Protocol for pragmatic randomized clinical trial to evaluate the completion of treatment of latent Mycobacterium tuberculosis infection with Isoniazid in the 300 mg formulation.

INTRODUCTION: It is essential to strengthen the treatment of latent tuberculosis infection (LTBI) to break the chain of transmission. The drug used worldwide for the treatment of LTBI is Isoniazid. A clinical trial conducted in Brazil has demonstrated the bioequivalence of Isoniazid in the 300 mg formulation with 3 tablets in the 100 mg formulation. Further studies are needed to evaluate the completion of treatment with Isoniazid 300 mg single tablet. OBJECTIVE: Describing a protocol for a clinical trial to evaluate the completion of treatment of LTBI with the drug Isoniazid in 300 mg tablet formulation compared to the use of Isoniazid in 100 mg tablet formulation. METHODS: This is a pragmatic, multicenter, randomized, open-label clinical trial registered on the Rebec RBR-2wsdt6 platform. Individuals 18 years of age or older with an indication for treatment of LTBI will be included, with only 1 individual per family nucleus. Individuals whose index case of active TB is categorized as retreatment, multidrug-resistant and extremely resistant, individuals transferred from the original center two or more weeks after the onset of treatment, and persons deprived of liberty will be excluded. The study intervention will be the treatment of LTBI with 1 tablet of Isoniazid 300 mg. The control group will receive the treatment of LTBI with 3 tablets of Isoniazid 100 mg. Follow-up will be performed at month 1, month 2 and at the end of treatment. The primary outcome will be completion of treatment. CONCLUSION: It is expected that with the treatment with the 300 mg formulation, more patients will complete the treatment based on the complexity index of pharmacotherapy. Our study intends to substantiate theoretical and operational strategies that respond to the demand for incorporation of a new formulation of the drug for the treatment of LTBI in the Unified Health System network.

Development and content validation of a mobile application for monitoring latent tuberculosis treatment.

BACKGROUND: Non-compliance with latent tuberculosis infection (LTBI) treatment is a reality. The objective of this study was to develop and validate an mobile device application for monitoring the treatment of LTBI. METHODS: We defined the requirements, elaborated on the application's conceptual map, generated implementation and prototyping alternatives, and validated content. RESULTS: Feedback on the validity of content were: "usefulness, consistency, clarity, objectivity, vocabulary, and precision" from professionals, and "clarity" from patients. CONCLUSIONS: The application proved to be easy to understand, according to the assessment of both professionals and people undergoing treatment for LTBI.

Access to government social programs and the tuberculosis control program: a multicenter study.

OBJECTIVES: to analyze government social initiatives aimed at people with tuberculosis and the possibilities of access to government social programs and income transfers through the perception of tuberculosis program managers. METHODS: descriptive, qualitative study with 19 managers from Belém, Recife, Campo Grande, and Rio de Janeiro, Brazil. Thematic content analysis was used. RESULTS: there is no specific government social support for people with tuberculosis; the benefits are intended for people in social vulnerability. There are partnerships between the institutions of the secondary social healthcare network, social assistance, and community institutions. FINAL CONSIDERATIONS: the support of official bodies is important for the control of tuberculosis; however, the profile of people's vulnerability is a determining factor for access to/destination of resources from these government social support programs.

ICNP® terminology subset for people with tuberculosis.

OBJECTIVES: to develop an ICNP® terminology subset to care for people with tuberculosis. METHODS: a methodological research that followed the following steps: identification and validation of empirical indicators of altered needs relevant to people with tuberculosis based on literature; cross-mapping of the empirical indicators of altered needs identified with ICNP® 2017 terms; construction of nursing diagnoses/outcomes and interventions; assessment of relevance of nursing diagnoses /outcomes and interventions and ICNP® terminology subset structuring. RESULTS: an ICNP® terminology subset was developed to care for people with tuberculosis with 51 diagnoses/outcomes and 264 nursing interventions, assessed by nurses from Primary Health Care and structured according to Wanda Horta's Theory of Basic Human Needs. FINAL CONSIDERATIONS: the subset is a technological instrument through which it is possible to identify the elements of nursing practice from the affected human needs.

[Spatial-temporal diffusion of yellow fever in a state in Southeast Brazil in 2017]. / Difusão espaço-temporal da febre amarela silvestre em um estado do Sudeste do Brasil, 2017.

