RESUMEN
BACKGROUND: The early identification of the Breathing Symptoms within the scope of Primary Health Care is recommended, and is also one of the strategies of national sanitary authorities for reaching the elimination of tuberculosis. The purpose of this study is to consider which attributes and which territories have shown the most significant progress in Primary Health Care, in terms of coordination of Health Care Networks, and also check if those areas of Primary Health Care that are most critical regarding coordination, there were more or less cases of avoidable hospitalizations for tuberculosis. METHODS: This is an ecological study that uses primary and secondary data. For analysis, coropletic maps were developed through the ArcGIS software, version 10.2. There was also the calculation of gross annual and Bayesian rates for hospitalizations for tuberculosis, for each Primary Health Care territory. RESULTS: There were satisfactory results for attributes such as Population (n = 37; 80.4 %), Primary Health Care (n = 43; 93.5 %), Support System (n = 45; 97.8 %); the exceptions were Logistics System (n = 32; 76.0 %) and Governance System, with fewer units in good condition (n = 31; 67.3 %). There is no evidence of any connection between networks' coordination by Primary Health Care and tuberculosis avoidable admissions. CONCLUSION: The results show that progress has been made regarding the coordination of the Health Care Networks, and a positive trend has been shown, even though the levels are not excellent. It was found no relationship between the critical areas of Primary Health Care and tuberculosis avoidable hospitalizations, possibly because other variables necessary to comprehend the phenomena.
Asunto(s)
Prestación Integrada de Atención de Salud , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Tuberculosis/diagnóstico , Teorema de Bayes , Brasil/epidemiología , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Encuestas Epidemiológicas , Hospitalización , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Tuberculosis/epidemiología , Tuberculosis/prevención & controlRESUMEN
INTRODUCTION: Tuberculosis (TB) is the primary cause of death among infectious diseases affecting groups in extreme poverty. Social improvements could reverse this situation in Brazil. This study aims to demonstrate the spatial relationship between social development (SD) and TB mortality in Natal, a city in northeastern Brazil. METHODOLOGY: Ecological study. The study population comprised TB deaths recorded in the Mortality Information System between 2008 and 2014. The units of analysis were 59 human development units (HDUs). Raw and smoothed mortality rates were calculated using the global empirical Bayes method. Primary components analysis was used to develop the SD indicators. An association between TB mortality and SD was verified using multiple linear regression analysis. Spatial autocorrelation was verified using models with global spatial effects. Analyses were performed using Statistica version 12.0, ArcGIS version 10.2, Statistical Package for the Social Sciences version 20.0, and OpenGeoDa 1.0.1. The significance level was established at 5% (p < 0.05). RESULTS: The TB mortality rate with non-random spatial distribution ranged between 0.52 and 8.90 per 100,000 inhabitants. The spatial lag model was chosen because it presented the highest log-likelihood value, lowest AIC, and highest R2. A negative association was found between TB mortality and SD (R2 = 0.207; p = 0.03). CONCLUSIONS: The results show a negative association between TB mortality and the high SD indicator. This study can support decision-making in terms of collective projects within public health in order to link the health field to other sectors, aiming for social well-being and human development.
Asunto(s)
Tuberculosis/mortalidad , Urbanización , Teorema de Bayes , Brasil/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Análisis EspacialRESUMEN
OBJECTIVES: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. METHODS: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten's regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. RESULTS: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. CONCLUSIONS: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.
