Validity and reliability of the tuberculosis-related stigma scale version for Brazilian Portuguese.

BACKGROUND: Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients. METHODS: The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study. RESULTS: As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%. CONCLUSION: The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context.

The role of Primary Healthcare in the coordination of Health Care Networks in Rio de Janeiro, Brazil, and Lisbon region, Portugal. / Atenção Primária à Saúde na coordenação das Redes de Atenção à Saúde no Rio de Janeiro, Brasil, e na região de Lisboa, Portugal.

Considering the trajectory of Rio de Janeiro e Lisboa region regarding strengths of the their health local systems to achieve health for all and equity, the study aimed to compare the organization of the Primary Healthcare from both regions, searching to identify the advancement which in terms of the Delivery Health Networks' coordination. It is a case study with qualitative approach and assessment dimensions. It was used material available online such as scientific manuscripts and gray literature. The results showed the different grades regarding Delivery Health Networks. Lisboa region present more advancement, because of its historic issues, it has implemented Primary Healthcare expanded and nowadays it achieved enough maturity related to coordination of its health local system and Rio de Janeiro suffers still influence from historic past regarding Primary Healthcare selective. The both regions has done strong bids in terms of electronic health records and telemedicine. After of the study, it is clearer the historic, cultural and politics and legal issue that determined the differences of the Primary Healthcare coordinator of the Delivery Health Network in Rio de Janeiro and Lisboa region.

Atenção Primária à Saúde na coordenação das Redes de Atenção à Saúde no Rio de Janeiro, Brasil, e na região de Lisboa, Portugal / The role of Primary Healthcare in the coordination of Health Care Networks in Rio de Janeiro, Brazil, and Lisbon region, Portugal

Resumo Considerando a trajetória do Rio de Janeiro e da Região de Lisboa no que tange ao fortalecimento dos seus sistemas de saúde para alcance da saúde para todos e da equidade, propôs-se uma análise comparativa da organização da Atenção Primária à Saúde, buscando identificar os avanços desta em termos de coordenação das Redes de Atenção à Saúde. Trata-se de um estudo de caso, de orientação qualitativa e com dimensões avaliativas. Utilizou-se material disponível online, considerando artigos científicos e literatura cinza. Os resultados acenam para compassos diferentes no tocante às RAS, na região de Lisboa, com maior velocidade, até por questões históricas, foi implementado o modelo de APS abrangente e que hoje alcançou grau de maturidade suficiente no que tange à coordenação do seu sistema, enquanto o Rio de Janeiro sofre influências dos resquícios históricos de uma Atenção Primária à Saúde seletiva. O plano de carreira aparece como estratégia para fixação das equipes de saúde. As regiões têm feito apostas fortes nos prontuários eletrônicos e na telemedicina. Depois do estudo, ficam claras as questões históricas, culturais e políticas e jurídicas que acabam por determinar diferenças na APS coordenadora de RAS no Rio de Janeiro e na região de Lisboa.

Abstract Considering the trajectory of Rio de Janeiro e Lisboa region regarding strengths of the their health local systems to achieve health for all and equity, the study aimed to compare the organization of the Primary Healthcare from both regions, searching to identify the advancement which in terms of the Delivery Health Networks' coordination. It is a case study with qualitative approach and assessment dimensions. It was used material available online such as scientific manuscripts and gray literature. The results showed the different grades regarding Delivery Health Networks. Lisboa region present more advancement, because of its historic issues, it has implemented Primary Healthcare expanded and nowadays it achieved enough maturity related to coordination of its health local system and Rio de Janeiro suffers still influence from historic past regarding Primary Healthcare selective. The both regions has done strong bids in terms of electronic health records and telemedicine. After of the study, it is clearer the historic, cultural and politics and legal issue that determined the differences of the Primary Healthcare coordinator of the Delivery Health Network in Rio de Janeiro and Lisboa region.

Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012).

