Discourses on short-coursetherapy for tuberculosis control. / Discursos sobre a terapia de curta duração para o controle da tuberculose.

OBJECTIVE:: to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control. METHOD:: qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded. RESULTS:: three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course. CONCLUSION:: treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.

Discursos sobre a terapia de curta duração para o controle da tuberculose / Discursos sobre la terapia de corta duración para el control de la tuberculosis / Discourses on short-coursetherapy for tuberculosis control

RESUMO Objetivo: analisar os sentidos produzidos por meio das experiências e percepções dos profissionais de saúde sobre a implementação da estratégia do tratamento diretamente observado de curta duração para o controle da tuberculose. Método: estudo qualitativo realizado em Moçambique com 15 profissionais de saúde. Critérios de inclusão: atuação no Programa de Controle da Tuberculose há mais de um ano e estar em atividade profissional no período da entrevista. Para a coleta de dados foi usado um roteiro semiestruturado e as entrevistas realizadas individualmente foram gravadas. Resultados: emergiram três unidades discursivas: os procedimentos no tratamento do doente; o papel de Agente Comunitário da Saúde e da família; as dificuldades na aplicação do tratamento diretamente observado de curta duração. Conclusão: o tratamento da tuberculose requer um envolvimento constante da família, da comunidade e principalmente do Estado na criação e aplicação de políticas de formação dos recursos humanos e melhoria de infraestruturas.

RESUMEN Objetivo: analizar los sentidos generados a partir de experiencias y visiones de profesionales de salud sobre la implementación de la estrategia del tratamiento directamente observado de corta duración para el control de la tuberculosis. Método: estudio cualitativo realizado en Mozambique con 15 profesionales de salud. Criterios de inclusión: actuación en Programa de Control de la Tuberculosis mayor a un año y estar activo profesionalmente durante el período de la entrevista. Datos recolectados utilizando rutina semiestructurada; las entrevistas individuales fueron grabadas. Resultados: surgieron tres unidades discursivas: procedimientos en el tratamiento del enfermo; papel del Agente Comunitario de Salud y de la familia; dificultades en aplicación del tratamiento directamente observado de corta duración. Conclusión: el tratamiento de la tuberculosis requiere de constante participación de la familia, la comunidad y, principalmente, del Estado; en la determinación y aplicación de políticas de formación de recursos humanos y mejoras de infraestructura.

ABSTRACT Objective: to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control. Method: qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded. Results: three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course. Conclusion: treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.

La prueba tuberculínica y el trabajo invisible de enfermería / The tuberculin test and the invisible nursing work

Introducción: La Tuberculosis es la segunda causa mundial de mortalidad, después del SIDA, causada por un agente infeccioso. Objetivos: teorizar la administración y lectura de la reacción Tuberculiníca como práctica enfermera, liberándola de concepciones positivistas y patriarcales que obturan el desarrollo del conocimiento enfermero. Métodos: revisión bibliográfica en las bases de datos especializadas (CUIDEN, REDALYC y LILACS) y análisis Meta teórico. Conclusiones: analizando críticamente la prueba Tuberculiníca se puede recuperar la práctica enfermera como fuente de teoría para incrementar el conocimiento enfermero, redundando en beneficio de los pacientes y el sistema de salud(AU)

Introduction: tuberculosis is worldwide the second cause of mortality caused by an infectious agent, after AIDS. Objectives: to theorize about the administration and reading of the tuberculin reactions as a nursing practice, freeing it from positivist and patriarchal conceptions that obdurate the development of the nursing knowledge. Methods: bibliographic review in the specialized databases (CUIDEN, REDALYC y LILACS) and meta-theoretical analysis. Conclusions: critically analyzing the tuberculin test, the nursing practice can be recovered as a source of theory to increase nursing knowledge, resulting in the benefit of patients and the health system(AU)

Perfil da resposta à prova tuberculínica em estudantes de enfermagem / Tuberculin skin test applied to nursing students

