Tuberculosis diagnostic pathway in a municipality in south-eastern Brazil.

OBJECTIVE: To analyse the pathway taken by tuberculosis (TB) patients from the first contact with the health services and the diagnosis of TB disease. METHOD: In a survey conducted in a south-eastern municipality of Brazil prioritised for TB control, a structured questionnaire was applied to 100 TB patients under treatment; secondary data recorded in two information systems were also collected for analysis. Diagrams were constructed to represent the patient pathway through the health services up to diagnosis. RESULTS: The emergency services were the point of entry into care for the majority of the patients. Those who first attended primary health care (PHC) centres needed to visit other health services for diagnosis. CONCLUSION: Our study shows that multiple visits to multiple health services are required for the majority of patients to be diagnosed with TB. It is necessary to reinforce the referral path established for TB diagnosis and communication among providers, who should play a clear role in obtaining early diagnosis.

Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view.

SETTING: Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.

City tuberculosis control coordinators' perspectives of patient adherence to DOT in São Paulo State, Brazil, 2005.

SETTING: Thirty-six priority cities in São Paulo State, Brazil, with a high incidence of tuberculosis (TB) cases, deaths and treatment default. OBJECTIVE: To identify the perspectives of city TB control coordinators regarding the most important components of adherence strategies adopted by health care teams to ensure patient adherence in 36 priority cities in the State of São Paulo, Brazil. DESIGN: Qualitative research with semi-structured interviews conducted with the coordinators of the National TB Control Programme involved in the management of TB treatment services in the public sector. RESULTS: The main issues thought to influence adherence to directly observed treatment (DOT) by coordinators include incentives and benefits delivered to patients, patient-health care worker bonding and comprehensive care, the encouragement given by others to follow treatment (family, neighbours and health professionals), and help provided by health professionals for patients to recover their self-esteem. CONCLUSION: The main aspects mentioned by city TB control coordinators regarding patient adherence to treatment and to DOT in São Paulo are improvements in communications, relationships based on trust, a humane approach and including the patients in the decision-making process concerning their health.

Tuberculosis teaching in Brazilian medical schools.

To achieve tuberculosis (TB) control, National Tuberculosis Programme guidelines should be implemented effectively. In a survey conducted in 2005-2006, 33 Brazilian medical school coordinators answered a questionnaire about TB education. The median time dedicated to TB was 27 h (4-119 h), spread over several disciplines, mainly biological and clinical. This included 12 h (0-88 h) of practical activities, mainly in university hospitals (53%). The recommendation to offer human immunodeficiency virus testing for TB patients was taught in only 54% of the schools. TB education in Brazil is fragmented and restricted to a biological approach, while field activities are insufficient and carried out in inadequate settings. Important changes to the TB curriculum are necessary.

Tuberculosis risks and socio-economic level: a case study of a city in the Brazilian south-east, 1998-2004.

OBJECTIVES: To explore tuberculosis (TB) risks in relation to potential determinants in the city of São José do Rio Preto, São Paulo State, Brazil; to analyse morbidity and mortality indicators in São José do Rio Preto, and to determine the relationship between the risk of TB and socio-economic level (SEL) using a geo-referenced information system (GIS) and the national census for 2000. METHOD: Standardised incidence rates and TB incidence and mortality rates were calculated. Socio-economic variables were determined using the statistical technique of principal component analysis. Data sources were the São Paulo State Data Analysis System (SEADE), the TB Notification Database (EPI-TB), the Information Department of the Brazilian Health Ministry (DATASUS), and the Brazilian Institute of Geography and Statistics (IBGE). New cases reported in 1998-1999 and 2003-2004 in the urban area of the city were geo-referenced and analysed. RESULTS: TB risk in the city is twice as high in areas of lower SEL than in areas with higher SEL. CONCLUSION: The identification of areas with different levels of risk enables the Municipal Health Department to propose innovative interventions to minimise the risk of disease at both individual and population level.

Survey on tuberculosis teaching in Brazilian nursing schools, 2004.

OBJECTIVE: To characterise tuberculosis (TB) teaching in Brazilian nursing schools by state and region and its theoretical and practical contents. METHODOLOGY: In an educational research survey in 2004, 347 nursing schools were identified. Questionnaires were posted to faculties providing training in TB. Data were compiled in a database with a view to descriptive result analysis. Replies to the questionnaire were received by 32% of the nursing schools contacted. RESULTS: Undergraduate TB teaching is heterogeneous. For training in theory, the principle teaching method is through classes in 102 (91.9%) nursing schools. Practical TB teaching is carried out at the primary care level (89.2%). Teachers update their knowledge through events and internet; little reference is made to manuals. The time devoted to practical TB teaching ranges from 10 to 20 hours, although this is not always included in student training. CONCLUSION: Teaching in TB should go beyond the traditional model that focuses only on biological aspects. It should introduce tools that lead to permanent behavioural change, such as a more human approach and social and psychological aspects, such as living conditions, habits and customs. It should involve new partners, such as families, communities and other health professionals, and identify obstacles within the university.

[Nursing and case management]. / Enfermería y gerencia de caso.

This study presents case management as a care delivery model which is used in a variety of settings in the United States health care system. It basically designates a specific professional or health care team which is responsible for the care of an individual patient in the whole clinical process by coordinating care throughout services and institutions in the system. In nursing, the model has been accepted to increase the nurse's commitment in the standardization of practice. Central concepts include analysis, clinical decision-making and resolution of problems.

