Analysis of vaccine loss due to temperature change.

OBJECTIVES: to analyze vaccine losses in a Health Region in the Northwest of São Paulo. METHODS: retrospective cross-sectional study with secondary data obtained from Temperature Change Notification Forms used by the Epidemiological Surveillance Group XXIX of São José do Rio Preto between 2010 and 2017. Descriptive and inferential analysis were performed using multiple linear regression and significance level of 95%. RESULTS: in total, 341 notifications of temperature changes were analyzed, of which 70.1% were caused by structural reasons, 57.8% in industrial refrigerators and 91.2% in primary care services. Of the doses that suffered a change in temperature, 41.4% were lost and 58.6% were administered to the population. The highest percentage of lost doses compared to those applied occurred in smaller municipalities, although they reported less. CONCLUSIONS: nursing workers who work in vaccination rooms should make efforts to prevent temperature changes and avoid losses and higher public expenses.

Analysis of vaccine loss due to temperature change / Análisis de pérdida de vacuna por cambio de temperatura / Análise da perda de vacinas por alteração de temperatura

ABSTRACT Objectives: to analyze vaccine losses in a Health Region in the Northwest of São Paulo. Methods: retrospective cross-sectional study with secondary data obtained from Temperature Change Notification Forms used by the Epidemiological Surveillance Group XXIX of São José do Rio Preto between 2010 and 2017. Descriptive and inferential analysis were performed using multiple linear regression and significance level of 95%. Results: in total, 341 notifications of temperature changes were analyzed, of which 70.1% were caused by structural reasons, 57.8% in industrial refrigerators and 91.2% in primary care services. Of the doses that suffered a change in temperature, 41.4% were lost and 58.6% were administered to the population. The highest percentage of lost doses compared to those applied occurred in smaller municipalities, although they reported less. Conclusions: nursing workers who work in vaccination rooms should make efforts to prevent temperature changes and avoid losses and higher public expenses.

RESUMEN Objetivos: analizar las pérdidas de vacunas en una Región de Salud del Noroeste de São Paulo. Métodos: estudio transversal retrospectivo, con datos secundarios obtenidos de los formularios de notificación de cambios de temperatura utilizados por el Grupo XXIX de Vigilancia Epidemiológica de São José do Rio Preto entre 2010 y 2017. Se realizó el análisis descriptivo e inferencial y se utilizó la regresión lineal múltiple y nivel de significancia del 95%. Resultados: se analizaron 341 notificaciones de cambios de temperatura, de las cuales el 70,1% fueron por motivos estructurales, el 57,8% en frigoríficos industriales y el 91,2% en los servicios de atención primaria. De las dosis que sufrieron un cambio de temperatura, el 41,4% se perdieron y el 58,6% se administraron a la población. El mayor porcentaje de dosis perdidas en comparación con las aplicadas se produjo en los municipios más pequeños, aunque informaron menos. Conclusiones: los trabajadores de enfermería que laboran en las salas de vacunación deben esforzarse por prevenir cambios de temperatura, evitando pérdidas y aumento de los gastos públicos.

RESUMO Objetivos: analisar as perdas de vacinas em uma Região de Saúde do Noroeste paulista. Métodos: estudo transversal retrospectivo, com dados secundários obtidos das fichas de notificação de alteração de temperatura utilizadas pelo Grupo de Vigilância Epidemiológica XXIX de São José do Rio Preto, entre 2010 e 2017. Foi realizada análise descritiva e inferencial, utilizando regressão linear múltipla e nível de significância de 95%. Resultados: foram analisadas 341 notificações de alteração de temperatura, sendo 70,1% causadas por motivos estruturais, 57,8% em refrigeradores industriais e 91,2% em serviços de atenção básica. Das doses que sofreram alteração de temperatura, 41,4% foram perdidas e 58,6% foram administradas na população. O maior percentual de doses perdidas em relação às aplicadas ocorreu em municípios menores, apesar de eles notificarem menos Conclusões: os trabalhadores de enfermagem que atuam em salas de vacinação devem se empenhar para prevenir alterações de temperatura, evitando perdas e aumento dos gastos públicos.

Dificuldades e facilidades do enfermeiro da Saúde da Família no processo de trabalho / Difficulties and facilities of the Family Health nurse in the work process

Resumo Introdução Os cuidados primários à saúde são discutidos internacionalmente desde 1978 com a Declaração de Alma-Ata. Quinze anos depois, nasceu no Brasil a Saúde da Família, em que se destaca o enfermeiro como um dos principais profissionais com atribuições no processo de trabalho que garante a prestação qualificada da assistência. Objetivo Analisar as dificuldades e as facilidades do processo de trabalho dos enfermeiros das Unidades Básicas de Estratégia Saúde da Família. Método Trata-se de um estudo de natureza descritiva, transversal e abordagem qualitativa, cujos dados foram obtidos a partir de entrevista semiestruturada. Os dados coletados em um período de três meses foram analisados por meio da análise temática. Resultados A análise revelou quatro núcleos de sentido relacionados à dificuldade: alta demanda espontânea, recursos humanos escassos, sobrecarga de atividades e educação permanente reduzida. Para as facilidades, foram identificados dois núcleos de sentido: formação holística e campo rico para pesquisas. Conclusão Os resultados forneceram subsídios para que os gestores de saúde implementem estratégias em prol do processo de trabalho dos enfermeiros, o que, consequentemente, refletirá em benefícios ao indivíduo, à família, à comunidade e a toda equipe de saúde.

