Epigenetic mechanisms and oral mucositis in children with acute lymphoblastic leukaemia.

This study aimed to investigate the relationship between epigenetic mechanisms and oral mucositis (OM) in paediatric patients with acute lymphoblastic leukaemia. Oral cells were collected from 76 participants, including 15 healthy individuals, 10 patients with acute lymphoblastic leukaemia but without a history of OM and 51 acute lymphoblastic leukaemia patients with a history of OM (35 with active OM and 16 who had recovered from OM). Global DNA methylation in the miR-9-1 and miR-9-3 genes was performed. Seven polymorphisms rs1801131, rs1801133 (MTHFR), rs2228611 (DNMT1), rs7590760, rs1550117 (DNMT3A), rs6087990, rs2424913 (DNMT3B) were genotyped and an analysis of association with global DNA methylation was performed. The global methylation levels were lower in cancer patients recovered from OM than in the other groups. A higher frequency of unmethylated profile for miR-9-1 and partially methylated profile for miR-9-3 was observed in cancer patients regardless of OM history compared to healthy patients. The GG genotype of the rs2228611 (DNMT1) polymorphism was associated with higher levels of global methylation in cancer patients irrespective of OM. It was concluded that global methylation is associated with mucosal recovery. The effect of DNMT1 genotype on the global DNA methylation profile, as well as the methylation profile of miR-9-1 and miR-9-3 in cancer patients is independent of OM.

Integrated oral care contributes positively to the course of treatment of oncopediatric patients.

The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.

Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model.

OBJECTIVE: To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. METHODS: This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. RESULTS: According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). CONCLUSION: The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.

Impact of the COVID-19 pandemic on the development of burnout syndrome in frontline physicians: prevalence and associated factors.

OBJECTIVE: To evaluate the prevalence of burnout syndrome (BS) in physicians working during the COVID-19 pandemic in Paraíba and to investigate the association between BS and the sociodemographic and labor variables of these professionals. METHODS: This was a cross-sectional study including physicians who were active during the pandemic in Paraíba, whether they were on the front line (group 1) or not (group 2). Sociodemographic and labor variables were collected, and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire was applied. RESULTS: A total of 126 physicians were included, including 82 who were on the front line. Among the professionals with results compatible with BS, 85.5% were in group 1, compared with 14.5% in group 2, and this difference was statistically significant. At the 5% level, the variables associated with BS were age (24-33 years), not having children, working on the front line, working in the COVID-19 ICU, being on duty, and having contracted COVID-19. CONCLUSIONS: This case series found a positive association between the development of BS and medical action on the front line of the COVID-19 pandemic in Paraíba.

Impact of Saliva and Cariogenic Microbiota on the Chemotherapy-Induced Oral Mucositis in Oncopediatric Patients: A Preliminary Longitudinal Study.

This study aims to evaluate the salivary parameters and cariogenic microbiota of pediatric oncological patients and their correlation with severe oral mucositis (SOM). A preliminary longitudinal study included patients in the age range from 4 to 18 years (n = 26), with diagnosis of primary cancer, who were followed up before and after time intervals of two, five, and ten weeks of induction chemotherapy. Oral mucosa examinations were performed by means of the modified Oral Assessment Guide (OAG) by calibrated examiners (κ > 0.70). Saliva analysis (unstimulated saliva flow (USF), clinical saliva viscosity (CSV), and pH) and microbiological (total Streptococcus (TS) and Streptococcus of the mutans group (SMG)) tests were performed using unstimulated saliva. The data were analyzed by the Wilcoxon and Spearman Correlation tests (α = 5%). The patients were predominantly of the female sex (n = 15; 57.7%), adolescents (n = 15; 57.7%), and patients with hematological tumors (n = 21; 80.8%). SOM was more frequent in the tenth week (n = 7; 28.6%). The values of USF, CSV, pH, TS, and SMG were not changed by the institution of chemotherapy (p > 0.05). These values were correlated with SOM and the time, TS and SMG, and CSV and SMG. The salivary and microbiological parameters investigated did not influence the severity of oral mucositis in the pediatric patients oncological..

Severe Oral Mucositis in Pediatric Cancer Patients: Survival Analysis and Predictive Factors.