Asunto(s)
Tuberculosis/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Espacio-Temporal , Adulto JovenRESUMEN
The study proposed to identify the prevalence of latent tuberculosis infection (LTBI) in persons living with HIV/AIDS (PLWHA), associated factors, and progression to active tuberculosis among the identified cases. This was an epidemiological and descriptive study. The study population consisted of PLWHA seen from 2003 and 2014 in a reference center for HIV/AIDS. Data were collected from patient files and the Brazilian Information System for Notifiable Diseases (SINAN). Bivariate statistical analysis used the chi-square test in which variables with p < 0.2 were selected to enter the multiple regression model. Type I error was set at 5% (p < 0.05) for all the tests. In the study, 690 cases were analyzed, and 66 (9.4%) had a diagnosis of LTBI, with a prevalence of 7.5 cases per 100 patients. Of the 53 cases (80.3%) of LTBI who were prescribed treatment with isoniazid, only 26 (39.4%) concluded treatment, and 10 (15.1%) dropped out. Male gender (adjusted OR = 1.8; 95%CI: 1.1-3.3), current incarceration (adjusted OR = 7.6; 95%CI: 2.35-24.9), and high lymphocyte count were associated with LTBI diagnosis (adjusted OR = 1.1; 95%CI: 1.1-1.2). Forty-seven (6.7%) of LTBI cases progressed to active TB. Diagnosis and treatment of LTBI in PLWHA were not prioritized, which contributed to the development of active disease among cases. The study contributed to knowledge on LTBI in PLWHA, demonstrating crucial aspects in the management of PLWHA and the importance of detecting LTBI and early initiation of isoniazid, aimed at improved quality of life and prognosis for PLWHA.
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Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Tuberculosis Latente/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapéutico , Brasil/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Tuberculosis Latente/tratamiento farmacológico , Masculino , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
INTRODUCTION: Tuberculosis (TB) is the most common infectious disease in the world. We aimed to analyze the spatial risk of tuberculosis mortality and to verify associations in high-risk areas with social vulnerability. METHODS: This was an ecological study. The scan statistic was used to detect areas at risk, and the Bivariate Moran Index was used to verify relationships between variables. RESULTS: High-risk areas of tuberculosis mortality were statistically significantly associated with domain 2 of the Social Vulnerability Index (I=0.010; p=0.001). CONCLUSIONS: This study provides evidence regarding areas with high risk and that vulnerability is a determinant of TB mortality.
Asunto(s)
Tuberculosis/etiología , Tuberculosis/mortalidad , Poblaciones Vulnerables/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Demografía , Femenino , Sistemas de Información Geográfica , Humanos , Lactante , Masculino , Persona de Mediana Edad , Medición de Riesgo/métodos , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Análisis Espacial , Adulto JovenRESUMEN
BACKGROUND: Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. METHODS: Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. RESULTS: A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). CONCLUSION: These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.
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Lepra/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Femenino , Humanos , Lactante , Lepra/transmisión , Masculino , Persona de Mediana Edad , Medición de Riesgo , Análisis Espacial , Topografía Médica , Adulto JovenRESUMEN
The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.
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Autoinforme , Estigma Social , Tuberculosis , Adulto , Brasil , Características Culturales , Femenino , Humanos , Masculino , Persona de Mediana Edad , TraduccionesRESUMEN
INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations.
Asunto(s)
Tuberculosis Pulmonar/mortalidad , Brasil/epidemiología , Humanos , Estudios Prospectivos , Factores Socioeconómicos , Agrupamiento Espacio-TemporalRESUMEN
OBJECTIVE: to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirão Preto, Brazil. METHOD: an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate. RESULTS: of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality. CONCLUSION: the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies.
Asunto(s)
Tuberculosis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Causas de Muerte , Femenino , Sistemas de Información Geográfica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To characterize deaths from pulmonary tuberculosis, according to sociodemographic and operational variables, in the city of São Luís, Brazil, and to describe their spatial distribution. METHODS: This was an exploratory ecological study based on secondary data from death certificates, obtained from the Brazilian Mortality Database, related to deaths from pulmonary tuberculosis. We included all deaths attributed to pulmonary tuberculosis that occurred in the urban area of São Luís between 2008 and 2012. We performed univariate and bivariate analyses of the sociodemographic and operational variables of the deaths investigated, as well as evaluating the spatial distribution of the events by kernel density estimation. RESULTS: During the study period, there were 193 deaths from pulmonary tuberculosis in São Luís. The median age of the affected individuals was 52 years. Of the 193 individuals who died, 142 (73.60%) were male, 133 (68.91%) were Mulatto, 102 (53.13%) were single, and 64 (33.16%) had completed middle school. There was a significant positive association between not having received medical care prior to death and an autopsy having been performed (p = 0.001). A thematic map by density of points showed that the spatial distribution of those deaths was heterogeneous and that the density was as high as 8.12 deaths/km2. CONCLUSIONS: The sociodemographic and operational characteristics of the deaths from pulmonary tuberculosis evaluated in this study, as well as the identification of priority areas for control and surveillance of the disease, could promote public health policies aimed at reducing health inequities, allowing the optimization of resources, as well as informing decisions regarding the selection of strategies and specific interventions targeting the most vulnerable populations.