The objective was to analyze the diffusion of cases of yellow fever in time and space in the epidemic of 2017 in the state of Espírito Santo, Brazil. An ecological observational study was performed with spatial analysis of yellow fever cases. Georeferencing of information and spatial analysis used the digital grid for the state of Espírito Santo, divided into 78 municipalities (counties), using the Arcgis software, 10.3. Geostatistical analysis was performed using the ordinary kriging function. The study found an incidence of 4.85/100,000 inhabitants of sylvatic yellow fever in Espírito Santo in 2017, with 29.74% case-fatality. Sylvatic yellow fever cases were distributed across 34 of the state's 78 municipalities, representing 43% of its territory. The temporal distribution of reported yellow fever cases in the current study occurred from the 1st to the 19th Epidemiological Weeks (EW). The geostatistical spatial analysis via ordinary kriging demonstrated spatial diffusion by yellow fever contagion among the municipalities in the state of Espírito Santo, with spatial continuity. The disease emerged in the state in the EW 1 through municipalities bordering on the state of Minas Gerais. Geoprocessing showed that yellow fever reached the state of Espírito Santo through the municipalities bordering on the state of Minas Gerais, moving eastward in the state and reaching the Atlantic coastline. There was a higher concentration of cases and persistence in the state's Central and Metropolitan regions, which have areas of Atlantic Forest, showing a pattern of diffusion continuity by contagion.

O objetivo foi analisar a difusão dos casos de febre amarela no tempo e no espaço, na epidemia de 2017, no Estado do Espírito Santo, Brasil. Estudo observacional ecológico, com análise espacial da difusão dos casos de febre amarela. Para o georreferenciamento das informações e a análise espacial, utilizou-se a malha digital do Estado do Espírito Santo, dividida em 78 municípios, por meio do software ArcGIS 10.3. Realizou-se uma análise de geoestatística utilizando a função krigagem ordinária. Nosso estudo mostrou uma incidência de 4,85/100 mil habitantes de febre amarela silvestre no Espírito Santo, no período de 2017, perfazendo uma letalidade de 29,74%. Os casos de febre amarela silvestre estão distribuídos em 34 municípios dos 78 que compõem o estado, representando 43% do território. A distribuição temporal dos casos de febre amarela registrados no presente estudo encontrava-se entre a 1ª e a 19ª Semana Epidemiológica (SE). Por meio da análise espacial de geoestatística por krigagem ordinária, foi possível demonstrar a difusão espacial por contágio da doença amarílica entre os municípios no Estado do Espírito Santo, com uma continuidade espacial. A doença surgiu no estado na SE 1 pelos municípios que realizam divisa com o Estado de Minas Gerais. O geoprocessamento demonstrou que a doença amarílica chegou ao Espírito Santo pelos municípios vizinhos ao Estado de Minas Gerais, seguindo em direção leste do estado, atingindo o litoral. Apresentou uma maior concentração de casos e tempo de permanência nas regiões Central e Metropolitana, que possuem áreas de Mata Atlântica, mostrando um padrão de continuidade da difusão por contágio.

El objetivo fue analizar la difusión de los casos de fiebre amarilla en el tiempo y espacio, en la epidemia de 2017 en el estado de Espírito Santo, Brasil. Estudio observacional ecológico, con análisis espacial de la difusión de los casos de fiebre amarilla. Para la georreferencia de la información y análisis espacial se utilizó la red digital del estado de Espírito Santo, dividida en 78 municipios, a través del software Arcgis 10.3. Se realizó un análisis de geoestadístico, utilizando la función krigagem ordinaria. Nuestro estudio mostró una incidencia de 4,85/100 mil habitantes de fiebre amarilla silvestre en Espírito Santo durante el período de 2017, ocasionando una letalidad de 29,74%. Los casos de fiebre amarilla silvestre están distribuidos en 34 municipios, de los 78 en los que se compone el estado, representando un 43% del territorio. La distribución temporal de los casos de febre amarela registrados en el presente estudio se encontraba entre la 1ª y la 19ª Semana Epidemiológica (SE). A través del análisis espacial de geoestadística por krigagem ordinaria fue posible demostrar la difusión espacial por contagio de la enfermedad amarílica entre los municipios en el estado de Espírito Santo, con una continuidad espacial. La enfermedad surgió en el estado en la SE 1, a través de los municipios que tienen frontera con el estado de Minas Gerais. El geoprocesamiento demostró que la enfermedad amarílica llegó al estado de Espírito Santo a través de los municipios vecinos al estado de Minas Gerais, siguiendo en dirección al este del estado, alcanzando el litoral. Presentó una mayor concentración de casos y tiempo de permanencia en las regiones Central y Metropolitana, que poseen areas de mata atlántica, presentando un patrón de continuidad de la difusión por contagio.

Classification and regression trees for predicting the risk of a negative test result for tuberculosis infection in Brazilian healthcare workers: a cross-sectional study.