This paper investigates the occurrence of severe oral mucositis and associated factors in blood and solid cancer pediatric patients subjected to cancer treatment, using a survival analysis. A longitudinal, descriptive, observational and inductive study of 142 pediatric patients aged from 0 to 19 years was conducted from 2013 to 2017. Data were collected using a form to record the sociodemographic characteristics and health-related aspects of patients and the modified Oral Assessment Guide (OAG). Survival analysis was performed using the Kaplan-Meier method and Cox semiparametric model. The median times to occurrence of severe oral mucositis were 35.3 and 77.1 days for patients with hematologic malignancies and solid tumors, respectively. The Cox model showed that white cell changes and platelet counts as well as the use of natural chemotherapeutic agents are risk factors for the occurrence of oral mucositis among patients with hematologic malignancies. Nonetheless, among patients with solid tumors, the occurrence of oral mucositis was associated with female sex, mixed ethnicity, the presence of metastasis, abnormal creatinine levels, a combination of chemotherapy, radiotherapy, and surgery, and the administration of chemotherapeutic agents included in the miscellaneous group. The time to occurrence of severe oral mucositis and its associated factors varied according to cancer type.

Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model / Análise dos fatores associados ao internamento na unidade de terapia intensiva de crianças e adolescentes com COVID-19: aplicação de um modelo multinível

ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. Methods This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. Results According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). Conclusion The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.

RESUMO Objetivo Identificar fatores associados ao internamento na unidade de terapia intensiva de crianças e adolescentes com COVID-19. Método Estudo de coorte retrospectiva, com dados secundários, de crianças e adolescentes hospitalizados (zero a 18 anos), notificados com COVID-19 na Paraíba, de abril de 2020 a julho de 2021, totalizando 486 registros. Foram realizadas análise descritiva, regressão logística e regressão multinível, considerando o nível de significância de 5%. Resultados Na regressão logística sem níveis hierárquicos, ocorreu aumento da chance de internamento na unidade de terapia intensiva em pacientes do sexo masculino (RC = 1,98; IC95% 1,18 - 3,32), com desconforto respiratório (RC = 2,43; IC95% 1,29 - 4,56), dispneia (RC = 3,57; IC95% 1,77 - 7,18) e residentes em cidades com grande porte populacional (RC = 2,70; IC95% 1,07 - 6,77). Foi observada diminuição da chance de cuidados intensivos com aumento da idade em anos (RC = 0,94; IC95%=0,90 - 0,97), presença de tosse (RC = 0,32; IC95% 0,18 - 0,59), febre (RC = 0,42; IC95% 0,23 - 0,74) e aumento no Índice de Gini (RC = 0,003; IC95% 0,000 - 0,243). Na análise multinível, a chance de internamento na unidade de terapia intensiva aumentou no sexo masculino (RC = 1,70; IC95%=1,68-1,71) e por conta do aumento no porte populacional do município a cada 100 mil habitantes (RC = 1,01; IC95% 1,01 - 1,03); a chance de internamento na unidade de terapia intensiva diminuiu em pacientes pardos versus não pardos (RC = 0,981; IC95% 0,97 - 0,99) e por conta do aumento a cada pontuação do Índice de Gini (RC = 0,02; IC95% 0,02 - 0,02). Conclusão Os efeitos das condições próprias do paciente e do contexto social na necessidade de cuidados intensivos em crianças e adolescentes com infecção pelo SARS-CoV-2 são mais bem estimados com a inclusão de um modelo de regressão multinível nas análises.

Factors Contributing to the Duration of Chemotherapy-Induced Severe Oral Mucositis in Oncopediatric Patients.

This study analyzes the factors contributing to the duration of severe oral mucositis in oncopediatric patients. A longitudinal study was conducted in the pediatric department of a cancer referral hospital between 2013 and 2017. Seventy-three patients diagnosed with cancer undergoing chemotherapy protocols were analyzed. Oral evaluations were performed using the Modified Oral Assessment Guide criteria, and the data were collected from the patients' records. The Kaplan-Meier method was used to estimate survival curves. Most patients were males (52.1%), of mixed race ("pardo") (49.3%), with a mean age of 7.56 years (±5.34). There was a predominance of patients diagnosed with solid tumors (52.1%), with no metastasis (86.3%), using natural product chemotherapeutics (56.2%), who had not undergone a bone marrow transplant (97.3%); amputation was observed in 35.6% of patients, while death rates were as high as 8.2%. The survival analysis estimated a mean time of 30.6 days until complete remission of severe oral mucositis. The regression analysis showed that patients over 10 years old had a median mucositis duration 1.4 times greater than those at the age of 10 years or younger. Patients without metastasis had a median mucositis duration 1.7 times greater than those with metastasis (p-value ≤ 0.10). Increasing age and the absence of metastasis were conditions that prolonged the duration of severe oral mucositis.