Asunto(s)
Tuberculosis Pulmonar/mortalidad , Análisis de Varianza , Autopsia , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia , Distribución por Sexo , Factores Socioeconómicos , Tuberculosis Pulmonar/prevención & controlRESUMEN
BACKGROUND: In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the "Pact for life" (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. CONCLUSIONS/SIGNIFICANCE: The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Lepra/epidemiología , Lepra/prevención & control , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Servicios de Salud Comunitaria , Estudios Transversales , Femenino , Humanos , Lepra/terapia , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten's regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.
RESUMO Objetivos: descrever o perfil epidemiológico da mortalidade por tuberculose (TB), analisar o padrão espacial dessas mortes e investigar a tendência temporal da mortalidade por tuberculose no Nordeste do Brasil. Métodos: estudo ecológico baseado em dados secundários de mortalidade. As mortes por TB foram incluídas no estudo. As estatísticas descritivas e as taxas brutas de mortalidade foram calculadas e suavizadas pelo Método Bayesiano Empírico Local. A regressão de Prais-Winsten foi utilizada para analisar a tendência temporal dos coeficientes de mortalidade por tuberculose. A técnica de densidade de Kernel foi utilizada para analisar a distribuição espacial da mortalidade por TB. Resultados: a tuberculose foi citada em 236 óbitos. A maioria das mortes por tuberculose ocorreu entre os homens, solteiros, de etnia mista e média de idade de 51 anos. As mortes por tuberculose concentraram-se nos distritos de saúde leste, oeste e norte e o coeficiente de mortalidade por tuberculose permaneceu estacionário ao longo do período de estudo. Conclusões: as análises do padrão espacial e da tendência temporal da mortalidade revelaram áreas com maiores taxas de mortalidade por TB, as quais devem ser priorizadas para intervenções de saúde pública visando o controle da doença.
RESUMEN Objetivos: describir el perfil epidemiológico de la mortalidad por tuberculosis (TB), analizar el patrón espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Métodos: estudio ecológico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadísticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Método Bayesiano Empírico Local. La regresión de Prais-Winsten se utilizó para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La técnica de densidad de Kernel se utilizó para analizar la distribución espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen étnico mixto y la edad media al momento de la muerte fue de 51 años. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el período de estudio. Conclusiones: los análisis del patrón espacial y la tendencia temporal de la mortalidad revelaron que ciertas áreas con tasas más altas de mortalidad por TB y, por lo tanto, deberían ser priorizadas en las intervenciones de salud pública dirigidas a esta enfermedad.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Tuberculosis/prevención & control , Análisis Espacial , Sistemas de Información en Salud/organización & administración , Estudios de Series Temporales , Mortalidad/tendencias , Sistemas de Información Geográfica/estadística & datos numéricosRESUMEN
Propôs-se verificar como a incidência e mortalidade por tuberculose (TB) se comportam em áreas cobertas pela Estratégia Saúde da Família e Bolsa Família, com ou sem desigualdade de renda. Estudo ecológico dos 26 Estados federados e o Distrito Federal do Brasil. Foram empregadas análises univariadas, multivariadas e análises espaciais. Na análise univariada, calculou-se a medida de posição (mediana) e a medida de dispersão (amplitude) das variáveis. Na análise multivariada, identificou-se sete grupos através da análise de agrupamento pelo método hierárquico. A construção dos mapas temáticos demonstrou uma distribuição heterogênea entre os grupos, devido às características particulares. O estudo evidenciou a realidade epidemiológica da TB no Brasil e seu comportamento em áreas cobertas pela Estratégia Saúde da Família e Programa Bolsa Família. Não observou diferenças no que se refere à incidência e mortalidade quando satisfatória cobertura desses programas, o que evidencia a relação da doença a outros determinantes.