OBJECTIVES: Healthcare workers (HCWs) have a high risk of acquiring tuberculosis infection (TBI). However, annual testing is resource-consuming. We aimed to develop a predictive model to identify HCWs best targeted for TBI screening. METHODOLOGY: We conducted a secondary analysis of previously published results of 708 HCWs working in primary care services in five Brazilian State capitals who underwent two TBI tests: tuberculin skin test and Quantiferon®-TB Gold in-tube. We used a classification and regression tree (CART) model to predict HCWs with negative results for both tests. The performance of the model was evaluated using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), cross-validated using the same dataset. RESULTS: Among the 708 HCWs, 247 (34.9%) had negative results for both tests. CART identified that physician or a community health agent were twice more likely to be uninfected (probability = 0.60) than registered or aid nurse (probability = 0.28) when working less than 5.5 years in the primary care setting. In cross validation, the predictive accuracy was 68% [95% confidence interval (95%CI): 65 - 71], AUC was 62% (95%CI 58 - 66), specificity was 78% (95%CI 74 - 81), and sensitivity was 44% (95%CI 38 - 50). CONCLUSION: Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.

Catastrophic costs and social sequels due to tuberculosis diagnosis and treatment in Brazil. / Custos catastróficos e sequelas sociais decorrentes do diagnóstico e tratamento da tuberculose no Brasil.

OBJECTIVE: To evaluate the impact of catastrophic costs on unfavorable tuberculosis treatment outcomes. METHODS: This was a prospective cohort study, conducted in five Brazilian state capitals (Manaus, Recife, Vitória, Campo Grande and Porto Alegre) from June 2016 to July 2018. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS: Of the 350 participants, 310 were included, of whom 30 presented unfavorable outcomes. Catastrophic cost (OR=2.53 -95% CI 1.13;5.67) and divorce (OR=5.29 -95% CI 1.39;20.05) increased the chances of unfavorable outcomes. CONCLUSION: Financial difficulties during tuberculosis treatment may impair its outcome. Catastrophic cost and divorce were determining factors for treatment outcomes.

Spatial analysis of syphilis in pregnancy and congenital syphilis in the state of Espírito Santo, Brazil, 2001-2018. / Análise espacial da sífilis em gestantes e sífilis congênita no estado do Espírito Santo, 2011-2018.

OBJECTIVE: to analyze the spatial distribution of syphilis cases in pregnancy and congenital syphilis cases, from 2011 to 2018. METHODS: this was an ecological study applying spatial analysis of syphilis cases in pregnancy and congenital syphilis reported on the Notifiable Diseases Information System; TerraView 4.2.0 software was used. RESULTS: seventy-eight municipalities were analyzed, and evidence of a significant cluster was found for syphilis in pregnant women (Moran index=0.38; p=0.01) and for congenital syphilis (Moran index=0.31; p=0.01) in the greater Vitória region and north coast municipalities; along the north and metropolitan coastal regions some 30 municipalities were identified as having higher occurrence of the outcomes, as well as some 14 municipalities with a high proportion of congenital syphilis and a low proportion of syphilis in pregnancy. CONCLUSION: the study identified places where interventions and prenatal care professional training need to be channeled, with the aim of controlling syphilis in pregnancy and congenital syphilis.

Family Health Strategy and determinants of directly observed treatment for tuberculosis in Brazil: a cross-sectional study with surveillance system data, 2014-2016. / Estratégia Saúde da Família e determinantes para o tratamento diretamente observado da tuberculose no Brasil: estudo transversal com dados do sistema de vigilância, 2014-2016.

OBJECTIVE: To assess the association between tuberculosis determinants and performance of directly observed treatment (DOT) under different levels of Family Health Strategy (FHS) coverage in Brazil. METHODS: This was a cross-sectional study using data on tuberculosis cases notified between 2014 and 2016 on the Notifiable Health Conditions Information System, as well as data on FHS coverage in the municipality of residence. Logistic regression was used. RESULTS: 177,626 individuals were included; being an alcohol user (odds ratio (OR) 1.09 - 95% confidence interval % [95%CI] 1.03;1.16), being deprived of liberty (OR=1.21 - 95%CI 1.12;1.32) and positive sputum smear microscopy (OR=1.15 - 95%CI 1.10;1.21) increased the chances of DOT being performed . When stratified by FHS coverage, these associations became weak in the highest stratum of coverage. CONCLUSION: DOT being performed was associated with determinants of tuberculosis. However, association was not confirmed among residents in municipalities with higher FHS coverage.

Management tools in nursing care for children with pressure injury.