Abstract Background Primary health care has been discussed internationally since 1978 with the Alma Ata Declaration. Fifteen years later the Family Health is born in Brazil, which the nurse is the one of the main professionals with attributions in the work process that ensures the qualified provision of the assistance. Objective To analyze the difficulties and facilities of the work process of nurses of the Basic Family Health Strategy Units. Method This is a descriptive, cross-sectional and qualitative study, the data being obtained from a semi-structured interview. The data collected over a period of three months were analyzed through the thematic analysis. Results The analysis revealed four sense nuclei related to the difficulty: high spontaneous demand, scarce human resources, activities overload and reduced permanent education. For the facilities were identified two nuclei of sense: holistic formation and rich field for research. Conclusion The results provide support for health managers to implement strategies for the nurses' work process, which will consequently reflect benefits to the individual, family, community and all health team.

Profile and speech-language rehabilitation of patients with laryngeal cancer. / Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe.

PURPOSE: to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. METHODS: cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. RESULTS: 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). CONCLUSION: Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

OBJETIVO: descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. MÉTODO: estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. RESULTADOS: prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). CONCLUSÃO: fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

Perfil e reabilitação fonoaudiológica de pacientes com câncer de laringe / Profile and speech-language rehabilitation of patients with laryngeal cancer

RESUMO Objetivo descrever o perfil clínico e sociodemográfico e o desfecho da reabilitação fonoaudiológica de pacientes com câncer de laringe. Método estudo transversal com 204 pessoas atendidas entre 1989 e 2015. A associação entre desfecho da fonoterapia e variáveis de caracterização sociodemográfica e clínicas foi verificada por técnicas univariadas e multivariadas. Resultados prevalência do gênero masculino (95,10%), 60 anos ou mais (53,43%), ensino fundamental (77,37%), setor de serviços (44,12), tabagistas e etilistas (81,63%); estágio T3 (30,4%), ausência de nódulos (72,00%) e de metástase (85,6%). O procedimento terapêutico mais frequente foi a laringectomia total ou parcial (69,61%). Houve associação da escolaridade, estágio da doença, hábitos e procedimento terapêutico com desfecho da fonoterapia (p<0,001). Conclusão fatores sociodemográficos e clínicos podem interferir no prognóstico da reabilitação vocal de pessoas com câncer de laringe. A otimização e diversificação de novos procedimentos terapêuticos são desafios na reabilitação fonoaudiológica destas pessoas.

ABSTRACT Purpose to describe the clinical and sociodemographic profile and analyze the voice rehabilitation outcomes of patients with laryngeal cancer. Methods cross-sectional study with 204 individuals with laryngeal cancer treated between 1989 and 2015. The variables describing the patients' profile were presented in absolute values (n) and percentage (%). The association between the speech-language therapy outcome and the sociodemographic and clinical characterization variables was verified by means of uni- and multivariate techniques. Results 95.1% of the patients are male; 53.43% are aged 60 or more; 77.37% have elementary education; 44.12% are in the service industry; 81.63% smoke and consume alcohol; 30.4% are stage T3. Absence of nodules was found in 72.00%, and of metastasis, in 85.6% of patients. The most frequent therapeutic procedure was complete or partial laryngectomy (69.61%). There was an association among education, disease stage, habits, and therapeutic outcome with speech-language therapy (p<0.001). Conclusion Several causes can affect the prognosis of vocal rehabilitation in patients with laryngeal cancer. Optimization and diversification of new therapeutic procedures are challenges for these patients' speech-language rehabilitation.

