Exiguidade nas estratégias de enfrentamento à tuberculose na atenção primária no Sul do Brasil / Exiguity in strategies to combat tuberculosis in primary care in Southern Brazil / Exigüidaden las estrategias de combate a la tuberculosis en la atención primaria en el Sur de Brasil

Objetivo: descrever as ações de detecção de casos da tuberculose (TB) realizadas pela Atenção Básica de Saúde dos municípios de Uruguaiana, Pelotas e Santa Maria, no estado do Rio Grande do Sul. Método:transversal, quantitativo, realizado com 385 profissionais de saúde, utilizando um questionário estruturado autopreenchido sobre a organização e o planejamento das ações de detecção de sintomáticos respiratórios. Resultados:identificou-se que, em Uruguaiana, cerca de um quarto dos profissionais referem que sua unidade planejou ações de detecção de TB, enquanto a proporção nos demais municípios não alcançou um décimo dos profissionais. Observou-se, que a busca de casos na comunidade, assim como a orientação dos ACS sobre sinais e sintomas da TB foi considerada praticamente inexistente em Santa Maria. Conclusão:apesar dos municípios estudados serem prioritários para o controle da TB, os profissionais da unidade de saúde não são estimulados a manter um olhar diferenciado sobre essa problemática no seu território.

Objective: to describe the actions to detect tuberculosis (TB) cases carried out by Primary Health Care in the municipalities of Uruguaiana, Pelotas and Santa Maria, in the state of Rio Grande do Sul. Method: cross-sectional, quantitative, carried out with 385 health professionals, using a self-administered structured questionnaire on the organization and planning of actions to detect respiratory symptomatics.Results:it was identified that, in Uruguaiana, about a quarter of professionals reportthat their unit planned TB detection actions, while the proportion in the other municipalities did not reach one tenth of professionals. It was observed that the search for cases in the community, as well as the guidance of CHAs on signs and symptoms of TB was considered practically non-existent in Santa Maria. Conclusion:although the municipalities studied are priorities for TB control, health unit professionals are not encouraged to maintain a differentiated look at this problem in their territory.

Objetivo: describir las acciones para detectarcasos de tuberculosis (TB) llevadas a cabo por la Atención Primaria de Salud en los municipios de Uruguaiana, Pelotas y Santa María, en el estado de Rio Grande do Sul.Método: transversal, cuantitativo, realizado con 385 profesionales de la salud, utilizando un cuestionario estructurado autoadministrado sobre la organización y planificación de acciones para detectar la sintomática respiratoria.Resultados: se identificó que, en Uruguaiana, alrededor de una cuarta parte de los profesionales informan que su unidad planeaba acciones de detección de tuberculosis, mientras que la proporción en los otros municipios no llegó a una décima parte de los profesionales. Se observó que la búsqueda de casos en la comunidad, así como la orientación de CHA sobre signos y síntomas de tuberculosis, se consideró prácticamente inexistente en Santa María.Conclusión: aunque los municipios estudiados son prioridades para el control de la tuberculosis, no se alienta a losprofesionales de las unidades de salud a mantener una mirada diferenciada a este problema en su território.

El control de la tuberculosis en Cuba desde fines del siglo XIX hasta 1930 / Tuberculosis control in Cuba from the late 19th century to 1930

Introducción: la tuberculosis es una enfermedad infectocontagiosa de evolución aguda, subaguda o crónica, conocida antes del año 1000 a.n.e. Sobre la existencia de la tuberculosis en Cuba hay noticias desde 1630; el conocimiento de los médicos cubanos sobre el mal se presentó en las publicaciones especializadas. Objetivo: presentar los principales aspectos de la historia del control de la tuberculosis en Cuba. Métodos: se siguió le método histórico-lógico, apoyados en la revisión documental. Resultados: en Cuba la lucha contra la tuberculosis se inició a finales del siglo XIX; se presentan las acciones tomadas hasta el año 1930. A finales del siglo XIX se creó la Liga Antituberculosa, la cual a principios del siglo XX tomó carácter nacional; se construyeron dispensarios para el tratamiento ambulatorio de los enfermos; en 1907 el primer sanatorio para el tratamiento internado de los pacientes. Pero después de la segunda década los trabajos de la lucha tuvieron un decrecimiento. En la segunda mitad de la década del 20 se creó una cátedra específica para su enseñanza en la Escuela de Medicina e instituciones que reforzarían, al menos en teoría, el trabajo dirigido hacia la mejora de la situación de la enfermedad en la población. Conclusiones: durante los primeros años del siglo XX, se organizaron los primeros servicios para el tratamiento de la tuberculosis, se inició un incipiente control sobre la enfermedad. Aunque los servicios y acciones fueron insuficientes, constituyeron un intento de mejorar la situación enfermedad en la población(AU)