Caracterização do câncer infantojuvenil no Brasil a partir dos Registros Hospitalares de Câncer (RHC), 2000-2016 / Characterization of childhood cancer in Brazil from the hospital-based cancer registries, 2000-2016 / Caracterización del cáncer infantil en Brasil a partir de los Registros de Cáncer del Hospital (RCH), 2000-2016

Objetivo: caracterizar o câncer infantojuvenil no Brasil, a partir da investigação nacional e regional dos registros hospitalares de câncer, no período de 2000 a 2016. Método: estudo observacional, retrospectivo e de base secundária, com amostra de 71.925 registros contendo informações de crianças e adolescentes (0 a 19 anos). Resultados: o câncer infantojuvenil foi mais frequente no sexo masculino com 39.049 (54,3%) casos, existindo 22.391 (31,1%) registros de crianças de 0 e 4 anos de idade e 19.892 (40,4%) com cor de pele parda. As leucemias, doenças mieloproliferativas e doenças mielodisplásicas acometeram 20.744 (28,8%) indivíduos. Os tumores sólidos foram diagnosticados em 42.087 (58,5%) crianças e adolescentes, sendo 23.941 (48,7%) submetidas a quimioterapia no início do tratamento e 56.518 (78,6%) que iniciaram o tratamento até 60 dias após comprovação diagnóstica. Conclusão: foi possível conhecer o perfil demográfico, clínico e assistencial das crianças e adolescentes com câncer no Brasil, e por regiões

Objective: to characterize childhood cancer in Brazil, based on the national and regional investigation of hospital-based cancer registries, from 2000 to 2016. Method: observational, retrospective and secondary-based study, with a sample of 71,925 records containing information of children and adolescents (0 to 19 years old). Results: infant-juvenile cancer was more frequent in males with 39,049 (54.3%) cases, with 22,391 (31.1%) records of children aged 0 and 4 years and 19,892 (40.4%) with color of brown skin. Leukemias, myeloproliferative diseases and myelodysplastic diseases affected 20,744 (28.8%) individuals. Solid tumors were diagnosed in 42,087 (58.5%) children and adolescents,23,941 (48.7%) of which underwent chemotherapy at the beginning of treatment and 56,518 (78.6%) who started treatment within 60 days of the diagnosis. Conclusion: it was possible to know the demographic, clinical and care profile of children and adolescents with cancer in Brazil, and by region

Objetivo: caracterizar el cáncer infantil en Brasil, con base en la investigación nacional y regional de registros hospitalarios de cáncer, de 2000 a 2016. Método: estudio observacional, retrospectivo y secundario, con una muestra de 71,925 registros que contienen información de niños. y adolescentes (0 a 19 años). Resultados: el cáncer infantil-juvenil fue más frecuente en el sexo masculino con 39.049 (54,3%) casos, con 22.391 (31,1%) registros de niños de 0 y 4 años y 19.892 (40,4%) con color de piel morena. Las leucemias, enfermedades mieloproliferativas y enfermedades mielodisplásicas afectaron a 20.744 (28,8%) individuos. Se diagnosticaron tumores sólidos en 42.087 (58,5%) niños y adolescentes, 23.941 (48,7%) de los cuales se sometieron a quimioterapia al inicio del tratamiento y 56.518 (78,6%) que iniciaron el tratamiento dentro de los 60 días del diagnóstico. Conclusión: fue posible conocer el perfil demográfico, clínico y de atención de niños y adolescentes con cáncer en Brasil y por región

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.