OBJECTIVES: to develop and validate management tools for the systematization of nursing care for children with pressure injuries. METHODS: methodological study in which the focus group technique was used for validation of tools in three different groups of 17 nurses. Conducted in April and May 2018 at a large pediatric hospital. RESULTS: two management tools were developed. The first was the Nursing care systematization instrument for children with pressure injury with three parts: a) risk factors; b) Psychobiological Basic Human Needs; c) signs of wound infection. The second was the Flowchart of pressure injury risk and prevention in pediatric patients with three categories: a) risk factors; b) Braden Q scale; c) nursing care. Final Considerations: the tools will support nurses in the care of children with pressure injuries by aiming at an individualized and systematized assessment based on a theoretical framework.

Completeness of yellow fever notification forms in the state of Espírito Santo, Brazil, 2017. / Completude das fichas de notificação de febre amarela no estado do Espírito Santo, 2017.

Objective to describe the completeness of data on yellow fever notification forms in the municipalities of the state of Espírito Santo, Brazil, in 2017. Methods this is a descriptive ecological study with data from the Notifiable Health Conditions Information System (SINAN); form completeness was categorized as poor (<70.0%), regular (70-89.9%) or excellent (≥90.0%); thematic maps were prepared. Results 53.1% of the municipalities had poor or regular classification for many notification form variables, especially case Final Classification (57.1%), Confirmation/Dismissal Criterion (63.2%) and Closure Date (26.5%), which are required fields. Conclusion completeness was poor or regular for several variables, pointing to the need for a systematic assessment of information on yellow fever held on SINAN.

Atenção à saúde da mulher na atenção primária: percepções sobre as práticas de enfermagem / Women's health care in primary care: perceptions about nursing practices / El cuidado de la salud de la mujer en la atención primaria: percepciones sobre las prácticas de enfermería

Objetivo: Identificar práticas de enfermagem direcionadas ao atendimento à saúde da mulher no âmbito da Atenção Primária à Saúde (APS), caracterizando-as pelo modo como ocorrem e lugar que ocupam no processo de trabalho dos Enfermeiros. Métodos: Trata-se de um estudo descritivo, exploratório e de natureza qualitativa. O material consta de 27 entrevistas com enfermeiros realizadas entre os meses de novembro de 2020 a março de 2021. Resultados: As ações de enfermagem direcionadas à saúde da mulher ocupam espaço representativo na agenda dos enfermeiros. As principais ações identificadas são voltadas à saúde materno-infantil. O planejamento familiar também foi identificado como medida educativa recorrente. Assistência às violências e ao climatério não foram mencionadas. Destacouse a autonomia dos enfermeiros na área de atuação em foco neste estudo como positiva no processo de trabalho. Conclusão: A prática do enfermeiro na APS privilegia a saúde no ciclo reprodutivo da mulher, principalmente no período pré-natal. Contudo, observam-se encaminhamentos na busca por uma prática integral, por meio da inclusão de ações mais humanizadas nos serviços. Ainda há a necessidade de se ampliar os focos de assistência à saúde da mulher na APS, e para isso é preciso fortalecer as discussões e estudos acerca dessas temáticas negligenciadas. (AU)

Objective: To identify nursing practices aimed at women's health care within the scope of Primary Health Care (PHC), characterizing them by the way they occur and the place they occupy in the nurses' work process. Methods: This is a descriptive, exploratory and qualitative study. The material consists of 27 interviews with nurses carried out between November 2020 and March 2021. Results: Nursing actions aimed at women's health occupy a representative space in the nurses' routine. The main actions identified are aimed at maternal and child health. Family planning was also identified as a recurrent educational action. Assistance to violence and climacteric were not mentioned. The nurses' autonomy in the area of expertise in focus in this study was highlighted as positive in the work process. Conclusion: The practice of nurses in PHC privileges health in the reproductive cycle of women, especially in the prenatal period. However, referrals are observed in the search for an integral practice, through the inclusion of more humanized actions in the services. There is still a need to expand the focus of women's health care in PHC, and for that it is necessary to strengthen the discussions and studies on these neglected themes. (AU)

