of care, transphobia, centralization of care in scarce qualified services for transgender children and youth, absence of family support, lack of health promotion actions within the community, especially in the school environment, and the common support from non-governmental initiatives. Conclusion: the centralization of actions in scarce specialized services in the country, and the structural transphobia can compromise the integral health care for transgender adolescents. There is an urgent need for a network of care capable of assisting the joint action by multi and interdisciplinary teams, with greater proactivity of the nurse with the transgender adolescent and their guardians in individual and collective actions; ambience; health promotion in schools for visibility and support in Primary Health Care since childhood.

Resumo Objetivo: analisar a atenção integral à saúde dos adolescentes transgêneros na perspectiva dos seus responsáveis. Método: estudo qualitativo fundamentado no referencial Rede Social proposto por Lia Sanicola, desenvolvido com 22 responsáveis por adolescentes transgêneros no Brasil por meio de entrevistas online individuais semiestruturadas. O material empírico foi analisado com a utilização da técnica de análise de conteúdo na modalidade temática. Resultados: Foram evidenciados a falta de ambiência e despreparo técnico de profissionais da saúde em relação à temática em todos os níveis de atenção, transfobia, centralização do cuidado em escassos serviços habilitados para pessoas trans no período infantojuvenil, invisibilidade do apoio à família, ausência de ações de promoção da saúde no âmbito comunitário, sobretudo, escolar, e, ainda, o acolhimento promovido, comumente, pelas iniciativas não governamentais. Conclusão: a centralização de ações em escassos serviços especializados no país e a transfobia estrutural podem comprometer a atenção integral à saúde dos adolescentes trans. Urge a necessidade de uma linha de cuidado capaz de auxiliar a atuação conjunta por equipe multi e interdisciplinar com maior proatividade do enfermeiro junto ao adolescente trans e seus responsáveis por meio de ações individuais e coletivas; ambiência; promoção da saúde nas escolas para visibilidade e acolhimento na Atenção Primária à Saúde desde a infância.

Resumen Objetivo: analizar la atención integral a la salud de los adolescentes transgénero desde la perspectiva de sus responsables. Método: estudio cualitativo basado en el marco de la Red Social propuesto por Lia Sanicola, desarrollado con 22 responsables de adolescentes transgénero en Brasil a partir de entrevistas en línea individuales semiestructuradas. El material empírico fue analizado mediante la técnica de análisis de contenido, modalidad temática. Resultados: se ha evidenciado la falta de ambiente y preparación técnica de los profesionales de la salud con relación al tema en todos los niveles de atención, transfobia, centralización del cuidado en los pocos servicios habilitados para personas trans en el período infantojuvenil, invisibilidad del apoyo a la familia, ausencia de acciones de promoción de la salud en el ámbito comunitario, especialmente en la escuela, y la acogida comúnmente por las iniciativas no gubernamentales. Conclusión: la centralización de acciones en los pocos servicios especializados del país y la transfobia estructural pueden comprometer la atención integral en salud de los adolescentes trans. Urge una línea de cuidado capaz de auxiliar la acción conjunta de un equipo multi e interdisciplinario, con mayor proactividad del enfermero con el adolescente transgénero y sus responsables en acciones individuales y colectivas; ambiente; promoción de la salud en las escuelas para la visibilidad y acogida en la Atención Primaria de la Salud desde la infancia.