Acesso ao diagnóstico da tuberculose em município brasileiro de médio porte / Access to diagnosis of tuberculosis in Brazilian medium-sized municipality / Acceso al diagnóstico de la tuberculosis en un municipio brasileño de mediano porte

RESUMO Objetivo Avaliar o acesso ao diagnóstico de tuberculose, na perspectiva dos doentes. Métodos Estudo transversal, com 108 doentes de tuberculose. Os dados foram coletados utilizando-se o instrumento Primary Care Assessment Tool (PCAT), validado para o Brasil, adaptado para atenção a tuberculose, incluiu indicadores socioeconómicos e demográficos, local do diagnóstico e de acesso ao diagnóstico de tuberculose. A análise dos dados foi de frequência, média, desvio-padrão, intervalo de confiança e teste Qui-quadrado. Resultados A maioria dos casos foi diagnosticada em hospitais (52,8%). O doente procurou a Unidade de Saúde em média três vezes, para conseguir atendimento. Os indicadores dificuldade de deslocamento, gasto com transporte motorizado e consulta no prazo de 24 horas para descoberta da doença foram não satisfatórios e regulares. Conseguir consulta para descobrir a tuberculose em 24 horas, foi não satisfatório. O teste qui-quadrado mostrou associação estatística entre locais de diagnóstico e procura pela unidade de saúde mais próxima da casa. Conclusão O diagnóstico precoce da Tuberculose na Atenção Primária apresenta fragilidades. São muitos desafios a serem enfrentados para o fortalecimento deste nível de atenção a saúde, com capacidade organizacional para a superação das deficiências relacionadas ao doente e ao serviço que dificultam o acesso ao diagnóstico da doença.(AU)

ABSTRACT Objetivo Evaluating access to tuberculosis diagnosis, from the perspective of patients. Methods Cross-sectional study with 108 tuberculosis patients. Data were collected using the brazilian instrument Primary Care Assessment Tool - PCAT-Brazil, adapted for attention to tuberculosis, including socio-economic and demographic indicators, location of diagnosis and diagnostic access tuberculosis. The analysis of the data was of frequency, average, standard deviation, confidence interval and Chi-square test. Results Most cases were diagnosed in hospitals (52.8%). The patient sought the Health Unit on average three times until receiving medical care. The indicators of difficulty of displacement, expenditure on motorized transport and consultation within 24 hours to discover the disease were not satisfactory and regular. The chi-square test showed a statistical association between diagnosis location and seeking the nearest health unit from home. Conclusions There are weaknesses in the early diagnosis of tuberculosis in primary care. There are many challenges to be faced to strengthen this level of health care, with organizational capacity to overcome the shortcomings related to the patient and the service that make it difficult to access the diagnosis of the disease.(AU)

RESUMEN Objetivo Evaluar el acceso al diagnóstico de tuberculosis, desde la perspectiva de los enfermos. Métodos Estudio transversal con 108 pacientes de tuberculosis. Los datos fueron recolectados utilizando el instrumento Primary Care Assessment Tool -PCAT-Brasil- . El análisis de los datos incluyeron frecuencia, media, desviación estándar, intervalo de confianza y prueba Chi-cuadrado. Resultados La mayoría de los casos fueron diagnosticados en hospitales (52,8%). El paciente buscó la Unidad de Salud en promedio tres veces, para conseguir atención. Los indicadores dificultad de desplazamiento, gasto con transporte motorizado y consulta en el plazo de 24 horas para el descubrimiento de la enfermedad, no fueron satisfactorios o regulares. La prueba de Chi-cuadrado mostró una asociación estadística entre el lugar de diagnóstico y la búsqueda de la unidad de salud más cercana al hogar. Conclusión El diagnóstico precoz de la tuberculosis en la Atención Primaria presenta fallas. Son muchos los desafíos a enfrentar para mejorar la atención, la capacidad organizacional para superar las deficiencias relacionadas con el enfermo y el servicio, que dificultan el acceso al diagnóstico de la enfermedad.(AU)

Primary Health Care and tuberculosis: services evaluation. / Atenção Primária à Saúde e tuberculose: avaliação dos serviços.

INTRODUCTION:: In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. OBJECTIVE:: To evaluate the performance of Primary Health Care services in tuberculosis treatment. METHODS:: This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure - process - results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable "Z". RESULTS:: The indicators "participation of professionals in tuberculosis patients' care" (structure) and "reference and counterreference" (process) had the best evaluations, whereas "professional training" (structure) and "external actions for tuberculosis control" (process) had the worst results. CONCLUSION:: The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.

Atenção Primária à Saúde e tuberculose: avaliação dos serviços / Primary Health Care and tuberculosis: services evaluation

RESUMO: Introdução: Visando controlar a tuberculose, o Ministério da Saúde recomenda a descentralização das ações de controle para a Atenção Primária à Saúde, sendo escassos os estudos acerca do desempenho do Programa de Controle da Tuberculose em contextos descentralizados. Objetivo: Avaliar o desempenho dos serviços da Atenção Primária à Saúde no tratamento da tuberculose. Métodos: Estudo avaliativo, realizado de maneira transversal em 2011. Foram entrevistados 239 profissionais de saúde da Atenção Primária à Saúde utilizando um instrumento estruturado com base no referencial de avaliação da qualidade dos serviços de saúde (estrutura, processo e resultado). O desempenho de tais serviços foi analisado mediante técnicas de estatística descritiva, validação e construção de indicadores e cálculo da variável reduzida Z. Resultados: Os indicadores “participação de profissionais no atendimento aos pacientes com tuberculose” (estrutura) e “referência e contrarreferência” (processo) foram os melhores avaliados, enquanto “capacitação dos profissionais” (estrutura) e “ações externas para o controle da tuberculose” (processo) tiveram os piores resultados. Conclusão: A descentralização das ações de controle da tuberculose vem ocorrendo de maneira verticalizada na Atenção Primária à Saúde. O desafio de controlar a tuberculose perpassa pela superação de fragilidades relacionadas ao envolvimento, à capacitação e à rotatividade profissional, que é a articulação entre os pontos de atenção e monitoramento das ações de controle na Atenção Primária à Saúde.