Objetivo: Identificar las prácticas de enfermería dirigidas al cuidado de la salud de la mujer en el ámbito de la Atención Primaria de Salud (APS), caracterizándolos por la forma en que ocurren y el lugar que ocupan en el proceso de trabajo del enfermero. Métodos: Se trata de un estudio descriptivo, exploratorio y cualitativo. El material consta de 27 entrevistas a enfermeras realizadas entre noviembre de 2020 y marzo de 2021. Resultados: Las acciones de enfermería dirigidas a la salud de la mujer ocupan un espacio representativo en la agenda de los enfermeros. Las principales acciones identificadas están dirigidas a la salud maternoinfantil. La planificación familiar también fue identificada como una acción educativa recurrente. No se mencionaron la asistencia a la violencia y el climaterio. La autonomía de los enfermeros en el área de especialización en foco de este estudio fue destacada como positiva en el proceso de trabajo. Conclusión: La práctica del enfermero en la APS privilegia la salud en el ciclo reproductivo de la mujer, especialmente en el período prenatal. Sin embargo, se observan derivaciones en la búsqueda de una práctica integral, a través de la inclusión de acciones más humanizadas en los servicios. Aún existe la necesidad de ampliar el enfoque de la atención a la salud de la mujer en la APS, y para eso es necesario fortalecer las discusiones y estudios sobre estos temas desatendidos. (AU)

[Spatial distribution of new tuberculosis cases in Vitória, State of Espírito Santo, between 2000 and 2005]. / Distribuição espacial dos casos novos de tuberculose em Vitória, Estado do Espírito Santo, no período entre 2000 e 2005.

We carried out an ecological study in which the spatial distribution of 979 new tuberculosis cases between 2000 and 2005 were analyzed. The risk was estimated using the local empirical Bayesian method. The local indicators of spatial association were calculated to evaluate autocorrelations of incidence between adjoining districts. We found that the tuberculosis cases were heterogeneously distributed between districts, and it was possible to identify regions in which there was a high risk of becoming ill.

Factors associated with cure when treating tuberculosis in the state of Rio de Janeiro, Brazil, 2011-2014. / Fatores associados à cura no tratamento da tuberculose no estado do Rio de Janeiro, 2011-2014.

OBJECTIVE: to analyze factors associated with cure when treating tuberculosis (TB) in the state of Rio de Janeiro, Brazil, from 2011 to 2014. METHODS: this was a cross-sectional study with data from the Notifiable Diseases Information System (SINAN); logistic regression was used for data analysis. RESULTS: of the 57,142 cases reported, 49,691 (86.96%) were included in the study; schooling ≥13 years (odds ratio (OR) 3.48; 95%CI 2.74;4.41) and residing in rural areas (OR 2.27; 95%CI 1.38; 3.73) were factors associated with a higher chance of cure; being male (OR 0.71; 95%CI 0.66;0.76) and brown skin color/race (OR 0.73; 95%CI 0.68;0.78) stood out as factors associated with less chance of cure. CONCLUSION: social and economic determinants were identified that influence the treatment outcome, evidencing the need for social support and guaranteed access to health services.

Monitoramento da periodicidade dos exames relacionados à saúde da mulher na Atenção Básica

Resumo: Foi observado que o rastreamento do câncer a partir do exame citopatológico e da mamografia é uma das atribuições dos enfermeiros na atenção básica. Em um território situado na cidade de vitória/ES, muitas mulheres não realizam preventivo e as que realizam não retornam para buscar os resultados, ocasionando atraso no tratamento. Identificamos a necessidade de criar um instrumento para auxiliar a mulher quanto a periodicidade dos exames, incentivando a participação popular nos cuidados de saúde. Neste sentido, o objetivo é relatar a experiência da elaboração de um cartão para orientação e controle da periodicidade dos exames para detecção do câncer de mama e de colo uterino e a inserção e distribuição do instrumento durante ação educativa coletiva na unidade. Realizamos reuniões para identificarmos os pontos a serem abordados no cartão e revisões bibliográficas sobre a temática. O instrumento intitulado como "Cartão Rastreio câncer de mama e de colo uterino", possui espaço para a identificação da usuária, explicação sobre a periodicidade dos exames e estilo de vida saudável. Destinamos ao profissional páginas para o preenchimento relacionado aos exames de rastreios realizados por esse usuário ao longo da vida. Concluímos que o instrumento proporciona o melhor monitoramento dos preventivos e das mamografias realizadas e contribui para a atuação profissional.