Impact of the COVID-19 pandemic on the development of burnout syndrome in frontline physicians: prevalence and associated factors

SUMMARY OBJECTIVE: To evaluate the prevalence of burnout syndrome (BS) in physicians working during the COVID-19 pandemic in Paraíba and to investigate the association between BS and the sociodemographic and labor variables of these professionals. METHODS: This was a cross-sectional study including physicians who were active during the pandemic in Paraíba, whether they were on the front line (group 1) or not (group 2). Sociodemographic and labor variables were collected, and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire was applied. RESULTS: A total of 126 physicians were included, including 82 who were on the front line. Among the professionals with results compatible with BS, 85.5% were in group 1, compared with 14.5% in group 2, and this difference was statistically significant. At the 5% level, the variables associated with BS were age (24-33 years), not having children, working on the front line, working in the COVID-19 ICU, being on duty, and having contracted COVID-19. CONCLUSIONS: This case series found a positive association between the development of BS and medical action on the front line of the COVID-19 pandemic in Paraíba.

Motor Alterations Favor the Occurrence of Oral Mucositis in Pediatric Oncology Patients

Objective: To identify the predictive factors for the appearance of oral mucositis (OM) in pediatric oncology patients based on their motor alterations. Material and Methods: This study was an observational, cross-sectional study with 2-19-year-old patients undergoing treatment at the pediatric oncology outpatient service of the Napoleão Laureano Hospital in João Pessoa, Brazil. The convenience sample consisted of 42 patients aged 2 to 19 years with a first diagnosis of cancer and under treatment. The instruments used were a questionnaire with sociodemographic questions - the modified Oral Assessment Guide (OAG) - and some categories of the International Classification of Functioning Disability and Health (CIF), applied by a calibrated examiner (Kappa>0.65). The data were organized in Excel spreadsheet and analyzed descriptively and inferentially using logistic regression (α=5%). Results: Most patients were female (52.4%, n=22), mean age of 11.6 years, median 12.0 years, self-declared as non-white (61.9%, n=26), non-white (66.7%, n=28), family monthly income of up to 2 Brazilian minimum wages (88.1%, n = 37). Most patients presented hematologic neoplasia (54.8%, n=23) with acute lymphoid leukemia (36.6%; n=15) and most of them were subjected to chemotherapy (45.2%; n = 19). OAG identified oral mucositis in a few cases (23.8%, n=10). Logistic regression and odds ratio showed that individuals with moderate and mild difficulty in changing basic body position had, respectively, 19.7 and 30.8 times more chances of developing oral mucositis. In patients with severe motor impairment, this risk is 17.3 times greater and those with mild difficulty in taking care of the bodily parts had an increase of 33.4 times the risk for oral mucositis. Conclusion: The deficit in motor activities increased the chances of developing oral mucositis.

Factors associated with oral biofilm in ICU patients with infectious diseases / Fatores associados à presença de biofilme oral em pacientes internados na UTI

Introduction: Hospitalization may cause a decline in oral health and affect the entire body. The intensive care unit (ICU) may be a favorable environment for oral biofilm to accumulate in critically ill patients. Objective: To identify factors associated with oral biofilm in ICU patients in a hospital for infectious diseases. Method: This was a retrospective, descriptive and inferential study with a quantitative approach. Data were collected from 178 medical records of patients from January 2012 to July 2015. Biofilm presence was assessed according to the Greene and Vermillion index. Potential influential factors were analyzed by logistic regression. Result: Among ICU patients, 69.1% were men, 60.7% had acquired immune deficiency (AIDS), 66.3% were ward patients, 50.6% were intubated, and 50.0% were sedated. The oral elements of the patients were mostly normal. The following characteristics were significantly associated with oral biofilm: changes in the lips, gums, cheeks, and palates and bleeding. Patients from the ward had a lower risk of biofilm. Conclusion: Increased oral biofilm accumulation was observed in patients with oral changes, and patient origin was associated with the presence of biofilm.

