Avaliação de ações de controle da tuberculose em um município brasileiro de grande porte / Evaluation of tuberculosis control actions in a large Brazilian municipality / Evaluación de las acciones de control de la tuberculosis en un municipio brasileño de gran tamaño

RESUMO Objetivo Avaliar as ações de controle da tuberculose realizadas em um município brasileiro de grande porte. Métodos Estudo transversal analítico de abordagem quantitativa, cuja população (N=137) abrangeu os doentes com tuberculose notificados no Sistema de Informação de Agravos e Notificação e que estavam em tratamento, com amostra (n=75) obtida após os critérios de inclusão e de exclusão. As variáveis estudadas foram: "unidade de saúde responsável pelo diagnóstico da tuberculose", "tempo gasto para receber o diagnóstico da tuberculose, após o início dos sinais e sintomas", "unidade de saúde responsável pelo tratamento da tuberculose" e "tipo de tratamento da tuberculose". Os dados foram obtidos a partir de entrevistas estruturadas e analisados por meio da estatística descritiva e analítica com a aplicação do Teste Qui Quadrado de Pearson, através do software R. Conclusão O estudo identificou que as ações de controle da tuberculose encontram-se centralizadas nos serviços especializados e na rede privada, o que contribui para o diagnóstico tardio e dificulta a quebra da cadeia de transmissão da doença, além do tratamento autoadministrado, modalidade que favorece o desfecho antagônico do tratamento.(AU)

ABSTRACT Objective To evaluate tuberculosis control actions in one large Brazilian municipality. Materials and Methods Quantitative, cross-sectional study, with a population (N=137) of patients with tuberculosis notified in the Sistema de Informação de Agravos e Notificação (Brazilian Case Registry Database). The final sample (n = 75) was obtained based on inclusion and exclusion criteria. The studied variables were: "health center in charge of diagnosing tuberculosis", "time elapsed since the onset of signs and symptoms until diagnosis of tuberculosis", "health center in charge of providing treatment of tuberculosis" and "type of tuberculosis treatment". Data were collected between March and July of 2015, and were obtained from structured interviews and analyzed through descriptive and analytic statistics by Chi square test method, using the R software. Conclusion The study identified that tuberculosis control actions are focused on specialized services and the private network, which contributes to a late diagnosis, and hinder the interruption of disease transmission. Self-administered treatment was also observed, modality that favors the antagonistic outcome of the treatment.(AU)

RESUMEN Objetivo Evaluar las acciones de control de la tuberculosis realizadas en un gran municipio brasileño. Métodos Estudio cuantitativo de corte transversal cuya población (N = 137) incluyó pacientes con tuberculosis que fueron notificados en el Sistema de Informação de Agravos e Notificação y que mediante los critérios de inclusión y exclusión, se obtuvo uma muestra de (n = 75) obtenida después de la inclusión y de exclusión. Las variables estudiadas fueron: "centro de salud responsable por el diagnóstico de tuberculosis", "tiempo empleado en recibir el diagnóstico de tuberculosis después de la aparición de signos y síntomas", "centro de salud responsable por el tratamiento de la tuberculosis" y "tipo de tratamiento de tuberculosis". Los datos se obtuvieron de entrevistas estructuradas y se analizaron mediante estadísticas descriptivas y analíticas a través de la prueba de Chi cuadrado de Pearson, utilizando el software R. Conclusión El estudio identificó que las acciones de control de la tuberculosis están centralizadas en los servicios especializados de salud y en la red privada, lo que contribuye al diagnóstico tardío y dificulta la ruptura de la cadena de transmisión de la enfermedad, además del tratamiento autoadministrado, modalidad que favorece el resultado antagónico del tratamiento.(AU)

Suicide attempts: epidemiologic trends towards geoprocessing.

In order to study data about suicide attempts and do the mapping of occurrence areas, it was developed an ecologic and exploring study, making use of techniques of geoprocessing, based on confirmed cases of suicide attempts. Cases of self-poisoning were included in the urban area of Campina Grande county, in the period of 2010-2013. A total of 446 suicide attempts were geo-referred, pointing up an incidence of 120 cases out of each 100,000 inhabitants. The sample was mostly feminine (66.4%), and 62.3% being up to 30 years old. Kernel's map remarked hot spot areas. Compared to surrounding areas the suicide risk of populations within the hot spots was increased (38%; Relative Risk = 1.38; p= 0.0029), with an average estimative of 165 suicide attempts out of 100,000 inhabitants. Through identification of hot spots and index of living conditions of the neighborhoods, it is possible to set priorities in terms of public policies for the prevention of suicide attempts and control of the marketing of substances that are potentially toxic.

Suicide attempts: epidemiologic trends towards geoprocessing / Tentativas de suicídio: tendências epidemiológicas quanto ao geoprocessamento

Abstract In order to study data about suicide attempts and do the mapping of occurrence areas, it was developed an ecologic and exploring study, making use of techniques of geoprocessing, based on confirmed cases of suicide attempts. Cases of self-poisoning were included in the urban area of Campina Grande county, in the period of 2010-2013. A total of 446 suicide attempts were geo-referred, pointing up an incidence of 120 cases out of each 100,000 inhabitants. The sample was mostly feminine (66.4%), and 62.3% being up to 30 years old. Kernel's map remarked hot spot areas. Compared to surrounding areas the suicide risk of populations within the hot spots was increased (38%; Relative Risk = 1.38; p= 0.0029), with an average estimative of 165 suicide attempts out of 100,000 inhabitants. Through identification of hot spots and index of living conditions of the neighborhoods, it is possible to set priorities in terms of public policies for the prevention of suicide attempts and control of the marketing of substances that are potentially toxic.

Resumo Para estudar os dados sobre tentativas de suicídio e mapear as áreas de incidência foi desenvolvido um estudo do tipo ecológico e exploratório, usando técnicas de geoprocessamento, com base em casos confirmados. Foram incluídos os casos de autoevenenamento, ocorridos na zona urbana do município de Campina Grande, para o período 2010-2013. Um total de 446 tentativas de suicídio foi georreferenciado, apontando uma incidência de 120 casos a cada 100.000 habitantes. A amostra foi majoritariamente feminina (66,4%), com 62,3% possuindo até 30 anos de idade. O mapa de Kernel evidenciou areas de hot spots. Populações dentro dos hot spots apresentaram um risco de suicídio 38% maior (Risco Relativo= 1,38; p = 0,0029), com uma estimativa média de 165 tentativas de suicídios por 100.000 habitantes. Através da identificação das áreas de hot spots e do índice de condições de vida dos bairros, pode-se estabelecer as prioridades em termos de políticas públicas de prevenção das tentativas de suicídio e de controle da comercialização de substâncias com potencial tóxico.

Patients' perception regarding the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment: a qualitative study.

BACKGROUND: Tuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients' perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment. METHODS: A qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP). RESULTS: A total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment. CONCLUSIONS: According to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.