This study aimed to verify tuberculosis (TB) incidence and mortality behavior in areas covered by the Family Health Strategy and Bolsa Família Program, with or with no income inequality. This is an ecological study of the 26 Brazilian federal states and the Federal District. We used univariate, multivariate and spatial analyzes. We calculated the univariate analysis, the measure of position (median) and the measure of dispersion (amplitude) of the variables. In the multivariate analysis, seven groups were identified through hierarchical grouping analysis. The thematic maps construction showed a heterogeneous distribution between the groups due to the specific characteristics. The study evidenced the epidemiological TB reality in Brazil and its behavior in areas covered by the Family Health Strategy and Bolsa Família Program. No differences were observed in incidence and mortality when coverage of these programs was satisfactory, which evidences the disease relation to other determinants.
Asunto(s)
Humanos , Tuberculosis/economía , Tuberculosis/mortalidad , Tuberculosis/epidemiología , Estrategias de Salud Nacionales , Programas de Gobierno , Brasil , RentaRESUMEN
Resumo: Propôs-se levantar a prevalência de infecção latente por tuberculose (ILTB) entre pessoas vivendo com HIV/AIDS (PVHA), fatores associados e se entre os casos identificados houve progressão para tuberculose ativa. Trata-se de estudo epidemiológico e descritivo. A população foi composta de PVHA, atendidas entre 2003 e 2014 em um centro de referência para HIV/AIDS. Os dados foram coletados com base em prontuários e fichas do Sistema de Informação de Agravos de Notificação (SINAN). Procedeu-se à estatística bivariada, com aplicação do teste qui-quadrado, em que as variáveis com valores de p < 0,2 foram selecionadas para entrar no modelo de regressão múltipla. Foi fixado em todos os testes o erro tipo I em 5% (p < 0,05). No estudo, 690 casos foram analisados, sendo que 66 (9,4%) apresentaram o diagnóstico de ILTB, tendo uma prevalência de 7,5 casos para cada 100 pacientes. Dos 53 (80,3%) casos de ILTB que tiveram o tratamento indicado com isoniazida, apenas 26 (39,4%) concluíram e 10 (15,1%) abandonaram. Observou-se que as variáveis sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situação prisional (OR ajustado = 7,6; IC95%: 2,35-24,9) e contagem de linfócitos mais altos são fatores associados ao diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Verificou-se que 47 (6,7%) dos casos de ILTB progrediram para TB ativa. O diagnóstico e o tratamento de ILTB nas PVHA não foram priorizados, o que contribuiu para o desenvolvimento de doença ativa entre os casos. O trabalho contribuiu para o avanço do conhecimento acerca da ILTB entre PVHA, demonstrando aspectos cruciais no que tange ao manejo de PVHA e ainda a importância da detecção da ILTB e a instituição precoce da isoniazida, visando à melhor qualidade de vida e prognóstico das PVHA.
Abstract: The study proposed to identify the prevalence of latent tuberculosis infection (LTBI) in persons living with HIV/AIDS (PLWHA), associated factors, and progression to active tuberculosis among the identified cases. This was an epidemiological and descriptive study. The study population consisted of PLWHA seen from 2003 and 2014 in a reference center for HIV/AIDS. Data were collected from patient files and the Brazilian Information System for Notifiable Diseases (SINAN). Bivariate statistical analysis used the chi-square test in which variables with p < 0.2 were selected to enter the multiple regression model. Type I error was set at 5% (p < 0.05) for all the tests. In the study, 690 cases were analyzed, and 66 (9.4%) had a diagnosis of LTBI, with a prevalence of 7.5 cases per 100 patients. Of the 53 cases (80.3%) of LTBI who were prescribed treatment with isoniazid, only 26 (39.4%) concluded treatment, and 10 (15.1%) dropped out. Male gender (adjusted OR = 1.8; 95%CI: 1.1-3.3), current incarceration (adjusted OR = 7.6; 95%CI: 2.35-24.9), and high lymphocyte count were associated with LTBI diagnosis (adjusted OR = 1.1; 95%CI: 1.1-1.2). Forty-seven (6.7%) of LTBI cases progressed to active TB. Diagnosis and treatment of LTBI in PLWHA were not prioritized, which contributed to the development of active disease among cases. The study contributed to knowledge on LTBI in PLWHA, demonstrating crucial aspects in the management of PLWHA and the importance of detecting LTBI and early initiation of isoniazid, aimed at improved quality of life and prognosis for PLWHA.