OBJECTIVE: To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS: This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScan™ were used in the analysis. RESULTS: We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7-4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4-36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2-0.3). We did not identify any space-time clusters. CONCLUSIONS: The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.

Integrated health service delivery networks and tuberculosis avoidable hospitalizations: is there a relation between them in Brazil?

BACKGROUND: The early identification of the Breathing Symptoms within the scope of Primary Health Care is recommended, and is also one of the strategies of national sanitary authorities for reaching the elimination of tuberculosis. The purpose of this study is to consider which attributes and which territories have shown the most significant progress in Primary Health Care, in terms of coordination of Health Care Networks, and also check if those areas of Primary Health Care that are most critical regarding coordination, there were more or less cases of avoidable hospitalizations for tuberculosis. METHODS: This is an ecological study that uses primary and secondary data. For analysis, coropletic maps were developed through the ArcGIS software, version 10.2. There was also the calculation of gross annual and Bayesian rates for hospitalizations for tuberculosis, for each Primary Health Care territory. RESULTS: There were satisfactory results for attributes such as Population (n = 37; 80.4 %), Primary Health Care (n = 43; 93.5 %), Support System (n = 45; 97.8 %); the exceptions were Logistics System (n = 32; 76.0 %) and Governance System, with fewer units in good condition (n = 31; 67.3 %). There is no evidence of any connection between networks' coordination by Primary Health Care and tuberculosis avoidable admissions. CONCLUSION: The results show that progress has been made regarding the coordination of the Health Care Networks, and a positive trend has been shown, even though the levels are not excellent. It was found no relationship between the critical areas of Primary Health Care and tuberculosis avoidable hospitalizations, possibly because other variables necessary to comprehend the phenomena.

Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012) / Análise espacial das internações evitáveis por tuberculose em Ribeirão Preto, SP (2006-2012)

ABSTRACT OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7-4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4-36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2-0.3). We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.

RESUMO OBJETIVO Descrever a distribuição espacial dos casos de internações evitáveis por tuberculose no município de Ribeirão Preto, SP, e identificar aglomerados espaciais e espaço-temporais de risco para a ocorrência desses eventos. MÉTODOS Estudo descritivo e ecológico que considerou os registros de internações no Sistema de Informação Hospitalar dos residentes de Ribeirão Preto, SP, no período de 2006 a 2012. Para as análises espaciais foram considerados somente os casos com endereços registrados, sendo os mesmos geocodificados. Recorreu-se à estatística de densidade Kernel para identificar as áreas de maior densidade, taxa bayesiana empírica local como método de suavização das taxas de incidência de internações e estatística de varredura para identificação de aglomerados de risco. Para as análises foram utilizados os softwares ArcGis 10.2, TerraView 4.2.2 e SaTScanTM. RESULTADOS Foram identificadas 169 internações por tuberculose. A maioria das internações ocorreu com pessoas do sexo masculino (n = 134; 79,2%) com idade mediana de 48 anos (DP = 16,2). A forma clínica predominante foi a pulmonar, com confirmação por exame microscópico da expectoração (n = 66; 39,0%). Foram geocodificados 159 (94,0%) casos. Observou-se distribuição espacial não aleatória de internações evitáveis por tuberculose, concentradas nas regiões norte e oeste do município. Por meio da estatística de varredura, identificaram-se três aglomerados espaciais de risco para internações por tuberculose, um na região norte do município (risco relativo [RR] = 3,4; IC95% 2,7-4,4); o segundo, na região central, onde há uma unidade prisional (RR = 28,6; IC95% 22,4-36,6); e o último, na região sul, área de proteção para as internações (RR = 0,2; IC95% 0,2-0,3). Não foram identificados aglomerados espaço-temporais. CONCLUSÕES A investigação mostrou áreas prioritárias para o controle e vigilância da tuberculose e um perfil de população atingida, evidenciando aspectos importantes a serem considerados em termos de gestão e organização dos serviços de saúde com vistas à efetividade da Atenção Primária à Saúde.

Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context.

BACKGROUND: Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. METHODS: A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. RESULTS: Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. CONCLUSION: The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.

Factors associated with knowledge about tuberculosis and attitudes of relatives of patients with the disease in Ribeirão Preto, São Paulo, Brazil.

OBJECTIVE: To investigate the knowledge regarding tuberculosis among relatives of patients with tuberculosis and the possible factors associated with this event and also to conduct comparative analyses between groups of relatives with or with few knowledge regarding tuberculosis, considering their attitudes in both groups. METHODS: Cross-sectional study in which the sample was obtained through simple and randomized method. The data were collected by trained interviewers and validated tool. Logistic regression analyses were done using statistical software SPSS, version 22.0. RESULTS: Among the 110 subjects recruited for the study, 85 (87.5%) were women, and the mean age was 49 years. Regarding common symptoms of tuberculosis, 102 relatives (90.9%) pointed the chronic cough; regarding the knowledge about tuberculosis transmission modes, 100 (90.9%) of them pointed symptomatic respiratory as the probable infection source. The relatives also reported other tuberculosis transmission models: sharing of clothes (n = 87; 79.1%) and household utensils (n = 66; 60%); sexual relations (n = 50; 50%). Illiterate relatives (adjusted OR = 4.39; 95%CI 1.11 - 17.36), those who do not watch or watch little television (adjusted OR = 3.99; 95%CI 1.2 - 13.26), and also those who do not have the Internet access (adjusted OR = 5.01; 95%CI 1.29 - 19.38) were more likely to have low knowledge regarding tuberculosis. Regardless the group, with or without tuberculosis knowledge, the attitudes of both were satisfactory. CONCLUSION: There are evidences that social inequity is associated to the tuberculosis knowledge of patient relatives.

Factors associated with knowledge about tuberculosis and attitudes of relatives of patients with the disease in Ribeirão Preto, São Paulo, Brazil / Fatores associados ao conhecimento sobre tuberculose e atitudes das famílias de pacientes com a doença em Ribeirão Preto, São Paulo

To investigate the knowledge regarding tuberculosis among relatives of patients with tuberculosis and the possible factors associated with this event and also to conduct comparative analyses between groups of relatives with or with few knowledge regarding tuberculosis, considering their attitudes in both groups.

Investigar o conhecimento das famílias sobre tuberculose e os possíveis fatores associados a essa ocorrência, além de efetuar uma análise comparativa dos grupos de familiares com conhecimento ou com pouco conhecimento quanto às suas atitudes para com o paciente com tuberculose.

Quality of primary health care: an analysis of avoidable hospitalizations in a Minas Gerais county, Brazil.

The aim of the study was to evaluate the quality of primary health care based on avoidable hospitalizations of men and women of all ages, from 2008 to 2012 in Alfenas County in the south of Minas Gerais state. This was an ecological study based on data from the Hospital Information System (HIS). The medical diagnoses selected for the study were pneumonia, diabetes mellitus and diseases of the circulatory system. There was a predominance of elderly males diagnosed with pneumonia, with an average hospital stay of five days. Admission rates for diseases of the circulatory system and diabetes mellitus tended to remain stable during the study period. While for pneumonia there was a tendency of growth that reached a plateau in early March 2009, bringing the average rate up from 2.01 to 3.51. The data suggest that primary health care is poorly organized to meet these diagnoses, particularly for pneumonia.

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012).

INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations.