Quality, opportunity, and treatment of data of tuberculosis and human immunodeficiency virus co-infection / Calidad, oportunidad y manejo de los datos de coinfección tuberculosis y virus de la inmunodeficiencia humana / Qualidade, oportunidade e tratamento de dados de tuberculose e coinfecção com vírus da imunodeficiência humana

Background and Objectives: The identification, evaluation, and use of methodological resources for data quality analysis is important to support planning actions of public policies for the control of tuberculosis (TB) and the co-infection TB and human immunodeficiency virus (HIV). The objective was to analyze the quality and timeliness of notification of TB and TB-HIV co-infection cases from the Notifiable Diseases Information System (SINAN - Sistema de Informação de Agravos de Notificação) in Espírito Santo State, from 2016 to 2018. Methods: This is a cross-sectional study of the quality of SINAN data using the Centers for Disease Control and Prevention (CDC) guidelines to analyze the quality and timeliness of SINAN-TB notification, with emphasis on the description of TB-HIV co-infection in Espírito Santo State, from 2016 to 2018. It considered five methodological steps that included quality analysis, standardization of records, duplicity analysis, the completeness of data through linkage with the SINAN-HIV database and anonymization of data. It obtained ethical approval under the number 4022892 on 12/05/2020. Results: The study showed that 89% of mandatory variables and 91% of essential variables showed satisfactory completeness. In TB-HIV co-infection 73% of the variables were completed, but essential variables related to TB treatment follow-up showed unsatisfactory completeness. The timeliness of reporting was considered regular. Conclusion: Improvements in work processes and the development of a specific methodological process for data treatment are necessary to qualify the information available in SINAN-TB.(AU)

Justificativa e Objetivos: A identificação, avaliação e emprego de recursos metodológicos para análise da qualidade dos dados é importante para fundamentar ações de planejamento das políticas públicas no controle da tuberculose (TB) e da coinfecção TB e o vírus da imunodeficiência humana (HIV). O objetivo é analisar a qualidade e a oportunidade de notificação dos casos de TB e coinfecção TB-HIV do Sistema de Informação de Agravos de Notificação (SINAN) no Espírito Santo, de 2016 a 2018. Métodos: Trata-se de um estudo transversal da qualidade dos dados do SINAN com uso do Guia do Centers for Disease Control and Prevention (CDC) de análise da qualidade e oportunidade de notificação do SINAN-TB, com ênfase na descrição da coinfecção TB-HIV no Espírito Santo, de 2016 a 2018. Considerou-se cinco etapas metodológicas que incluíram análise da qualidade, padronização dos registros, análise de duplicidade, a completitude dos dados por meio de linkage com o banco de dados do SINAN-HIV e anonimização dos dados. Obteve aprovação ética sob parecer de nº 4022892 em 12/05/2020. Resultados: O estudo mostrou que 89% das variáveis obrigatórias e 91% das variáveis essenciais apresentaram completitude satisfatória. Na coinfecção TB-HIV 73% das variáveis foram preenchidas, porém variáveis essenciais relacionadas ao acompanhamento do tratamento para TB apresentaram completitude insatisfatória. A oportunidade de notificação foi considerada regular. Conclusão: Melhorias nos processos de trabalho e elaboração de processo metodológico específico para o tratamento dos dados são necessárias para qualificar as informações disponíveis no SINAN-TB.(AU)

Justificación y Objetivos: La identificación, evaluación y utilización de recursos metodológicos de análisis de la calidad de los datos es importante para apoyar la planificación de políticas públicas de control de la tuberculosis (TB) y la coinfección con el virus de la inmunodeficiencia humana (VIH). El objetivo es analizar la calidad y oportunidad de la notificación de casos de TB y coinfección TB-VIH del Sistema de Informação de Agravos de Notificação (SINAN), en el Estado del Espírito Santo, desde el año 2016 hasta 2018. Métodos: Este es un estudio transversal utilizando el análisis de la Guía de los Centros para el Control y Prevención de Enfermedades (CDC) de la calidad y oportunidad de la notificación en SINAN-TB, con énfasis en la descripción de la coinfección TB-VIH, en el Estado del Espírito Santo, desde el año 2016 hasta 2018. Fueran considerados cinco pasos metodológicos que incluyeron análisis de calidad, estandarización de registros, análisis de duplicidad, vinculación con la base de datos SINAN-VIH y anonimización de datos. Obtuvo aprobación ética bajo dictamen nº 4022892 el 12/05/2020. Resultados: El 89% de las variables obligatorias y el 91% de las variables esenciales se completaron satisfactoriamente. En la coinfección TB-VIH el 73% de las variables fueron completadas, mientras que las variables esenciales relacionadas con el acompañamiento del tratamiento para la TB presentaron una completitud insatisfactoria. La oportunidad de notificación fue considerada regular. Conclusión: Las mejoras en los procesos de trabajo y la elaboración de un proceso metodológico específico para el tratamiento de los datos son necesarias para cualificar la información disponible en el SINAN-TB.(AU)

Aplicativo SARA para tratamento de pessoas com tuberculose: estudo metodológico / Aplicación SARA para tratamiento de personas con tuberculosis: estudio metodológico / SARA application for treating people with tuberculosis: a methodological study