Resumen: Se propone averiguar la prevalencia de infección latente por tuberculosis (ILTB) entre personas viviendo con VIH/SIDA (PVVS), sus factores asociados, y si entre los casos identificados hubo progresión hacia la tuberculosis activa. Se trata de un estudio epidemiológico y descriptivo. La población estaba compuesta de PVVS, atendidas entre 2003 y 2014 en un centro de referencia para VIH/SIDA. Los datos fueron recogidos en base a historiales clínicos y fichas del Sistema Brasileiro de Información de Enfermedades de Notificación Obligatoria (SINAN). Se procedió a una estadística bivariada, con aplicación del test chi-cuadrado, donde las variables con valores de p < 0,2 fueron seleccionadas para entrar en el modelo de regresión múltiple. Se fijó en todos los tests el error tipo I en un 5% (p < 0,05). En el estudio, se analizaron 690 casos, donde 66 (un 9,4%) presentaron el diagnóstico de ILTB, teniendo una prevalencia de 7,5 casos para cada 100 pacientes. De los 53 (80,3%) casos de ILTB que tuvieron el tratamiento indicado con isoniazida, sólo 26 (39,4%) lo concluyeron y 10 (15,1%) lo abandonaron. Se observó que las variables sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situación en régimen de prisión (OR ajustado = 7,6; IC95%: 2,35-24,9) y un cómputo de linfocitos más altos son factores asociados al diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Se verificó que 47 (6,7%) de los casos de ILTB progresaron hacia una tuberculosis activa. El diagnóstico y el tratamiento de ILTB en las PVVS no fueron priorizados, lo que contribuyó al desarrollo de la enfermedad activa entre los casos. El trabajo contribuyó al avance del conocimiento acerca de la ILTB entre PVVS, demostrando aspectos cruciales en lo que atañe al manejo de PVVS, e incluso la importancia de la detección de ILTB y la administración precoz de la isoniazida, con el fin de mejorar la calidad de vida y el pronóstico de las PVVS.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Tuberculosis Latente/epidemiología , Brasil/epidemiología , Prevalencia , Factores de Riesgo , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Progresión de la Enfermedad , Tuberculosis Latente/tratamiento farmacológico , Antituberculosos/uso terapéuticoRESUMEN
Abstract INTRODUCTION: Tuberculosis (TB) is the most common infectious disease in the world. We aimed to analyze the spatial risk of tuberculosis mortality and to verify associations in high-risk areas with social vulnerability. METHODS: This was an ecological study. The scan statistic was used to detect areas at risk, and the Bivariate Moran Index was used to verify relationships between variables. RESULTS: High-risk areas of tuberculosis mortality were statistically significantly associated with domain 2 of the Social Vulnerability Index (I=0.010; p=0.001). CONCLUSIONS: This study provides evidence regarding areas with high risk and that vulnerability is a determinant of TB mortality.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Tuberculosis/etiología , Tuberculosis/mortalidad , Poblaciones Vulnerables/estadística & datos numéricos , Factores Socioeconómicos , Brasil/epidemiología , Demografía , Factores de Riesgo , Distribución por Sexo , Distribución por Edad , Medición de Riesgo/métodos , Sistemas de Información Geográfica , Análisis Espacial , Persona de Mediana EdadRESUMEN
Resumo O processo de estigmatização associado à tuberculose tem sido pouco valorizado em pesquisas nacionais, sendo esse um aspecto social importante para o controle da doença, sobretudo nas populações marginalizadas. Este artigo apresenta as fases do processo de adaptação cultural para o Brasil da escala Tuberculosis-related stigma para doentes com tuberculose. Trata-se de um estudo metodológico, em que foram realizadas a tradução e a retrotradução dos itens da escala e validação semântica com 17 sujeitos da população-alvo. Após a tradução, a versão conciliada retrotraduzida foi comparada com a versão original pela coordenadora do projeto no Sul da Tailândia, que deu seu parecer favorável para a versão final em português do Brasil. A partir dos resultados da validação semântica, realizada com os doentes de tuberculose, pode-se identificar que, de forma geral, a escala foi bem aceita e de fácil compreensão por parte dos participantes.