Quality of primary health care: an analysis of avoidable hospitalizations in a Minas Gerais county, Brazil / Qualidade da atenção primária à saúde: uma análise segundo as internações evitáveis em um município de Minas Gerais, Brasil

The aim of the study was to evaluate the quality of primary health care based on avoidable hospitalizations of men and women of all ages, from 2008 to 2012 in Alfenas County in the south of Minas Gerais state. This was an ecological study based on data from the Hospital Information System (HIS). The medical diagnoses selected for the study were pneumonia, diabetes mellitus and diseases of the circulatory system. There was a predominance of elderly males diagnosed with pneumonia, with an average hospital stay of five days. Admission rates for diseases of the circulatory system and diabetes mellitus tended to remain stable during the study period. While for pneumonia there was a tendency of growth that reached a plateau in early March 2009, bringing the average rate up from 2.01 to 3.51. The data suggest that primary health care is poorly organized to meet these diagnoses, particularly for pneumonia.

O objetivo do estudo foi avaliar a qualidade da atenção primária à saúde, com base nas internações evitáveis, de homens e mulheres de todas as faixas etárias, no período de 2008 a 2012, em uma cidade do sul de Minas Gerais. Trata-se de um estudo ecológico realizado a partir dos dados do Sistema de Informação Hospitalar (SIH-SUS). Os diagnósticos médicos selecionados foram: pneumonia, diabetes mellitus e doenças do sistema circulatório. Houve predomínio de idosos, do sexo masculino, com diagnóstico de pneumonia, mediana do tempo de internação de cinco dias e aumento dos gastos com tais hospitalizações. A tendência da taxa de hospitalização para as doenças do sistema circulatório e diabetes mellitus manteve-se estável durante o período em estudo. Quanto à pneumonia, verificou-se uma tendência crescente, sendo encontrado um platô no início de março de 2009, que elevou a taxa média de 2,01 para 3,51. Os dados sugerem que a atenção primária à saúde está pouco organizada para atender a esses diagnósticos, principalmente no que se refere à pneumonia.

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

INTRODUCTION: The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS: Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS: In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS: The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations. .

Patients' perceptions on the performance of a local health system to eliminate leprosy,Paraná State, Brazil.

BACKGROUND: In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the "Pact for life" (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. CONCLUSIONS/SIGNIFICANCE: The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.

Estigma social e as famílias de doentes com tuberculose: um estudo a partir das análises de agrupamento e de correspondência múltipla / Social stigma and the families of patients with tuberculosis: a study based on cluster and multiple correspondence analysis

O estigma social da tuberculose é um desafio que se coloca à gestão do cuidado na área da saúde pública. O objetivo deste estudo foi investigar o estigma social em famílias de doentes com TB e identificar o perfil daquelas que são acometidas pelo evento em relação às condições socioeconômicas e demográficas. Trata-se de um estudo transversal realizado no município de Ribeirão Preto, São Paulo, Brasil, em 2011, com uma amostra de 110 sujeitos. Os dados foram analisados mediante técnica descritiva univariada e análises de agrupamento e de correspondência múltipla. Os grupos com estigma apresentaram baixa escolaridade, acesso incipiente aos meios de informação e pouca mobilização referente à compreensão sobre a doença, diferenciando-se dos demais grupos que apresentam comportamentos e atitudes positivas, com níveis de escolaridade mais elevados, acesso contínuo aos meios de informação e se dizem conhecedores da TB. A identificação de diferentes perfis aponta para necessidade de serem desenvolvidas ações em saúde sensíveis às singularidades das famílias no que se refere ao estigma social da doença.

The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirão Preto, state of São Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.

[Social stigma and the families of patients with tuberculosis: a study based on cluster and multiple correspondence analysis]. / Estigma social e as famílias de doentes com tuberculose: um estudo a partir das análises de agrupamento e de correspondência múltipla.

The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirão Preto, state of São Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.

[Coordination of primary healthcare networks: semantic validation of an adapted instrument]. / Coordenação das redes de atenção à saúde pela atenção primária: validação semântica de um instrumento adaptado.