ABSTRACT: Introduction: In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. Objective: To evaluate the performance of Primary Health Care services in tuberculosis treatment. Methods: This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure - process - results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable “Z”. Results: The indicators “participation of professionals in tuberculosis patients’ care” (structure) and “reference and counterreference” (process) had the best evaluations, whereas “professional training” (structure) and “external actions for tuberculosis control” (process) had the worst results. Conclusion: The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.

Recidiva da Tuberculose: fatores associados em um Grupo de Vigilância Epidemiológica de São Paulo / Tuberculosis Recurrence: Associated Factors in an Epidemiological Surveillance Group of São Paulo

Analisar os fatores associados aos casos de recidiva de tuberculose (TB) em notificações no Grupo de Vigilância Epidemiológica XXIX/São José doRio Preto/SP. Trata-se de um estudo caso-controle, analisando as notificações de TB pulmonar no período de 1996 a 2014. Considerou-se caso notificações de ͞Recidiva͟ e controle: notificações classificadas como caso ͞Novo͟ e cujo desfecho foi ͞Cura͟. Utilizou-se para a análise dos dados o odds ratio e análise multivariada com intervalo de confiança de 95%. As variáveis sexo e desfecho desfavorável no 7º mês permaneceram significativamente associadas à recidiva. O sexo masculino apresentou 1,8 vezes maior risco (p=0,0551) e os indivíduos que obtiveram desfecho desfavorável no 7º mês de tratamento apresentaram 4,6 vezes mais chance de ter recidiva (p=0,0000). Foram encontrados dois fatores associados à recidiva: o sexo masculino e o desfecho desfavorável do tratamento, o que mostra a necessidade de avaliar a qualidade da assistência prestada.

Analyze the factors related to cases of tuberculosis (TB) recurrence in reports of the Epidemiological Surveillance Group XXIX/São José do Rio Preto/SP. This is a case-control study that analyzes pulmonary TB reports in the period between 1996 and 2014. Cases were reports of ͞Recurrence" and control: reports classified as "New" case and with "Healed" outcome. Odds ratio and multivariate analysis with 95% confidence interval were used to analyze the data. The variables of gender and adverse outcome in the 7th month remained significantly associated with recurrence. Males showed 1.8 times greater risk (p = 0.0551) and individuals who obtained an adverse outcome in the 7thmonth of treatment were 4.6 times more likely to recur (p = 0.0000). We found two factors associated with recurrence: male gender and adverse treatment outcome, which shows the need to assess the quality of the care provided.

A coordenação da assistência no controle da tuberculose na visão da equipe de enfermagem / The coordination of assistance in tuberculosis control in the nursing team's view / La cordinación de la asistencia en el control de la tuberculosis en la visión del equipo de enfermería

Objetivo: analisar a coordenação da assistência aos portadores de tuberculose pela equipe de enfermagem.Método: estudo epidemiológico, descritivo tipo inquérito, analítico e transversal. 79 profissionais deenfermagem foram entrevistados com formulário pré-estruturado e os dados foram analisados com técnicas deanálise descritiva e o teste T-Student para grupos independentes. Resultados: os enfermeiros classificaram acoordenação da assistência mais efetiva que os auxiliares/técnicos de enfermagem, houve diferençaestatística das opiniões entre as categorias, principalmente sobre sistemas de informação. Conclusão: acoordenação da assistência à tuberculose ainda é frágil e são precisos esforços individuais da equipe epolíticos municipais para que seja atingida a assistência coordenada da tuberculose.(AU)

Objective: to analyze the coordination of care for tuberculosis patients by the nursing team. Method: this is an epidemiological study, descriptive, and survey, analytical and transversal type. There were 79 nursing professionals interviewed with a pre-structured form, and the data were analyzed using descriptive analysis techniques and the T-Student test for independent groups. Results: Nurses classified care coordination as more effective than nursing assistants/technicians, there were statistical differences between categories, especially information systems. Conclusion: Coordination of tuberculosis care is still fragile, and individual efforts of the team and municipal politicians are needed to achieve coordinated tuberculosis care.(AU)