Resumo Objetivo Construir um aplicativo para o acompanhamento do tratamento de pessoas com tuberculose. Métodos Estudo metodológico com três fases: preparação do mapa conceitual por meio de manuais do Ministério da Saúde do Brasil e da Organização Mundial da Saúde; a construção do aplicativo com a elaboração do projeto de navegação e a prototipagem; e validação por conteúdo e semântica guiada pelo método de Pasquale com validação de conteúdo por juízes especialistas em saúde em ambiente online e validação de semântica pelo público-alvo, pessoas com tuberculose atendidas em uma unidade de saúde de Natal, no Rio Grande do Norte, Brasil, por meio da Técnica Delphi analisada a partir do Índice de Validade de Conteúdo. Resultados Construiu-se o aplicativo em sua versão final após três etapas da Técnica Delphi. Na etapa Delphi 3, o Índice de Validade de Conteúdo global foi de 0,92, sendo avaliado por sete juízes especialistas nas regiões Norte, Nordeste, Centro-Oeste, Sul e Sudeste e validado por seis pessoas com tuberculose atendidas, alcançando um Índice de Validade de Conteúdo global de 0,98. Conclusão O aplicativo foi validado quanto ao conteúdo e à semântica por juízes especialistas, em uma perspectiva multiprofissional, e atuantes na área de tuberculose de mais de uma região do Brasil e pelo público-alvo a que se destina, sendo considerado uma ferramenta importante para somar às estratégias de controle para o fim da tuberculose.

Resumen Objetivo Elaborar una aplicación para el seguimiento del tratamiento de personas con tuberculosis. Métodos Estudio metodológico de tres fases: preparación del mapa conceptual por medio de manuales del Ministerio de Salud de Brasil y de la Organización Mundial de la Salud; desarrollo de la aplicación con la elaboración del proyecto de navegación y creación del prototipo; y validación de contenido y semántica guiada por el método de Pasquale, en la cual la validación de contenido fue realizada por jueces especialistas en salud en ambiente virtual y la validación semántica por el público destinatario, personas con tuberculosis atendidas en una unidad de salud de Natal, estado de Rio Grande do Norte, Brasil, mediante el método Delphi analizado a partir del Índice de Validez de Contenido. Resultados Se elaboró la aplicación en su versión final luego de tres etapas del método Delphi. En la etapa Delphi 3, el Índice de Validez de Contenido global fue 0,92, evaluado por siete jueces especialistas de las regiones Norte, Nordeste, Centro-oeste, Sur y Sudeste, y validado por seis personas con tuberculosis atendidas, con un Índice de Validez de Contenido global de 0,98. Conclusión La aplicación fue validada respecto al contenido y a la semántica por jueces especialistas, bajo una perspectiva multiprofesional y del área de tuberculosis con presencia en más de una región de Brasil, y por el público destinatario. Fue considerada una herramienta importante para sumar a las estrategias de control para el fin de la tuberculosis.

Abstract Objective To develop an application for monitoring the treatment of individuals with tuberculosis. Methods A methodological study with three phases: preparation of the concept map according to the manuals of the Brazilian Ministry of Health and the World Health Organization; development of the application, with navigation and prototyping design; and based on Pasquale's method, content validation was performed by health experts in an online environment with semantic validation by the target audience, individuals with tuberculosis treated in a health unit in Natal, Rio Grande do Norte, Brazil, using the Delphi technique, analyzed using the Content Validity Index. Results The final version of the application was developed after three rounds of the Delphi technique. In the third Delphi round, the overall Content Validity Index was 0.92, as rated by seven expert evaluators in the North, Northeast, Central-West, South, and Southeast of Brazil, and validated by six patients being treated for tuberculosis, obtaining an overall Content Validity Index of 0.98. Conclusion The application was validated regarding content and semantics by expert evaluators working in the area of tuberculosis in more than one region of Brazil, from a multidisciplinary perspective, and by the target audience for which it is intended. It was considered an important tool to contribute to control strategies for the treatment of tuberculosis.