Introdução: A hospitalização pode provocar deterioração da saúde bucal, repercutindo em todo o corpo. A UTI pode ser um ambiente favorável ao acúmulo de biofilme oral em pacientes críticos. Objetivo: Identificar fatores associados à presença do biofilme em pacientes da UTI de um hospital de doenças infectocontagiosas. Método: Estudo retrospectivo, descritivo e inferencial, com abordagem quantitativa. Os dados foram obtidos em prontuários de pacientes da UTI, de janeiro de 2012 a julho de 2015. O biofilme foi avaliado de acordo com o índice de Greene e Vermillion. Os fatores influentes foram analisados por regressão logística. Resultado: Entre os pacientes da UTI, 69,1% eram homens, 60,7% pacientes com AIDS, 66,3% pacientes na enfermaria, 50,6% intubados e 50,0% sedados. Seus elementos orais eram na maioria normais. As seguintes características foram significativamente associadas a biofilmes orais: alterações orais nos lábios, gengivas, bochechas e palatos e sangramento. Pacientes da enfermaria apresentaram menor risco de apresentar biofilmes. Conclusão: o aumento do acúmulo de biofilme oral foi observado em pacientes com alterações na boca e a procedência do paciente foi associada à presença de biofilme.

A expansão do tratamento supervisionado (TS) para o controle da tuberculose na Paraíba (1999/2005) / The expansion of the treatment observed (TS) for the control of tuberculosis in Paraiba (2000/2005)

O tratamento supervisionado (TS) é um dos pilares da Estratégia DOTS (Directly Observed Treatment Short-course) e sua adoção vem sendo recomendada, para o controle da tuberculose (TB). Neste estudo objetivou-se analisar as potencialidades e fragilidades no processo de expansão do Tratamento Supervisionado (TS) nos seis municípios considerados prioritários para o controle da TB na Paraíba-PB/Brasil. Pesquisa de natureza qualitativa, que utilizou a entrevista semi-estruturada com 21 profissionais envolvidos na implantação e expansão do DOTS nos seis municípios. Os dados foram analisados pela técnica de análise de conteúdo, modalidade temática. Como potencialidades foram identificadas: apoio dos gestores no processo de descentralização do TS para as Unidades de Saúde da Família (USF); compromisso dos profissionais e boa comunicação entre USF e referências. Dentre as fragilidades relatadas observa-se a falta de apoio dos gestores para garantir infra-estrutura e estímulo financeiro para o profissional; falta de qualificação profissional; alta rotatividade dos profissionais e centralização da distribuição de medicamento. Apesar dos esforços para implantação do TS, reconhece-se que sua ampliação esta condicionada a capacidade gerencial e ao compromisso político dos gestores.

The supervised treatment (TS) is a pillar of the DOTS strategy (Directly Observed Treatment Short-course) and its adoption has been recommended for the control of tuberculosis (TB). The study aimed to analyze the strengths and weaknesses in the expansion process of the supervised treatment in six cities considered as priorities for the TB control in Paraíba-PB/Brazil. The qualitative research used semi-structured interview with 21 professionals involved in the implementation and expansion of DOTS in the cities, data were analyzed through thematic content analysis. As strengths it was identified: support to managers in the decentralization process of TS to the Family Health Units (USF); professionals? engagement and good communication between USFs and references. Among the reported weaknesses it is observed the lack of support from managers to ensure infra-structure and financial incentive to the professional; lack of professional qualification; high professional turnover and centralization of drug distribution. Despite the efforts for the TS implementation, it is recognized that its expansion is subject to the managerial ability and the managers? political commitment.

El tratamiento supervisado (TS) es uno de los pilares de la Estrategia DOTS (Directly Observed Treatment Short-course) y su adopción está siendo recomendada para el control de la tuberculosis (TB). En este estudio se objetivó analizar las potencialidades y fragilidades en el proceso de expansión del Tratamiento Supervisado (TS) en seis municipios considerados prioritarios para el control de TB en Paraíba-PB/Brasil. Es una investigación cualitativa que utilizó entrevista semi-estructurada con 21 profesionales implicados en la implantación y expansión del DOTS en los seis municipios, se hizo el análisis de contenido temático de los datos. Como potencialidades fueron identificadas: apoyo de los gestores en el proceso de descentralización del TS para las Unidades de Salud de la Familia (USF); compromiso de los profesionales y buena comunicación entre USFs y referencias. Entre las fragilidades relatadas se observa la falta de apoyo de los gestores para garantizar infra-estructura y estímulo financiero para el profesional; falta de cualificación profesional; alta rotación de los profesionales y centralización de la distribución de medicamento. A pesar de los esfuerzos para implementación del TS, se reconoce que su ampliación está condicionada a la capacidad gerencial y al compromiso político de los gestores.