Abstract The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Tuberculosis , Autoinforme , Estigma Social , Traducciones , Brasil , Características CulturalesRESUMEN
Objective: to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirão Preto, Brazil.Method: an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate.Results: of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality.Conclusion: the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies.
Objetivo: caracterizar as diferenças do perfil clínico e epidemiológico dos casos de óbitos que tiveram a tuberculose como causa básica e causa associada, e analisar a distribuição espacial dos casos de óbito por tuberculose nos territórios de Ribeirão Preto, SP.Método: trata-se de estudo ecológico em que a população foi composta por 114 casos de óbito por tuberculose. Realizaram-se análise bivariada e da densidade de pontos definidas como estimativa de Kernel.Resultados: dos casos de óbito por tuberculose, 50 foram causa básica e 64 associada. Idade (p=0,008) e setor responsável pelo atestado do óbito (p=0,003) foram as variáveis que apresentaram associação estatisticamente significante com a causa do óbito. A distribuição espacial, em ambos os eventos, não ocorreu de forma aleatória, formando clusters em regiões do município.Conclusão: a diferença no perfil dos casos de óbito por tuberculose, como causa básica e como causa associada, esteve pautada na idade e no setor responsável pelo preenchimento da Declaração de Óbito. A não aleatoriedade da distribuição espacial dos casos sugere áreas vulneráveis à ocorrência desses eventos. Conhecer essas áreas pode contribuir para a escolha de estratégias de controle da doença.
Objetivo: caracterizar las diferencias del perfil clínico y epidemiológico de los casos de muertes que tuvieron la tuberculosis como causa básica y causa asociada, y analizar la distribución espacial de los casos de muerte por tuberculosis en los territorios de Ribeirao Preto, SP.Método: se trata de estudio ecológico en que la población fue compuesta por 114 casos de muerte por tuberculosis. Se realizaron análisis bivariados y de densidad de puntos definidas como estimativa de Kernel.Resultados: entre los casos de muerte por tuberculosis, 50 tuvieron causa básica y 64 asociada. La edad (p=0,008) y el sector responsable por el certificado de defunción (p=0,003) fueron las variables que presentaron asociación estadísticamente significativa con la causa de la muerte. La distribución espacial, en los dos eventos, no ocurrió de forma aleatoria, formando clusters en regiones del municipio.Conclusión: la diferencia en el perfil de los casos de muerte por tuberculosis, como causa básica y como causa asociada, estuvo vinculada con la edad y el sector responsable por el llenado del Certificado de Defunción. La no aleatoriedad de la distribución espacial de los casos sugiere áreas vulnerables a la ocurrencia de esos eventos. Conocer esas áreas puede contribuir para poder elegir estrategias de control de la enfermedad.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Tuberculosis/mortalidad , Brasil/epidemiología , Causas de Muerte , Sistemas de Información GeográficaRESUMEN
INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations. .
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Depresión/mortalidad , Frecuencia Cardíaca , Distribución de Chi-Cuadrado , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/psicología , Depresión/fisiopatología , Frecuencia Cardíaca/fisiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
OBJECTIVE: To characterize deaths from pulmonary tuberculosis, according to sociodemographic and operational variables, in the city of São Luís, Brazil, and to describe their spatial distribution. METHODS: This was an exploratory ecological study based on secondary data from death certificates, obtained from the Brazilian Mortality Database, related to deaths from pulmonary tuberculosis. We included all deaths attributed to pulmonary tuberculosis that occurred in the urban area of São Luís between 2008 and 2012. We performed univariate and bivariate analyses of the sociodemographic and operational variables of the deaths investigated, as well as evaluating the spatial distribution of the events by kernel density estimation. RESULTS: During the study period, there were 193 deaths from pulmonary tuberculosis in São Luís. The median age of the affected individuals was 52 years. Of the 193 individuals who died, 142 (73.60%) were male, 133 (68.91%) were Mulatto, 102 (53.13%) were single, and 64 (33.16%) had completed middle school. There was a significant positive association between not having received medical care prior to death and an autopsy having been performed (p = 0.001). A thematic map by density of points showed that the spatial distribution of those deaths was heterogeneous and that the density was as high as 8.12 deaths/km2. CONCLUSIONS: The sociodemographic and operational characteristics of the deaths from pulmonary tuberculosis evaluated in this study, as well as the identification of priority areas for control and surveillance of the disease, could promote public health policies aimed at reducing health inequities, allowing the optimization of resources, as well as informing decisions regarding the selection of strategies and specific interventions targeting the most vulnerable populations. .