Introduction: tuberculosis is an infectious contagious disease of acute, subacute or chronic evolution. Known before the year 1 000 B.C., news about its presence in Cuba dates back to 1630. Cuban doctors' knowledge about the condition appeared in specialized publications. Objective: present the main aspects of the history of tuberculosis control in Cuba. Methods: the historical-logical method was applied, supported by document review. Results: the fight against tuberculosis started in Cuba in the late 19th century. A description is provided of the actions taken until the year 1930. The Anti-Tuberculosis League was founded at the end of the 19 th century, and acquired nationwide scope at the beginning of the 20th century. Dispensaries were built for ambulatory treatment. The first inpatient sanatorium was founded in 1907. However, after the second decade, the fight against tuberculosis witnessed a decline. In the second half of the 1920s, a specific professorship was created to be taught at the School of Medicine and institutions which would reinforce, at least theoretically, the work aimed at improving the status of the disease in the population. Conclusions: during the early years of the 20th century, the first services for the treatment of tuberculosis were created and incipient control of the disease was started. Insufficient as the services and actions were, they constituted an attempt to improve the status of the disease in the population(AU)

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Agente Comunitario de Salud / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Community Health Agent

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal facilitador como agente comunitario de salud a fin de sumar acciones de lucha en favor de la adherencia.

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el participante: Agente Comunitario de Salud. Material de apoyo / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Participant Guide: Community Health Agent. Support material

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del material de apoyo para el Agente Comunitario de Salud a fin de sumar acciones de lucha en favor de la adherencia.

Sistema de Información Gerencial de Tuberculosis SIGTB. Manual de usuario / SIGTB Tuberculosis Management Information System. User manual

La presente publicación describe la metodología que facilita al usuario la operación de las diferentes pantallas de captura y consulta de la información que se administra en el Sistema de Información Gerencial de Tuberculosis -SIGTB

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Personal de Salud / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Health Personnel

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal de salud a fin de sumar acciones de lucha en favor de la adherencia(

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Personal de Salud. Material de apoyo / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Health Personnel. Support material

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal de salud a fin de sumar acciones de lucha en favor de la adherencia

Treatment guidelines for latent tuberculosis infection.

The treatment of latent tuberculosis infection (LTBI) has been established as valid for patients at high risk for developing active tuberculosis. Treatment of LTBI is also considered an important strategy for eliminating tuberculosis (TB) in Japan. In recent years, interferon-gamma release assays have come into widespread use; isoniazid (INH) preventive therapy for HIV patients has come to be recommended worldwide; and there have been increases in both types of biologics used in the treatment of immune diseases as well as the diseases susceptible to treatment. In light of the above facts, the Prevention Committee and the Treatment Committee of the Japanese Society for Tuberculosis have jointly drafted these guidelines. In determining subjects for LTBI treatment, the following must be considered: 1) risk of TB infection/ development; 2) infection diagnosis; 3) chest image diagnosis; 4) the impact of TB development; 5) the possible manifestation of side effects; and 6) the prospects of treatment completion. LTBI treatment is actively considered when relative risk is deemed 4 or higher, including risk factors such as the following: HIV/AIDS, organ transplants (immunosuppressant use), silicosis, dialysis due to chronic renal failure, recent TB infection (within 2 years), fibronodular shadows in chest radiographs (untreated old TB), the use of biologics, and large doses of corticosteroids. Although the risk is lower, the following risk factors require consideration of LTBI treatment when 2 or more of them are present: use of oral or inhaled corticosteroids, use of other immunosuppressants, diabetes, being underweight, smoking, gastrectomy, and so on. In principle, INH is administered for a period of 6 or 9 months. When INH cannot be used, rifampicin is administered for a period of 4 or 6 months. It is believed that there are no reasons to support long-term LTBI treatment for immunosuppressed patients in Japan, where the risk of infection is not considered markedly high. For pregnant women, HIV-positive individuals, heavy drinkers, and individuals with a history of liver injury, regular liver function tests are necessary when treatment is initiated and when symptoms are present. There have been reports of TB developing during LTBI treatment; therefore, attention should be paid to TB development symptoms. When administering LTBI treatment, patients must be educated about side effects, the risk of developing TB onset, and the risks associated with discontinuing medication. Treatment outcomes and support for continuation of treatment are evaluated in cooperation with health centers. As stipulated by the Infectious Diseases Control Law, doctors are required to notify a health center when an individual develops TB. Based on this notification, the health center registers the patient, sends a public health nurse to visit the patient and give instructions, and provides medication adherence support. The patient applies at a health center for public expenses for medical care at a designated TB care facility. Pending approval in a review by an infectious disease examination council, the patient's copayment is reduced.

