Effect of social development in reducing tuberculosis mortality In northeastern Brazil areas.

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.

[Access to diagnosis of tuberculosis in Brazilian medium-sized municipality]. / Acesso ao diagnóstico da tuberculose em município brasileiro de médio porte.

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

Poverty: socioeconomic characterization at tuberculosis.

This study aimed to evaluate the epidemiological status of Tuberculosis regarding to the socioeconomic characteristics of São José do Rio Preto between 1998 and 2004. Indexes estimated for 432 urban census tracts from the demographic census of 2000, sorted systematically according to the values of socioeconomic factors and grouped into quartiles were taken into account. The socioeconomic characterization was outlined based on Schooling, Income, and Number of Residents. The incidence rates were considered for 1998, 1999, 2003, and 2004. The socioeconomic factor accounted for 87% of the total variation. The disease prevalence is higher in the poorest areas. The incidence rate and the risk of being infected by TB in the poorest areas declined in 2003 and 2004. The results confirm that TB is determined by the population's living conditions in the city studied. It strengthens the relevance of understanding the TB conditional social factors to transform the worrisome scenario in which this population is inserted.

Gerencia de caso: análisis de concepto / Case management: analysis of the concept

El estudio tiene como objetivo definir el concepto de gerencia de caso, existente en la literatura del área de enfermería americana. Para realizarlo, fueron utilizadas dos revistas de enfermería: Nursing Management y Journal of Nursing Administration de las décadas del 80 y del 90, disponibles en la Biblioteca Central de la Universidad de São Paulo de Ribeirão Preto. El análisis del concepto se realizó en la perspectiva de RODGERS (1993), destacando los atributos esenciales, los eventos antecedentes, consecuentes"y términos substitutos del tema en estudio. La gerencia de caso se expresa como un modelo que integra calidad y costo como estructura organizada, para mejorar la calidad del cuidado y la cobertura del servicio; también se expresa como un proceso sistemático. Se resaltan en la gerencia de caso: los eventos antecedentes, como la necesidad de disminuir costos, los cambios en la práctica de reembolso, la fragmentación del cuidado, el mejoramiento en la calidad del cuidado, la continuidad del cuidado y la reducción en el tiempo de hospitalización. Los eventos consecuentes, como la continuidad del cuidado, la disminución de la fragmentación, el mejoramiento de la calidad del cuidado y del costo, la práctica interdisciplinaria, y la satisfacción de los profesionales. El término substituto predominante es cuidado gerenciado. El concepto de gerencia de caso adquiere diferentes denominaciones de acuerdo con el lugar donde es utilizado. No obstante, siempre tiene como característica central la abogacía del paciente.