Factors associated with carrying out molecular tests for the diagnosis of COVID-19 in the State of Espírito Santo, Brazil / Fatores associados à realização de testes moleculares para o diagnóstico da COVID-19 no Estado do Espírito Santo, Brasil

Backgroung: Brazil was slow to implement an expanded testing policy for COVID-19, which may have affected the most vulnerable population's access to testing services.Objective: to evaluate the factors associated with performing the molecular test for COVID-19.Methods: cross-sectional study of secondary data from the COVID-19 panel in the state of Espírito Santo. COVID-19 suspicion notification forms were included between September 11, 2020 and March 2, 2021. Hierarchical logistic regression was used to estimate the odds ratio (OR) with 95% confidence interval (CI95%).Results: 419,771 notification forms were analyzed. The prevalence of performing the molecular teste for COVID-19 was 81.1% (CI95% 81.0-81.2). Elderly (OR= 2.70 ­ CI95% 2.56-2.85), health professional (OR=1 .43 ­ CI95% 1.36-1.50), chronic cardiovascular disease (OR=1.13 ­ CI95% 1.09-1.17), diabetes mellitus (OR=1.07 ­ CI95% 1.01- 1.14) and hospitalization (OR=5.95 ­ CI95% 4.53;7.82) were more likely to have undergone the molecular test. Male sex (OR=0.96 ­ CI95% 0.94-0.98), black skin color (OR=0.75 ­ CI95% 0.73-0.78), yellow skin color (OR=0.74 ­ CI95% 0.71-0.77), residing in the northern health region (OR=0.37 ­ CI95% 0.36-0.39) and the homeless population (OR=0.76 ­ CI95% 0.67-0.85) had the lowest chance of having undergone the molecular test.Conclusion: Social, economic, contextual factors and the risk of aggravation of the disease were associated with carrying out the molecular test for COVID-19 in the state of Espírito Santo. Actions are needed to guarantee the access of the most vulnerable population to molecular testing.

Introdução: o Brasil demorou a implementar uma política de testagem ampliada para COVID-19 no qual pode ter afetado o acesso da população mais vulnerável aos serviços de testagem.Objetivo: analisar os fatores associados à realização de testes moleculares para o diagnóstico da COVID-19.Método: estudo transversal de dados secundários do painel COVID-19 do estado do Espírito Santo. Foram incluídas fichas de notificação de suspeita de COVID-19 entre 11 de setembro de 2020 a 02 de março de 2021. Empregou-se regressão logística hierárquica para estimativa de razão de chances (odds ratio, OR) com intervalo de confiança de 95% (IC95%).Resultados: Foram incluídos no estudo 419.771 fichas de notificação. A prevalência da realização do teste molecular para COVID-19 foi 81,1 % (IC95% 81,0%;81,2%). Idosos (OR= 2,70 ­ IC95% 2,56-2,85), profissional da saúde (OR=1,43 ­ IC95% 1,36-1,50), doença cardiovascular crônica (OR=1,13 ­ IC95% 1,09-1,17), diabetes mellitus (OR=1,07 ­ IC95% 1,01-1,14) e hospitalização (OR=5,95 ­ IC95% 4,53;7,82) apresentaram maior chance de ter realizado o teste molecular. Sexo masculino (OR=0,96 ­ IC95% 0,94-0,98), cor da pele preta (OR= 0,75 ­ IC95% 0,73-0,78), cor da pele amarela (OR=0,74 ­ IC95% 0,71-0,77), residir na região norte de saúde (OR=0,37 ­ IC95% 0,36-0,39) e a população em situação de rua (OR=0,76 ­ IC95% 0,67-0,85) apresentaram a menor chance de ter realizado o teste molecular.Conclusão: Fatores sociais, econômicos e o risco de agravamento da doença foram associados a realização do teste molecular para COVID-19 no estado do Espírito Santo. É necessário ações que garantam o acesso da população mais vulnerável ao teste molecular.

Tuberculosis infection among primary health care workers.

OBJECTIVE: To estimate the prevalence of and determine the risk factors associated with latent Mycobacterium tuberculosis infection (LTBI) among primary health care workers in the city of Vitória, Brazil. METHODS: This was a cross-sectional study with data collected through a survey regarding socio-demographic, occupational, clinical, and exposure characteristics, as well as knowledge about tuberculosis, conducted between 2011 and 2012. All participants underwent a tuberculin skin test (TST), and TSTs were read at 72 h by a trained professional. RESULTS: A total of 218 primary health care workers participated in the study. The prevalence of TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points was, respectively, 39.4% (95% CI: 32.9-45.9) and 54.1% (95% CI: 47.4-60.7). Regarding occupational categories, community health agents had the highest proportion of TST positivity, regardless of the cut-off point (≥ 10 mm: 47.5%; and ≥ 5 mm: 60.5%). Regarding factors associated with TST results, "having had a previous TST" showed a statistically significant association with TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points (OR = 2.5 [95% CI: 1.17-5.30] and OR = 2.18 [95% CI: 1.23-3.87], respectively). CONCLUSIONS: The prevalence of LTBI was found to be high among the primary health care workers in this sample. Therefore, we recommend the establishment of a periodic screening program for LTBI and implementation of effective biosafety policies for the prevention of this infection among primary health care workers.