[Prospects for the renovation of the medical system for tuberculosis and human resource development in the near future].

The status of tuberculosis (TB) in Japan was changed to decline and decreased dramatically after The World War II with the great nationwide efforts. Along with the decrease of TB people's attentions to tuberculosis has been reducing significantly, including the medical personnel. In the 1990s, TB returned to increase again, then Emergency Declaration against TB by Minister of Health and Welfare in 1999 drew the public attentions to TB again. Unfortunately, however, there have been many hospitals that cannot deal with TB properly. On the other hand, non-tuberculous mycobacteriosis (NTM) is increasing recently, which bothers many physicians or pulmonologists. "Japanese Respiratory Society" (JRS) was founded as "Japan Society of Chest Diseases" derived from "Japanese Society for Tuberculosis" (JSTB) in 1961, when almost all the members were the members of both the Societies. Now, after 50 years of JRS foundation, only one in four members of JRS may join to JSTB. However, the needs for training opportunities about TB and NTM do exist indeed, which is suggested by the fact that "Tuberculosis course", the joint program with JSTB, held in every annual JRS meeting has been filled with a lot of standing audience. In order to support these needs for training about TB, JSTB began the Certification System for TB and NTM in 2011. More than 1,000 certified physicians were born so far. In addition, the decreased number of JSTB members has returned to increase significantly. The most important challenge is to make a future countermeasure against TB and NTM, and also to promote the development of human resources based on the current situation and forecast of TB. This symposium was planned along the theme of this congress, "TB control for the next generation" in response to the wishes of the Congress President Dr. Yamagishi. On behalf of the Ministry of Health, Labour and Welfare, Dr. Yoshizawa talked about the future measures and challenges, and the human resource development for the future, based on the current situation of the medical system for tuberculosis. Dr. Fujita, the chairman of the committee of the certification system, talked about the JSTB Certification System, and the prospect of the human resource development. Dr. Nagai talked about the training opportunities for TB and NTM such as the "Educational seminar" in the annual meeting of JSTB or the "Tuberculosis course" in the annual meeting of JRS. Nurse and the Public health nurse are also the important members of the medical team for TB. Ms. Nagata talked about the human resources development of nurse responsible for tuberculosis care. Finally, Dr. Kudo, who originally proposed the JSTB Certification System as the chairman of the future planning committee, addressed the history and the foresights of the near future medical care system for TB as a special remark. We wish all the members may share the prospects of future medical care for TB and NTM, which may help for improving the future medical system.

El difícil camino del control sanitario de la tuberculosis / The difficult road to achieve sanitary tuberculosis control

Tuberculosis continues to be a worldwide prevalent disease. Chile has established a tuberculosis control program since the earliest 70s which contributed to decrease the annual incidence of tuberculosis by 50 percent every decade, reaching the rate of 20 per 100.000 inhabitants the year 2000 ("early phase of tuberculosis elimination as a public health problem "). Unfortunately since this time the descent rate is becoming slower and between years 2009-2011 has achieved a stationary rate of13 x 100.000. This deterioration in the epidemiological situation of tuberculosis in Chile runs in parallel with the successive reductions in the budget assignedfor its control. A higher incidence of tuberculosis in high risk groups (HIVpopulation, migrants, prisoners and elderly people) were not responsible for this epidemiologic deterioration. Lack of diagnosis in smear positive pulmonary tuberculosis patients is the most important source ofpersistent community infection. Only 25 percent of the estimated goal of sputum smear screening among medical consultations in primary care was achieved. Between the years 20062010 193.416 less sputum smear examinations were done. This means that nearly 966 smear positive tuberculosis patients were no identified as we know that about 0.5 percent smears are positive in this setting. A shortage of funds for tuberculosis in our country could increase its incidence as it was shown in Brazil, Cuba and Uruguay and would demand larger resources to strengthen the tuberculosis program. This epidemiological scene is worse in the Metropolitan Region where 40 percent of the country population concentrated 60 percent of the incidence of tuberculosis the year 2011. In this area we found counties with the highest rates. There is the need to strengthen the tuberculosis program in these areas and to organize teams in the primary care settings in order to increase case finding through the performance of sputum smears in symptomatic adult patients.