O objetivo deste estudo foi quantificar a prevalência da prova tuberculínica (PT) positiva entre estudantes de enfermagem da Universidade Federal de Goiás. Em setembro de 2006, na cidade de Goiânia – GO, os participantes responderam a um questionário específico e a prova foi feita pela técnica de Mantoux em dois tempos, utilizando-se o derivado protéico purificado-Rt 23. Entre os 65 alunos que completaram o estudo, 10(15,4 por cento) tiveram PT positiva, sendo 4(10,5 por cento) do primeiro ano da graduação e 6(22,2 por cento) do quinto ano (p= 0,29). Os alunos do 5º ano tiveram maior número de contatos com tuberculose em relação aos alunos do 1º ano (p< 0,05). Sobre atividades profissionais ou estágios fora do hospital-escola, 60 por cento responderam que os exerciam. Portanto, o progressivo aumento do contato com pacientes no decorrer do curso pode explicar o maior percentual de PT positiva no quinto ano. O estudo reforça a importância de os estudantes de enfermagem utilizarem as normas de biossegurança em tuberculose.

The objective of this piece of research was to quantify the prevalence of positive tuberculin skin test (TST) among nursing students from the Federal University of Goiás – UFG, in Goiania, GO, Brazil, in September, 2006. The participants answered a specific questionnaire and a two-turn TST was performed through the Mantoux technique, using PPD-Rt 23. Out of those 65 students who had gone through testing, 10(15,4 percent) had positive TST; 4(10.5 percent) of them were in the first year and 6(22.2 percent) were in the fifth, (p= 0,29). The students in the 5th year had had longer contact with people contaminated with tuberculosis (TB) than the students in the 1st year (p< 0,05). 60 percent of the participants answered that they work or take traineeship out of the school hospital. Therefore, the increasing contact with TB patients along the undergraduate years can account for the higher percentage of positive TST in the fifth year. The study reinforces the importance of compliance with rules of biosecurity against TB for nursing students.

El objetivo del estudio fue cuantificar la prevalencia de la prueba tuberculinica (PT) positiva entre estudiantes de enfermería de la Universidad Federal de Goiás. En septiembre de 2006, en la ciudad de Goiânia – GO – Brasil, los participantes contestaron a un cuestionario específico y la prueba fue realizada con la técnica de Mantoux en dos veces, usándose el derivado proteínico purificado-Rt 23. De los 65 que concluyeron el estudio, 10(15.4 por ciento) estudiantes tuvieron la PT positiva, siendo 4(10.5 por ciento) del primer año y 6(22.2 por ciento) del quinto, (p= 0.29). Los estudiantes del 5° año tuvieron más contacto con la tuberculosis que aquellos del 1° año (p< 0.05). Sobre actividades profesionales o estágios fuera del hospital-escuela, 60 por ciento de los participantes informaron que lo hacían. Por consiguiente, el aumento progresivo del contacto con los pacientes durante el curso puede explicar el porcentaje más grande de PT positiva en el quinto año. El estudio refuerza como es importante la conformidad con reglas de bioseguridad en tuberculosis para los estudiantes de enfermería.

[Assessment of nurses' understanding of tuberculin testing at a general hospital]. / Valoración del conocimiento de la prueba de la tuberculina entre el personal de enfermería de un hospital general.

BACKGROUND: The last ten years have seen a resurgence of tuberculosis, yet little information is available about the implementation of tuberculin testing and consistency in its use and interpretation. OBJECTIVE: To evaluate knowledge of tuberculin testing among hospital nurses. MATERIAL AND METHOD: A questionnaire on various aspects of the tuberculin test was administered to registered nurses assigned to various services of our university hospital. The questions were grouped by sections (techniques for administering the test, reading the results and interpreting them). RESULTS: One hundred thirty-five nurses were surveyed; 127 (94%) answered all the questions. Overall, only 42% responded to 10 or more of the 14 items on the questionnaire. By sections, questions related to technique of administration, reading the tuberculin test result and interpreting it were answered correctly by 46%, 11% and 7% of the subjects, respectively. Only two variables were independently related to the number of correct responses: 1) working on a medical ward at the time of the survey or 2) administering the test more than once a week. CONCLUSIONS: This study confirms that hospital nurses' understanding of tuberculin testing is unacceptable. A team of professionals skilled in tuberculin testing should be designated at every level of the health care system to assure the reliability of tests performed for clinical or research purposes.