Objetivo: analizar la cordinación de la asistencia a los portadores de tuberculosis por el equipo de enfermería. Método: estudio epidemiológico, descriptivo tipo inquérito, analítico y transversal. 79 profesionales de enfermería fueron entrevistados con formulario pre-estructurado y los datos fueron analizados con técnicas de análisis descriptiva y el test T-Student para grupos independientes. Resultados: los enfermeros clasificaron la cordinación de la asistencia más efectiva que los auxiliares/técnicos de enfermería, hubo diferencia estadística de las opiniones entre las categorías, principalmente sobre sistemas de información. Conclusión: la cordinación de la asistencia a la tuberculosis aún es frágil y son precisos esfuerzos individuales del equipo y políticos municipales para que sea afectada la asistencia cordinada de la tuberculosis.(AU)

[Delay in tuberculosis diagnosis in adults in a city of São Paulo State, Brazil, in 2009: a cross-sectional study]. / Atraso do diagnóstico da tuberculose em adultos em um município paulista em 2009: estudo transversal.

OBJECTIVE: to evaluate patient and health service characteristics associated with tuberculosis (TB) diagnosis delay. METHODS: this was a cross-sectional study conducted in São José do Rio Preto-SP in 2009; the 'entry point' and 'access to diagnosis' dimensions of the Primary Care Assessment Tool (PCAT) were selected to analyze patient and HS delay. RESULTS: 99 TB patients were included in the study; the median time related to patient and HS delay was 15 days; delay in seeking services was lower among smokers (PR= 0.71; 95%CI 0.54;0.94) and alcohol users (PR=0.75; 95%CI 0.57;0.99); TB diagnosis delay was related to not being able to get a medical appointment on the same day (PR=1.63; 95%CI 1.22;2.18), TB not being suspected (PR=2.07; 95%CI 1.18;3.62) and seeking care in health services four times or more (PR=2.34; 95%CI 1.55;3.53). CONCLUSION: delay in seeking care was lower among smokers and alcohol users; shortcomings in access to diagnosis characterized health services delay.

Atraso do diagnóstico da tuberculose em adultos em um município paulista em 2009: estudo transversal / Delay in tuberculosis diagnosis in adults in a city of São Paulo State, Brazil, in 2009: a cross-sectional study / Retraso diagnóstico de tuberculosis en adultos en un municipio paulista en 2009: estudio transversal

OBJETIVO: analisar características dos doentes e dos serviços de saúde associadas ao atraso do diagnóstico da tuberculose (TB). MÉTODOS: estudo transversal realizado em São José do Rio Preto-SP, em 2009; utilizaram-se as dimensões 'porta de entrada' e 'acesso ao diagnóstico' do Primary Care Assessment Tool. RESULTADOS: foram incluídos 99 doentes de TB; o tempo mediano de atraso relacionado ao doente e ao serviço foi de 15 dias; houve menor atraso entre doentes tabagistas (RP=0,71; IC95% 0,54;0,94) e etilistas (RP=0,75; IC95% 0,57;0,99); o atraso do serviço associou-se à não obtenção de consulta no mesmo dia (RP=1,63; IC95% 1,22;2,18), não suspeição da doença (RP=2,07; IC95% 1,18;3,62) e procura pelos serviços quatro vezes ou mais (RP=2,34; IC95% 1,55;3,53). CONCLUSÃO: doentes fumantes e etilistas tiveram menor atraso na busca por atendimento; fragilidades de acesso ao diagnóstico configuraram o atraso dos serviços de saúde.

OBJECTIVE: to evaluate patient and health service characteristics associated with tuberculosis (TB) diagnosis delay. METHODS: this was a cross-sectional study conducted in São José do Rio Preto-SP in 2009; the 'entry point' and 'access to diagnosis' dimensions of the Primary Care Assessment Tool (PCAT) were selected to analyze patient and HS delay. RESULTS: 99 TB patients were included in the study; the median time related to patient and HS delay was 15 days; delay in seeking services was lower among smokers (PR= 0.71; 95%CI 0.54;0.94) and alcohol users (PR=0.75; 95%CI 0.57;0.99); TB diagnosis delay was related to not being able to get a medical appointment on the same day (PR=1.63; 95%CI 1.22;2.18), TB not being suspected (PR=2.07; 95%CI 1.18;3.62) and seeking care in health services four times or more (PR=2.34; 95%CI 1.55;3.53). CONCLUSION: delay in seeking care was lower among smokers and alcohol users; shortcomings in access to diagnosis characterized health services delay.