This cross-sectional study conducted a semantic validation of the instrument for evaluating the coordination of primary care networks, adapted to the evaluation checklist on the degree of integration of healthcare networks, considering each item's relevance, coherence, and comprehension by the study's reference population. The sample consisted of 56 healthcare professionals that work in the Family Health Strategy in Alfenas, Minas Gerais State, Brazil. The instrument has five dimensions and 78 items with Likert-type responses. The process involved three stages: evaluation and adaptation of the items by a group of experts, evaluation and suggestions for the items by 50 health professionals, and confirmation of the items by six health professionals. The instrument's items proved comprehensible for the reference population. The instrument can be a useful tool to back decision-making by policymakers in reorganizing local health systems.

[The families and directly observed treatment of tuberculosis: senses and prospects to the production of care]. / Famílias e o tratamento diretamente observado da tuberculose: sentidos e perspectivas para produção do cuidado.

The purpose was to identify the families' participation on care management of patients with tuberculosis. Also, to ascertain the contribution offered by health professionals for patients'families with ongoing treatment, and investigate the importance attributed by the families to the directly observed treatment It is a descriptive, cross-sectional study conducted in the municipality of Ribeirão Preto/SP with families of patients diagnosed with tuberculosis. For data collection, it was developed an instrument that underwent pretesting and content validation. Ninety four subjects were interviewed. According to the results, 64 (68.096) relatives participated in the care management and 81 (86.2%) reported a good relationship with the staff. Sixty three family members (67%) did not receive any guidance about drugs and 75 (80.0%) of the respondents considered the strategy as relevant. The findings indicate that the Directly Observed Treatment has limitations regarding the guidelines of clinical management of the disease, the inclusion of family in care management and understanding of its goals.

Coordenação das redes de atenção à saúde pela atenção primária: validação semântica de um instrumento adaptado / Coordination of primary healthcare networks: semantic validation of an adapted instrument / Coordinación de las redes de atención para la salud en la atención primaria: validación semántica de un instrumento adaptado

Objetivou-se efetuar a validação semântica do instrumento de avaliação da coordenação das redes de atenção à saúde pela atenção primária, adaptado do checklist de avaliação do grau de integração das redes de atenção à saúde, considerando a relevância, a coerência e a compreensão de cada item para a população de referência do estudo. Trata-se de um estudo metodológico de corte transversal. A amostra foi composta de 56 profissionais de saúde que atuam na Estratégia Saúde da Família, em Alfenas, Minas Gerais, Brasil. O instrumento possui cinco dimensões e 78 itens com respostas do tipo Likert. O processo envolveu três etapas: avaliação e adaptação dos itens pelo grupo de especialistas, avaliação e sugestão dos itens por 50 profissionais de saúde e confirmação dos itens por seis profissionais de saúde. Ao final da validação semântica, os itens do instrumento se mostraram compreensíveis pela população de referência. Ao término do processo de validação, o instrumento poderá ser uma ferramenta útil para subsidiar a tomada de decisão de gestores para a reorganização dos sistemas locais de saúde.

This cross-sectional study conducted a semantic validation of the instrument for evaluating the coordination of primary care networks, adapted to the evaluation checklist on the degree of integration of healthcare networks, considering each item’s relevance, coherence, and comprehension by the study’s reference population. The sample consisted of 56 healthcare professionals that work in the Family Health Strategy in Alfenas, Minas Gerais State, Brazil. The instrument has five dimensions and 78 items with Likert-type responses. The process involved three stages: evaluation and adaptation of the items by a group of experts, evaluation and suggestions for the items by 50 health professionals, and confirmation of the items by six health professionals. The instrument’s items proved comprehensible for the reference population. The instrument can be a useful tool to back decision-making by policymakers in reorganizing local health systems.