Habilidades en la realización y lectura de pruebas tuberculínicas / Skills for carrying out and reading tuberculin tests

Aunque las personas que administren y lean las pruebas tuberculínicas sean las mismas, se han encontrado variaciones notables en las resultados. En este estudio nos propusimos medir la consistencia y variabilidad en las lecturas de las pruebas tuberculínicas de un grupo de enfermeras en entrenamiento del Programa Nacional de Control de Tuberculosis en Cuba. Se realizó un taller de entrenamiento de 5 enfermeras usando un lector patrón de la OPS. Se realizaron 560 pruebas de Mantoux en adultos, trabajadores de 3 centros laborales, según técnica estándar de la OMS y recomendaciones de la Unión Internacional contra la Tuberculosis y Enfermedades Respiratorias. Las lecturas se hicieron a ciegas y para disminuir la variabilidad se hicieron ajustes permanentes. El índice de correlación más alto fue de la lectora A (69,6(por ciento), seguido de la C (67,3(por ciento) y la B (64,7(por ciento). Las diferencias mayores se produjeron en las lecturas altas. Para participar en investigaciones de campo estas lectoras deberán ejercitarse más, hasta comprobar que algunos defectos que aún persisten, se hayan corregido(AU)

Administering and interpreting the PPD tuberculin skin test.

Early detection and treatment are of paramount importance in our efforts to bring tuberculosis (TB) under control. In this context, screening high-risk populations for active TB and TB infection is crucial. Most individuals who become infected with Mycobacterium tuberculosis do not develop overt disease.

Patient's self-interpretation of tuberculin skin tests.

BACKGROUND: In the outpatient use of tuberculin skin testing (purified protein derivative [PPD]), it is at times inconvenient to have a patient revisit for interpretation. Therefore, we assessed patients' ability to self-interpret these test results. METHODS: In keeping with prior custom, patients were seen by an experienced nurse, who performed skin testing with PPD intermediate strength as well as mumps and Candida anergy control tests in some cases, and explained the procedure. The patients were asked to return 48 to 72 h later, at which time one of the researchers recorded their test interpretations before they were again evaluated by the nurse. RESULTS: Sixty-eight patients were studied, of whom 59 returned at appropriate interval. Eighteen patients had a positive PPD test reaction of 10 to 20 mm induration, which only one patient correctly identified as a positive test result. However, positive anergy control tests were correctly interpreted in 10 of 27 cases. CONCLUSION: The small number of positive PPD test result recognition by these patients may be partially attributed to their lack of education, as well as foreign birth and denial of illness. PPD results should be checked by an experienced professional.

Tuberculin testing: placement and interpretation.

1. The Mantoux skin test is the currently accepted standard for determination of infection with Mycobacterium tuberculosis. It is less than 100% sensitive and specific; however, no better method currently exists. 2. Placement and interpretation of the tuberculin skin test should be provided by health practitioners who are qualified as a result of education and experience. 3. Always produce a "wheal" when administering a tuberculosis (TB) skin test. If a significant amount of the dose leaks from the injection site or the injection is administered subcutaneously, the test should be repeated immediately at another site. 4. Induration, not erythema, should be considered in interpreting the TB skin test. The absence of induration with erythema greater than 10 mm in diameter may indicate the injection was made too deeply and retesting is indicated. 5. A history of BCG vaccination is not a contraindication to PPD skin testing. The larger the reaction to PPD, the greater the probability of TB infection.