OBJETIVO: analizar características de pacientes y servicios de salud (SS) asociados al retraso diagnóstico de tuberculosis (TB). MÉTODOS: estudio transversal en São José do Rio Preto-SP, 2009; se utilizaron las dimensiones 'puerta de enlace' y 'acceso al diagnóstico' del Primary Care Assessment Tool (PCAT). RESULTADOS: se incluyeron 99 pacientes con TB; la mediana de tiempo de retraso relacionado al paciente y SS fue 15 días; hubo menor demora entre fumadores (RP=0.71; IC95% 0.54;0.94) y consumidores de alcohol (RP=0.75, IC95% 0.57;0.99); el retraso de SS se relacionó con la no obtención de consulta el mismo día (RP=1,63; IC95% 1,22;2,18), sin sospecha de TB (RP=2,07; IC95% 1,18;3,62) y búsqueda de SS cuatro veces o más (RP=2,34; IC95% 1,55;3,53). CONCLUSIÓN: pacientes fumadores y consumidores de alcohol tenían menor retraso en la búsqueda de atención; falta de acceso al diagnóstico configuran retraso de SS.

Death in patients with tuberculosis and diabetes: Associated factors.

AIMS: Identify factors associated with death in patients with tuberculosis and diabetes. METHOD: The descriptive - analytic epidemiologic study using secondary data of tuberculosis cases reported in TBWEB from 1996 to 2014 is used. The profile analysis of the variables in relation to death controlled by the cure of the patients was performed by the software R, the independent variables that could be associated with the dependent variable in a 20% significance level, using the chi-square test. The analysis was performed on an unconditional logistic regression model. Odds ratio (OR) adjusted measures were obtained in order to evaluate the strength of association between independent variables. RESULTS: Looking into the database TBWEB, from 1996 to 2014, 5361 cases of TB were reported, and from these cases, 4447 contained information about the closure and were complete. Patients with TB and DM represented 306 cases (6.35%). In relation to death, protective factors were: diabetes with OR: 0.69; follow up received during the treatment of medium and high complexity services, with OR: 0.51 and the other type with OR: 0.56. CONCLUSION: Diabetes appeared as a protective factor for death in patients with tuberculosis in this study. The development of studies like this allows the expansion of knowledge on the TB-DM association.

Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study.

BACKGROUND: Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management. OBJECTIVE: To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto-SP, Brazil. METHODS: Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed. RESULTS: Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified. CONCLUSIONS: There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.

Risco de mortalidade associado aos níveis glicêmicos em pacientes com septicemia naTerapia Intensiva / Mortality risk associated with blood sugar levels in patients with septicemia in Intensive Care

Estimar o risco de mortalidade associado aos níveis glicêmicos em pacientes com septicemia em umaUnidade de Terapia Intensiva. Métodos: estudo de coorte retrospectivo com 263 pacientes com septicemiainternados em uma unidade de terapia intensiva, utilizando dados do sistema de gestão hospitalar. Resultados:houve maior frequência de pacientes na faixa etária de 14 a 59 anos (52,1%), sexo masculino (55,9%), raçabranca (85,9%), de especialidades clínicas (65,8%); o período de internação variou de 2 a 132 dias; 91,6%dos pacientes (n=241) estavam hiperglicêmicos no momento da hospitalização. Ocorreram 37 (14,1%) óbitos,sendo mais frequentes nos pacientes que apresentaram hiperglicemia na hospitalização (1,49 óbitos/1000pacientes). Conclusão: a hiperglicemia mostrou-se fator de risco para mortalidade em pacientes internados naUnidade de Terapia Intensiva...

Efeitos adversos da poliquimioterapia para hanseníase: utilização de doses alternativas e avaliação pós alta / Adverse effects of multidrug therapy for leprosy: use of alternative doses and post discharge evaluation

O tratamento da hanseníase pode causar efeitos adversos relacionados à Rifampicina (RMP) ou Dapsona (DDS) levando à mudança no esquema terapêutico. Objetivou-se determinar as causas da mudança do tratamento e avaliar as condições clínicas dermatológicas dos pacientes que fizeram uso da terapêutica alternativa. De 182 pacientes tratados entre 1997-2008, 34 (18,7%) fizeram doses alternativas e 21 foram entrevistados. O perfil foi constituído por casados, de 40 à 59 anos, baixa condição socioeconômica e escolaridade. Os pacientes paucibacilares (PB) e multibacilares (MB) sem o uso de DDS e de RMP tiveram as últimas baciloscopias (BAAR) negativas (>50%), e os resultados positivos dos outros mostrou involução lenta. A forma clínica mais incidente foi a virchowiana nos intolerantes à DDS, e a dimorfa nos sem a RMP. Os efeitos adversos acometeram mais os MB. Nos intolerantes à DDS, a mudança do esquema terapêutico foi relacionada às causas hematológicas (48,5%) e os à RMP, as hepáticas (50%). Na avaliação as placas e nódulos desapareceram. As manchas, dor geral ou localizada em membros, diminuição da sensibilidade e da força muscular com aparecimento de garra móvel foram significativas. A evolução das incapacidades revelou a necessidade de monitorar atentamente a função neural nos casos de alta.