El objetivo del estudio fue efectuar la validación semántica de los ítems que componen el instrumento de evaluación de la coordinación de las redes de atención para la salud, a través de la atención primaria, con una adaptación de la lista de verificación para evaluar el grado de integración de las redes de atención de la salud, considerando la relevancia, la coherencia y la comprensión de cada ítem para la población de referencia en el estudio. Se trata de un estudio metodológico y de corte transversal. La muestra estuvo conformada por 56 profesionales de la salud que actúan en la Estrategia Salud para la Familia y reclutados en Alfenas, Minas Gerais, Brasil. El instrumento posee cinco dimensiones y 78 ítems con respuestas del tipo Likert. El proceso contó con tres etapas: evaluación y adaptación de los ítems por el grupo de especialistas, evaluación y sugerencia de los ítems, realizada por 50 profesionales de la salud, evaluación y certificación de los ítems, realizada por seis profesionales de la salud. Después de terminar la última fase de la validación semántica, los ítems del instrumento mostraron ser una herramienta útil para apoyar la toma de decisiones de los gestores en la reorganización de los sistemas de salud locales.

The families and directly observed treatment of tuberculosis: senses and prospects to the production of care / Las familias y el tratamiento directamente observado de la tuberculosis: sentidos y perspectivas para la producción del cuidado / Famílias e o tratamento diretamente observado da tuberculose: sentidos e perspectivas para produção do cuidado

The purpose was to identify the families' participation on care management of patients with tuberculosis. Also, to ascertain the contribution offered by health professionals for patients' families with ongoing treatment, and investigate the importance attributed by the families to the directly observed treatment. It is a descriptive, cross-sectional study conducted in the municipality of Ribeirão Preto/SP with families of patients diagnosed with tuberculosis. For data collection, it was developed an instrument that underwent pretesting and content validation. Ninety four subjects were interviewed. According to the results, 64 (68.0%) relatives participated in the care management and 81 (86.2%) reported a good relationship with the staff. Sixty three family members (67%) did not receive any guidance about drugs and 75 (80.0%) of the respondents considered the strategy as relevant. The findings indicate that the Directly Observed Treatment has limitations regarding the guidelines of clinical management of the disease, the inclusion of family in care management and understanding of its goals.

El objetivo fue identificar la participación de familiares en la gestión del cuidado del enfermo con tuberculosis, averiguar el aporte de los profesionales de la salud para las familias de pacientes en tratamiento e investigar la importancia atribuida por esas familias al tratamiento directamente observado. Estudio descriptivo, corte transversal y realizado en el municipio de Ribeirão Preto/SP con las familias de pacientes diagnosticados con tuberculosis. Para obtener los datos fue elaborado un instrumento que pasó por la validación del contenido y preexamen. Fueron entrevistados 94 sujetos. De acuerdo con los resultados, 64 (68,0%) de los familiares participaron de la gestión del cuidado; 81 (86,2%) relataron una buena relación con el equipo, 63 (67%) no recibieron orientación sobre medicamentos y 75 (80,0%) consideraron la estrategia como relevante. Los resultados señalan que el Tratamiento Directamente Observado presenta limitaciones sobre las orientaciones del manejo clínico de la enfermedad, la inclusión de la familia en la gestión del cuidado y en la comprensión de los objetivos.

O objetivo foi identificar a participação das famílias na gestão do cuidado do doente de tuberculose, o aporte oferecido pelos profissionais de saúde às famílias de doentes em tratamento e a importância atribuída pelas famílias ao Tratamento Diretamente Observado. Trata-se de um estudo descritivo de corte transversal, realizado no município de Ribeirão Preto, SP, junto às famílias dos pacientes diagnosticados de tuberculose. Para coleta de dados, foi elaborado um instrumento que passou pela validação de conteúdo e pré-teste. Foram entrevistados 94 sujeitos. Nos resultados, 64 (68,0%) dos familiares participaram da gestão do cuidado, 81 (86,2%) relataram boa relação com a equipe, 63 (67%) não receberam orientação dos medicamentos e 75 (80,0%) consideraram a estratégia como relevante. Os achados do estudo apontam que o Tratamento Diretamente Observado apresenta ainda limitações quanto às orientações do manejo clínico da doença, a inclusão da família na gestão do cuidado e na compreensão dos seus objetivos.