OBJETIVO: Caracterizar os óbitos por tuberculose pulmonar em São Luís (MA) segundo variáveis sociodemográficas e operacionais e descrever sua distribuição espacial. MÉTODOS: Estudo ecológico e exploratório baseado em dados secundários oriundos das declarações de óbitos por tuberculose pulmonar do Sistema de Informação sobre Mortalidade. Foram incluídos todos os óbitos por tuberculose pulmonar ocorridos na zona urbana de São Luís entre 2008 e 2012. Foram realizadas análises univariadas e bivariadas das variáveis sociodemográficas e operacionais dos óbitos investigados e a distribuição espacial dos eventos por kernel density estimation. RESULTADOS: No período estudado, foram registrados 193 óbitos. A mediana de idade foi de 52 anos. Dos 193 indivíduos, 142 (73,60%) eram do sexo masculino, 133 (68,91%) da raça/cor parda, 102 (53,13%) eram solteiros, e 64 (33,16%) haviam completado o ensino fundamental. Observou-se que não ter recebido assistência médica antes do óbito teve uma associação estatisticamente significativa com a realização de necropsia (p = 0,001). O mapa temático por densidade de pontos demonstrou uma heterogeneidade na distribuição espacial dos óbitos, com taxas de até 8,12 óbitos/km2. CONCLUSÕES: As características sociodemográficas e operacionais dos óbitos por tuberculose pulmonar evidenciadas nessa investigação, bem como a identificação dos locais prioritários para o controle e a vigilância da doença, poderão auxiliar a gestão pública na diminuição das iniquidades em saúde e permitir uma otimização dos recursos, fornecendo subsídios para a escolha de estratégias e intervenções ...
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Pulmonar/mortalidad , Análisis de Varianza , Autopsia , Brasil/epidemiología , Características de la Residencia , Distribución por Sexo , Factores Socioeconómicos , Tuberculosis Pulmonar/prevención & controlRESUMEN
A tuberculose é uma doença infecciosa e contagiosa intimamente relacionada a condições de pobreza, tendo como um dos maiores problemas o abandono do tratamento. Com o objetivo de descrever os principais fatores associados ao abandono do tratamento da tuberculose pulmonar apontados pela literatura científica, se realizou esta revisão integrativa. Os resultados apontam a história de abandono prévio, uso de álcool e outras drogas, baixa escolaridade e melhora dos sintomas clínicos da doença como os principais fatores associados ao abandono. A identificação das pessoas com maior risco para abandonar o tratamento, deve ser prática no cotidiano dos serviços de saúde, em especial na atenção básica, que atualmente é a grande responsável pelo controle da tuberculose no Brasil.
Tuberculosis is an infectious and contagious disease deeply related to poverty, having as one of the most important problems the treatment dropout. In order to describe the main factors associated with treatment abandonment of pulmonary tuberculosis appointed by the scientific literature, this integrative review was performed. The results show the history of previous noncompliance, use of alcohol and other drugs, low education and improvement of the clinical symptoms of the disease as main factors associated with noncompliance. The identification of individuals at higher risk for abandoning treatment should be practical in everyday health services, especially in primary care, which is currently largely responsible for tuberculosis control in Brazil.
La tuberculosis es una enfermedad infecciosa y contagiosa muy relacionada con las condiciones de pobreza, teniendo como uno de los mayores problemas el abandono del tratamiento. A fin de describir los principales factores asociados con el abandono del tratamiento de la tuberculosis pulmonar señalados por la literatura científica, se realizó esta revisión integradora. Los resultados muestran la historia de abandono previo, el uso de alcohol y otras drogas, el bajo nivel educativo y la mejora de los síntomas clínicos de la enfermedad como los principales factores asociados con el abandono. La identificación de las personas en mayor riesgo de abandono del tratamiento debe ser práctica en los servicios de salud, especialmente en la atención primaria que actualmente es en gran medida responsable del control de la tuberculosis en Brasil.