Leprosy treatment can cause adverse effects related to rifampin (RMP) or dapsone (DDS) leading to changes of the therapeutic regimen. The objective was to determine the causes of changes in the treatment and to evaluate the clinical dermatological conditions of patients who underwent alternative therapy. Out of 182 patients treated between 1997- 2008, 34 (18.7%) underwent alternative doses, and 21 were interviewed. The profile of the patients was: married, 40 to 59 years, low socioeconomic and educational status. The latest bacilloscopic index (BI) of paucibacillary (PB) and multibacillary (MB) patients that did not use DDS and RMP was negative (> 50%), and the positive results observed in the other patients evidenced slow recovery. The most frequent clinical form was lepromatous in patients intolerant to DDS and borderline leprosy in those without RMP. Adverse effects were most commonin MB patients. Intolerance to DDS was related to hematological causes (48.5%), and intolerance to RMP was due to hepatic conditions (50%). Upon evaluation nodules and plaques disappeared. Plaques, generalor localized pain in limbs, reduced sensitivity and muscular strength with the appearance of claw were significant findings. The development of disabilities revealed the need of careful monitoring of the neural function in cases discharged from treatment.

[Delay in seeking initial care for tuberculosis diagnosis]. / Atraso na procura pelo primeiro atendimento para o diagnóstico da tuberculose.

Descriptive study, which aimed to analyze the time between the perception of TB symptoms onset and the first search for health services, according to TB patient characteristics in São José do Rio Preto - SP. 97 TB patients in treatment were interviewed with a structured instrument. The delay was identified by the median time between the perception of TB symptom's onset and the patients demand for care (> 15 days). To identify the variables related to delay the prevalence ratio were calculated. There was a delay seeking care among: male patients, aged 18 to 29 and 50 to 59 years, lower education and higher family income, pulmonary cases without HIV co-infection, presenting milder symptoms, users of alcoholic beverages and tobacco, those who did not perform preventive health control, and who sought health services closer to home. The recognition of users' profiles in the search for care is paramount for defining strategies that favor the use of services in a timely manner.

[Tuberculosis diagnosis and performance assessment of the first health service used by patients in São José do Rio Preto, São Paulo State, Brazil]. / Diagnóstico da tuberculose: desempenho do primeiro serviço de saúde procurado em São José do Rio Preto, São Paulo, Brasil.

This cross-sectional study aimed to analyze the first health service to which patients turned for tuberculosis diagnosis in São José do Rio Preto, São Paulo, Brazil, 2009. Eighty-one patients in treatment were interviewed with a questionnaire based on the Primary Care Assessment Tool adapted to TB care and used as a reference for health services performance (structure and process). Data analysis used descriptive and multiple correspondence techniques. Nearly half of the patients initially came to emergency care departments (49.4%), and most TB diagnoses were made in hospitals (39.5%) and primary care services (30.9%). Specialized services were associated with the best diagnostic performance, as opposed to emergency departments, with the worst performance. Primary care services were associated with intermediate performance and weaknesses in infrastructure. The reach of effective detection of TB cases in the portals of entry into the health system involves enhanced diagnostic suspicion, thus emphasizing the need for investments in the management of human resources training for the identification of individuals with respiratory symptoms.

Diagnóstico da tuberculose: desempenho do primeiro serviço de saúde procurado em São José do Rio Preto, São Paulo, Brasil / Tuberculosis diagnosis and performance assessment of the first health service used by patients in São José do Rio Preto, São Paulo State, Brazil / Diagnóstico de la tuberculosis: desempeño del primer servicio de salud solicitado en São José do Rio Preto, São Paulo, Brasil

This cross-sectional study aimed to analyze the first health service to which patients turned for tuberculosis diagnosis in São José do Rio Preto, São Paulo, Brazil, 2009. Eighty-one patients in treatment were interviewed with a questionnaire based on the Primary Care Assessment Tool adapted to TB care and used as a reference for health services performance (structure and process). Data analysis used descriptive and multiple correspondence techniques. Nearly half of the patients initially came to emergency care departments (49.4%), and most TB diagnoses were made in hospitals (39.5%) and primary care services (30.9%). Specialized services were associated with the best diagnostic performance, as opposed to emergency departments, with the worst performance. Primary care services were associated with intermediate performance and weaknesses in infrastructure. The reach of effective detection of TB cases in the portals of entry into the health system involves enhanced diagnostic suspicion, thus emphasizing the need for investments in the management of human resources training for the identification of individuals with respiratory symptoms.