Evolução temporal e distribuição espacial da hanseníase em município de baixa endemicidade no estado de São Paulo / Evolución temporal y distribución espacial de la lepra en una ciudad de baja endemia en el estado de São Paulo, Brasil / Temporal evolution and spatial distribution of leprosy in a municipality with low endemicity in São Paulo state, Brazil

Objetivo: Analisar a distribuição espacial e temporal da hanseníase em cenário de baixa endemicidade no estado de São Paulo, Brasil. Métodos: Estudo ecológico, sobre casos de hanseníase notificados no município de Ribeirão Preto, entre 2006 e 2016. A tendência temporal da taxa de detecção de hanseníase foi verificada mediante decomposição de séries temporais, e identificadas as áreas de alta e de baixa ocorrência da doença utilizando-se a técnica Getis-Ord Gi*. Resultados: Foram registrados 890 casos, e a taxa de detecção apresentou uma tendência crescente no período analisado, com crescimento médio de 1% ao mês. Identificaram-se áreas de alta ocorrência da doença na região norte do município (99% e 95% de confiança). Conclusão: A taxa de detecção de hanseníase apresentou tendência temporal crescente, e a análise espacial permitiu visualizar que a região do município com maior ocorrência da doença se caracteriza por apresentar as maiores desigualdades sociais.

Objetivo: Analizar la distribución espacial y temporal de la lepra en un escenario de baja endemicidad en el estado de São Paulo, Brasil. Métodos: Estudio ecológico con casos de lepra en Ribeirão Preto, entre 2006 y 2016. La tendencia temporal de la detección de la lepra se verificó a través de la descomposición de series de tiempo e identificaron áreas de alta y baja ocurrencia utilizando la técnica Getis-Ord Gi*. Resultados: Fueron 890 casos y la tasa de detección mostró una tendencia creciente en el período de 2011 a 2015, con un crecimiento promedio de 1% mensual. Se identificaron áreas de alta ocurrencia de la enfermedad en la región norte de la ciudad (99% y 95% de confianza). Conclusión: El análisis temporal mostró que la tasa de detección de lepra presentó una tendencia creciente y el análisis espacial mostró que la región de la ciudad con mayor ocurrencia de la enfermedad se caracteriza por presentar las mayores desigualdades sociales.

Objective: To analyze the spatial and temporal distribution of leprosy in a scenario of low endemicity in the state of São Paulo, Brazil. Methods: Ecological study with leprosy cases in Ribeirão Preto, between 2006 to 2016. The temporal trend of leprosy detection was verified through the decomposition of time series and identified areas of high and low occurrence of the disease using the Getis-Ord Gi* technique. Results: There were 890 cases, and the detection rate showed an increasing trend in the period from 2011 to 2015, with an average growth of 1% per month. Areas of high occurrence of the disease were identified in the northern region of the city (99% and 95% confidence). Conclusion: The temporal analysis showed that the rate of detection of leprosy presented an increasing trend, and the spatial analysis showed that the region of the municipality with the highest occurrence of the disease is characterized by presenting the greatest social inequalities.

Unsatisfactory completeness of nurses' records in the medical records of users with tuberculosis / Completud insatisfactorio de los registros de enfermeros en los prontuarios de los usuarios con tuberculosis / Completude insatisfatória dos registros de enfermeiros nos prontuários dos usuários com tuberculose

ABSTRACT Objectives: to evaluate the completeness of nurses' records on the execution of the nursing process in assistance of tuberculosis patients at Primary Care. Methods: this was a retrospective documental study, with 190 records in Family Health Units of a city in the state of Paraíba. The data were analyzed according to descriptive statistics, Pareto Diagram, and trend analysis. Results: the overall mean incompleteness of records was 53.01% (DP=26.13). Therefore, the results presented very poor completeness classification related to nursing diagnosis (88.9%), nursing assessment (66.8%), data collection (60.5%), while nursing interventions were classified as regular (11.1%). The nursing diagnosis was the only variable with a decreasing trend of non-completeness. Conclusions: incompleteness of nurses' records in the medical records of users with tuberculosis. Evaluation strategies, permanent and continuing education are indispensable in the quality of nurses' documentation, directly implying the Systematization of Quality in Nursing Care.

