Environmental and social effects on the incidence of tuberculosis in three Brazilian municipalities and in Federal District.

INTRODUCTION: The territorial characteristics, heterogeneities of landscapes, and the regional profiles of Brazil show great disparities in the spatial distribution of tuberculosis burden. Objective of this study is to analyze the effects of environmental and social factors on tuberculosis incidence in three Brazilian municipalities and in the Federal District of Brazil. METHODOLOGY: We performed an ecological study carried out with 131,576 new cases of tuberculosis registered in the Brazilian national disease notification system. For our research we used climatic data, topographic data and socioeconomic data. RESULTS: Wind speed and vapor pressure increased the risk of tuberculosis infection between 4.6 and 5.8 times in the 3 municipalities, in comparison with the Federal District. In Recife socioeconomic aspects showed a greater association with tuberculosis. Lack of garbage collection, poor basic sanitation, and access to drinking water, respectively, increased 49, 33, and 28 times the risk of infection. In the multiple regression analysis, Rio de Janeiro showed several environmental characteristics - such as precipitation (p = 0.002), radiation (p = 0.020) and water vapor (p = 0.055) - and social characteristics associated with tuberculosis - such as the lack of sewage treatment, which revealed a 13.5-fold higher risk of infection (p < 0.001). CONCLUSIONS: Incidence in the areas studied was influenced by environmental and social conditions at different levels depending on the territory where the problem was identified. The results make it possible to guide an urban and social policy to reach the targets set out in the WHO End tuberculosis Strategy in large Brazilian urban agglomerations.

Second month sputum smear as a predictor of tuberculosis treatment outcomes in Brazil.

OBJECTIVE: The value of sputum smear microscopy (SSM) after 2 months of treatment in the management of pulmonary tuberculosis is controversial. We analysed second month-SSM conversion as a predictor of treatment success in Brazil. RESULTS: Overall successful outcome rate was 89.4%. The predictive value of second month-SSM conversion for successful outcomes was 85.2% 72,479/85,118), while the predictive value of non-conversion for unfavourable outcomes was 26.9% (2712/10,071). Unfavourable treatment outcomes were twice more likely among patients who did not convert (adjusted OR = 2.06; 1.97-2.16).

Surgical teams' attitudes and opinions towards the safety of surgical procedures in public hospitals in the Brazilian Federal District.

BACKGROUND: According to the World Health Organization, the WHO surgical safety checklist can prevent complications, improve communication and contribute to postsurgical safety culture; hence, there is a need to investigate the attitudes and opinions of surgical teams regarding safety utilizing the WHO instrument. The aim of this study was to assess the attitudes and opinions towards surgical safety among operating room professionals in three public hospitals in the Brazilian Federal District. METHODS: A cross-sectional study was conducted with the use of a checklist based on the safety attitudes questionnaire-operating room, sent out during the pre- and post-intervention surveys of the WHO surgical safety checklist (period I and period II) between 2012 and 2014. RESULTS: About 470 professionals, mostly nurse technicians, responded to the questionnaire in both periods. Regarding the perception of safety and agreement about the collaboration of the operating team, a significant statistical improvement of the nursing staff and anesthesiologists was observed in the operating room after the checklist was implemented. After utilizing the checklist before each surgical procedure, concerns about patient safety and compliance with standards as well as rules and hand-washing practices in the operating room statistically improved after the post-intervention, especially by the nursing staff. The checklist was considered easy and quick to use by most respondents. They also believed that the checklist inclusion improved communication, reflecting significant differences. At least 90.0 % of respondents from each team agreed that the checklist helps prevent errors in the operating room. CONCLUSIONS: The study results showed progress in relation to the attitudes and opinions regarding surgical safety from operating teams in relation to the checklist response in the surveyed units. However, difficulties in its implementation are experienced, especially in relation to checklist use acceptance by the surgeons. New studies are needed to verify the sustainability of the surgical teams' changes in attitudes in the hospitals studied.