Estudo transversal com objetivo de analisar o desempenho do primeiro serviço de saúde procurado para o diagnóstico da TB pulmonar em São José do Rio Preto, São Paulo, Brasil, em 2009. Foram entrevistados 81 doentes em tratamento. Adotou-se um questionário baseado no Primary Care Assessment Tool, adaptado para atenção à TB, e o referencial de avaliação dos serviços de saúde (estrutura e processo). Os dados foram analisados mediante técnicas descritivas e análise de correspondência múltipla. O principal serviço procurado foi o Pronto Atendimento (UPA) (49,4%) e o que mais diagnosticou os casos de TB foi o hospital (39,5%) e a atenção básica (30,9%). Os serviços especializados apresentaram associação com o melhor desempenho no diagnóstico e a UPA com o pior. A atenção básica associou-se com desempenho intermediário e fragilidades na estrutura. O alcance de uma detecção eficaz dos casos de TB nas principais portas de entrada perpassa pela melhoria na suspeição, reforçando a necessidade de investimentos da gestão na capacitação dos recursos humanos para a identificação dos sintomáticos respiratórios.

Estudio transversal con el objetivo de analizar el desempeño del primer servicio de salud solicitado para el diagnóstico de la TB pulmonar en São José do Rio Preto, São Paulo, Brasil, en 2009. Se entrevistaron a 81 enfermos en tratamiento. Se adoptó un cuestionario basado en el Primary Care Assessment Tool, adaptado para atención a la TB, y el referencial de evaluación de los servicios de salud (estructura y proceso). Los datos se analizaron mediante técnicas descriptivas y análisis de correspondencia múltiple. El principal servicio solicitado fueron las urgencias (Pronto Atendimento-UPA) en un 49,4% y el que más diagnosticó los casos de TB fue el hospital (39,5%) y la atención primaria (30,9%). Los servicios especializados presentaron una asociación con el mejor desempeño en el diagnóstico y la UPA con el peor. La atención básica se asoció con un desempeño intermedio y puntos débiles en la estructura. El alcance de una detección eficaz de los casos de TB, en las principales vías de acceso a los servicios sanitarios, pasa por la mejoría en la capacidad de inferencia de los síntomas, reforzando la necesidad de inversiones base en la capacitación de recursos humanos para la identificación de la sintomatología respiratoria.

Atraso na procura pelo primeiro atendimento para o diagnóstico da tuberculose / Delay in seeking initial care for tuberculosis diagnosis / Demora en la búsqueda de la primera consulta para el diagnóstico de la tuberculosis

Estudo descritivo que objetivou analisar o tempo decorrido entre a percepção dos sintomas da tuberculose (TB) e a primeira busca por serviço de saúde segundo características dos doentes com TB em São José do Rio Preto - SP. Entrevistaram-se 97 doentes com TB utilizando instrumento estruturado. Identificou-se atraso do doente pela mediana do tempo entre a percepção dos sintomas e busca por atendimento (> 15 dias). Calculou-se a razão de prevalência para identificar variáveis relacionadas ao atraso. Houve atraso entre: doentes do sexo masculino, com 18 a 29 e 50 a 59 anos, baixa escolaridade, maior renda familiar, casos pulmonares, não coinfectados com HIV, sintomas fracos, consumidores de bebidas alcoólicas e tabaco, que não realizavam controle preventivo de saúde e procuravam o serviço de saúde mais próximo do domicílio. O reconhecimento do perfil dos usuários na busca por atendimento é primordial para definir estratégias que favoreçam a utilização dos serviços em momento oportuno.

Descriptive study, which aimed to analyze the time between the perception of TB symptoms onset and the first search for health services, according to TB patient characteristics in São José do Rio Preto - SP. 97 TB patients in treatment were interviewed with a structured instrument. The delay was identified by the median time between the perception of TB symptom's onset and the patients demand for care (> 15 days). To identify the variables related to delay the prevalence ratio were calculated. There was a delay seeking care among: male patients, aged 18 to 29 and 50 to 59 years, lower education and higher family income, pulmonary cases without HIV co-infection, presenting milder symptoms, users of alcoholic beverages and tobacco, those who did not perform preventive health control, and who sought health services closer to home. The recognition of users' profiles in the search for care is paramount for defining strategies that favor the use of services in a timely manner.

Estudio descriptivo objetivando analizar el tiempo transcurrido entre la percepción de los primeros síntomas de tuberculosis (TB) y la búsqueda de una primera consulta en servicios de salud, según características de los enfermos de TB en São José de Rio Preto-SP. Fueron entrevistados 97 enfermos de TB, utilizándose instrumento estructurado. Se identificó atraso del enfermo por la mediana de tiempo entre percepción de síntomas y búsqueda de atención (>15 días). Se calculó la razón prevalente para identificar variables relacionadas al atraso. Existió atraso entre: enfermos masculinos, con 18 a 29 y 50 a 59 años, baja escolarización, mayor renta familiar, casos pulmonares, no coinfectados con HIV, síntomas débiles, consumidores de alcohol y tabaco, sin control sanitario preventivo, buscando servicio de salud próximo al domicilio. El reconocimiento del perfil de pacientes buscando atención es primordial para definir estrategias que favorezcan la utilización de los servicios en el momento oportuno.