RESUMEN Objetivos: evaluar completud de registros de enfermeros sobre la ejecución del proceso de enfermería en el cuidado a personas con tuberculosis en la Atención Primaria. Métodos: estudio documental, retrospectivo, con 190 prontuarios en Unidades de Salud de la Familia de una ciudad del estado de Paraíba. Datos analizados segundo estadística descriptiva, Diagrama de Pareto y análisis de tendencia. Resultados: mediana general de incompletud de registros fue de 53,01% (DP=26,13). Clasificación de completud muy mala relativa al diagnóstico de enfermería (88,9%), evaluación de enfermería (66,8%), levantamiento de datos (60,5%), mientras intervenciones de enfermería se clasificaron como regular (11,1%). Diagnóstico de enfermería fue la única variable con tendencia de no completud decreciente. Conclusiones: Incompletud de registros de enfermeros en los prontuarios de usuarios con tuberculosis. Estrategias de evaluación, educación permanente y continuada son indispensables en la calidad de documentación de los enfermeros, implicando directamente la Sistematización de Asistencia de Enfermería de calidad.

RESUMO Objetivos: avaliar a completude dos registros de enfermeiros acerca da execução do processo de enfermagem no cuidado às pessoas com tuberculose na Atenção Primária. Métodos: estudo documental, retrospectivo, com 190 prontuários em Unidades de Saúde da Família de uma cidade no estado da Paraíba. Os dados foram analisados segundo estatística descritiva, Diagrama de Pareto e análise de tendência. Resultados: a média geral de incompletude dos registros foi de 53,01% (DP=26,13). Classificação de completude muito ruim relativa ao diagnóstico de enfermagem (88,9%), avaliação de enfermagem (66,8%), levantamento de dados (60,5%), enquanto as intervenções de enfermagem se classificaram como regular (11,1%). O diagnóstico de enfermagem foi a única variável com tendência de não completude decrescente. Conclusões: incompletude dos registros de enfermeiros nos prontuários dos usuários com tuberculose. Estratégias de avaliação, educação permanente e continuada são indispensáveis na qualidade da documentação dos enfermeiros, implicando diretamente a Sistematização da Assistência de Enfermagem de qualidade.

Tuberculosis forecasting and temporal trends by sex and age in a high endemic city in northeastern Brazil: where were we before the Covid-19 pandemic?

BACKGROUND: The aim of this study was to describe the temporal trend of tuberculosis cases according to sex and age group and evidence the level of disease before the Covid-19 pandemic in a TB high endemic city. METHODS: This was a time series study carried out in a city in northeast Brazil. The population was composed of cases of tuberculosis, excluding those with HIV-positive status, reported between the years 2002 and 2018. An exploratory analysis of the monthly rates of tuberculosis detection, smoothed according to sex and age group, was performed. Subsequently, the progression of the trend and prediction of the disease were also characterized according to these aspects. For the trends forecast, the seasonal autoregressive linear integrated moving average (ARIMA) model and the usual Box-Jenkins method were used to choose the most appropriate models. RESULTS: A total of 1620 cases of tuberculosis were reported, with an incidence of 49.7 cases per 100,000 inhabitants in men and 34.0 per 100,000 in women. Regarding the incidence for both sexes, there was a decreasing trend, which was similar for age. Evidence resulting from the application of the time series shows a decreasing trend in the years 2002-2018, with a trend of stability. CONCLUSIONS: The study evidenced a decreasing trend in tuberculosis, even before the Covid-19 pandemic, for both sex and age; however, in a step really slow from that recommended by the World Health Organization. According to the results, the disease would have achieved a level of stability in the city next years, however it might have been aggravated by the pandemic. These findings are relevant to evidence the serious behavior and trends of TB in a high endemic scenario considering a context prior to the Covid-19 pandemic.

Unsatisfactory completeness of nurses' records in the medical records of users with tuberculosis.