La tuberculosis (TB) sigue siendo una patología prevalente a nivel mundial. Chile tiene un Programa de Control de la Tuberculosis eficaz desde el año 1973, el que ha permitido disminuir la incidencia anual de la enfermedad en 50 por ciento cada década, hasta alcanzar el año 2000 una tasa de 20 x 100.000 habitantes ("umbral de la etapa de eliminación "). Sin embargo, desde entonces el país ha presentado un descenso menor, llegando a una situación estacionaria, con tasas cercanas a 13 x 100.000 los años 2009-2011. Este deterioro en la situación epidemiológica de la tuberculosis en Chile corre paralelo a las sucesivas reducciones del presupuesto asignado a su control. La mayor incidencia de tuberculosis en pacientes VIH, población migrante, población privada de libertad y adultos mayores han demostrado no ser los responsables de este retroceso epidemiológico. La mayor causa de este deterioro se debe a la pérdida de la capacidad diagnóstica de los casos transmisores de la enfermedad en la comunidad (casos pulmonares bacilíferos), reflejado por el bajo índice de pesquisa (número de baciloscopias realizadas por cada 1.000 consultas de morbilidad general de adultos en la atención primaria), que es 12,8 x 1.000 a nivel nacional, en circunstancias que la meta es 50 x 1,000. Esto ha determinado la reducción de 193.416 baciloscopias de pesquisa entre los años 2006-2010, lo que sin duda mantiene en circulación un número estimado de 966pacientes contagiosos no diagnosticados en este período de 4 años. Esto hace temer que en Chile se pudiera producir próximamente un nuevo aumento de la tuberculosis, es decir, una reversión epidemiológica, como la que se observó en Brasil, Cuba y Uruguay cuando se redujeron los recursos destinados a sus programas antituberculosos. El control de este rebrote, en esos países, requirió de la inyección de ingentes recursos económicos. Este deterioro epidemiológico es más intenso en la Región Metropolitana, que en 2011 concentraba en el 40 por...

Acercamiento a la vida y obra del Doctor Ambrosio Grillo y Portuondo / Approach to the life and work of Doctor Ambrosio Grillo y Portuondo

El presente trabajo aproxima a los lectores a la vida y obra del Dr Ambrosio Grillo y Portuondo, ilustre médico cubano, nacido en Santiago de Cuba y fundador de la Liga Antituberculosa de Cuba. Fue el primer presidente del Colegio Médico de esta zona del país. Subvencionó durante el primer cuatrimestre la revista científica Finlay, Órgano Oficial del Colegio Médico de Santiago de Cuba. Además de sus extraordinarias virtudes como galeno, sus coterráneos le consideraron como uno de los mejores alcaldes que tuvo este territorio.

The present work approaches the readers to the life and work of Dr Ambrosio Grillo y Portuondo, distinguished Cuban Physician, born in Santiago de Cuba and founder of the antituberculous Cuban league. He was the first president of the Medical Association of this area of the country. He subsidized during the first four-month period the Finlay scientific magazine, Official Organ of the Medical Association in Santiago de Cuba. Appart from his extraordinary virtues as physician, his fellow countrymen considered him as one of the best mayors that this territory had.

[30th anniversary of the "Kuratorium Tuberkulose in der Welt"]. / 30 Jahre Kuratorium Tuberkulose in der Welt.

The "Kuratorium Tuberkulose in der Welt" is a non-profit association to fight tuberculosis (TB) in the world. It was founded by a group of idealist physicians 30 years ago. Its tasks are to fight against TB, especially in developing countries, to propagate the knowledge of TB prevention and therapy, and to promote research in the field of TB. The "Kuratorium" has set up projects in Santa Cruz (Bolivia), Kathmandu (Nepal), Lomé (Togo), Kiev (Ukraine), and Stavropol (Russia). In cooperation with the WHO, the International Union against Tuberculosis and Lung Disease (IUATLD), and local anti-tb-organisations microbiologic laboratories were established for case detection and therapeutic monitoring. Local staffs were trained and strategies to combat TB were implemented. For more than 30 years the "Kuratorium Tuberkulose in der Welt" has worked successfully and beneficially, despite of often difficult political situations. It has received great appreciation for its achievements.