OBJECTIVES: to evaluate the completeness of nurses' records on the execution of the nursing process in assistance of tuberculosis patients at Primary Care. METHODS: this was a retrospective documental study, with 190 records in Family Health Units of a city in the state of Paraíba. The data were analyzed according to descriptive statistics, Pareto Diagram, and trend analysis. RESULTS: the overall mean incompleteness of records was 53.01% (DP=26.13). Therefore, the results presented very poor completeness classification related to nursing diagnosis (88.9%), nursing assessment (66.8%), data collection (60.5%), while nursing interventions were classified as regular (11.1%). The nursing diagnosis was the only variable with a decreasing trend of non-completeness. CONCLUSIONS: incompleteness of nurses' records in the medical records of users with tuberculosis. Evaluation strategies, permanent and continuing education are indispensable in the quality of nurses' documentation, directly implying the Systematization of Quality in Nursing Care.

Policy transfer of the directly observed treatment of tuberculosis: speeches of health managers.

OBJECTIVE: To analyze the effects of meanings produced by the speechess of health managers about the Policy Transfer of Directly Observed Treatment of Tuberculosis. METHOD: Qualitative study developed in 2017 with six managers working in health services located in municipalities in the state of Paraíba. The corpus, constituted by interviews, was analyzed by Discourse Analysis. RESULTS: The speeches expressed aspects favorable to the operationalization of the policy transfer process, such as investing in human, technological, physical and material resources; coordinating management in the organization of the network and raising the awareness of the professionals involved. Barriers were identified, such as the prevalence of cases in the Reference Unit; professional turnover; prejudice and social vulnerability. CONCLUSIONS: The study showed that financial investments, government pacts and commitment of the actors involved in the production of care are necessary to carry out the policy transfer process in the municipalities investigated.

Social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from northeastern Brazil.

INTRODUCTION: Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil. The disease is socially determined, caused mainly by inequalities as overcrowding, bad conditions of housing, unemployment, and limited access to health care. The aim of this study was to identify the social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from the Northeast. METHODOLOGY: This was an ecological study, which has gathered patients diagnosed with tuberculosis through secondary data source in a city from the northeast of Brazil. The GAMLSS statistical model has been applied considering as response variable the count of Tuberculosis cases and the independent variable, the social conditions. The double Poisson distribution was considered in the analysis. The best model fitted was selected according the Akaike information criterion value. For all tests, the p value < 0.05 was considered as statistically significant. RESULTS: 460 patients with diagnosis of tuberculosis were identified, which represents an incidence of 36.3 cases/100,000 in males and 20.7 cases/100,000 in females. Regarding social inequality associated with tuberculosis, income (households with per capita income between 1/8 and 3 minimum wages), gender and age (Proportion of males under 15 years of age) were associated with the disease. CONCLUSIONS: The findings evidenced the social determinants associated with tuberculosis, with a greater occurrence of the disease in areas with mostly male children and low-income families, these issues must be managed within and beyond the health sector, which is mandatory for the Tuberculosis elimination.

Cultural adaptation and updating of the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire.

OBJECTIVE: to translate and culturally adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire to the Brazilian context and to develop and evaluate a sociodemographic and occupational characterization questionnaire to compose the adapted questionnaire. METHOD: five stages were conducted to adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire, namely: translation, synthesis of the translations, evaluation by a committee of judges, back translation and pre-test. As for the complementary questionnaire, it was elaborated and evaluated by a committee of judges and a pre-test was carried out. RESULTS: the questionnaires were validated and the pre-test stage was conducted with health workers and students. CONCLUSION: the final version adapted to the Brazilian context was called Questionário de avaliação de risco e gestão da exposição de trabalhadores e estudantes de saúde no contexto da covid-19 and is available for use, together with the final version of the Sociodemographic and occupational questionnaire: Risk assessment and management of exposure of health care workers and students in the context of covid-19. These questionnaires may assist in mitigating the risks of infection, illness and death of health workers and students due to covid-19.

Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil.

BACKGROUND: A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. METHODS: We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient's diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox's regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. RESULTS: One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. CONCLUSION: Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.