[International health: various current concepts]. / Saúde internacional: alguns aspectos conceituais contemporâneos.

This study is a theoretical approach on international health with the purpose to point out some aspects which can enhance the understanding of the International Health field and its operational and conceptual elements in the socio-economic process of integration of neighboring countries.

[Knowledge obtained in the master's program of public health nursing at the Nursing School of Ribeirao Preto - USP and its relationship with health practices]. / O conhecimento produzido no programa de mestrado de enfermagem em saúde pública da Escola de Enfermagem de Ribeirão Preto-USP e suas relações com as práticas de saúde.

The purpose of this study was to analyze the research objects of the theses produced in the Master Program on Public Health offered by the Department of Maternal-Infant Nursing and Public Health--University of São Paulo at Ribeirão Preto College of Nursing and their relationship with the problems originated from health care practice. These practices were classified within six major areas: Health Care Organization, Health Promotion, Health-Disease Process, Nutrition-Feeding, Professional Practice and Immunology. The contribution of works focussing on the crisis of health paradigms, gender relations and Social Movements in Health were emphasized. Authors concluded that the themes are closely related to the students' professional context, enabling them to present suggestions regarding interventions in health practices.

[Overview of the health situation in Peru]. / Visión panorámica de la situación de salud en el Perú.

This work presents a general view of the health situation in Peru in the last few decades by presenting a short historic development of health and pointing out the changes that have taken place as a consequence of the social, economic and political transformations and affected the population's health. The process of change in public and private health services, the influence of conceptions and sanitary policies of international organizations, the health system and the health situation are mentioned. Two problems of great impact are presented: the cholera epidemics and political violence.

Nursing and the health system in Brazil.

The purpose of this article is to describe nursing in the Brazilian health system and to analyze the characteristics of nursing personnel in Brazil. This description includes types of health institutions, services rendered, and the distribution of nursing personnel by professional categories in 1956, 1982, and 1995. Discussion of the challenges facing Brazilian nurses is presented using data from the Brazilian Institute of Geography and Statistics (IBGE), Federal Nursing Board (COFEn), Regional Nursing Board (COREn), and the Brazilian Nursing Association (ABEn). An increase in the number of outpatient units and in diagnostic and therapeutic examinations has led to an increased the demand for nurses. Public health nurses participate in planning, management, sanitary education, health promotion, and supervision of nursing care provided by nursing technicians, assistants, and other helpers.

[Public health literature: teaching of a new look in the health-illness process]. / A literatura em saúde pública: o ensino de um "novo olhar" sobre o processo saúde-doença.

This paper presents the use of Brazilian literature in public health nursing courses at the University of São Paulo at Ribeirão Preto College of Nursing. The goal is a preliminary report about experiences that intend to keep the students in touch in order to wide their view of reality, in which relationships between the men and health-illness process are established in the complexity and singularity of human being (ill and life) in each place and time. In the first stage, this experience is based on New History conceptual framework (Ecolle des Annale), in the complexity's paradigm (MORIN) and circularity concept and sign's paradigm (GINZBURG).

[Relationship between university and health services. Building work situations]. / A relação universidade e serviços de saúde--construindo possibilidades de trabalho.

The present study aims at reporting the experience of construction of an interinstitutional relationship: university and health services, pointing out the possibilities and difficulties of the process.

[Information systems in the management process of the health services. Reflections]. / O sistema de informações no processo gerencial dos serviços de saúde: algumas reflexões.

The present study aims at reflecting about the organization of the information system as an important tool in the management of health services, especially in the process of municipalization.

[Agents of nursing in São Paulo health practices: from the bacteriological model to the health program (1889-1983)]. / Os agentes de enfermagem nas práticas sanitárias paulistas: do modelo bacteriológico à programação em saúde (1889-1983).

The historical roots of the nursing profession in public health in the state of São Paulo from 1900-1980 have been identified. Nurses have effectively participated to implement a new public health program--"Programação em Saúde", having the assignment to train, coordinate, supervise/manage other nurses who lacked specialized training. The nurse's understanding of her role in the health process was limited to individual performance with emphasis on technical ability, without understanding the purpose of her actions in the overall model.

[Breast feeding and dietary supplementation]. / Aleitamento materno e suplementação alimentar.

This study was conducted in five health centers of the Secretariat of Health of the State of São Paulo, in the city of Ribeirão Preto, during July 1983. In order to ascertain feeding practices, interviews were given to 389 mothers at the time of their children's enrollment in the food supplement program. Contradictions were observed between the objectives and implementation of the breast-feeding promotion program in view of the high number of children enrolled in the milk supplement program prior to reaching six months of age, and the number of those under three months who were partially or completely breast-fed and were also being enrolled in the supplement program. The major reasons given by mothers for early weaning were that they had insufficient milk or their "milk had dried up", followed by the mother's need to work outside the home, and mammary causes. Maintaining breast-feeding up to the time of enrollment of the child in the milk supplement program was associated with mothers who were multiparous and had had previous experience with breast-feeding.

[Health reform: the consequences for the teaching of the administration of community nursing services]. / Reforma sanitária: implicações para o ensino de administração de serviços de enfermagem na comunidade.

This study is aimed at characterizing the administrative activities performed by nurses at health institutions engaged in a process of restructuring the sanitary system. The instrument consisted of a questionnaire and concentrated on the formulation of a theoretical frame for the administrative practice of a nurse. The collected data showed that nurses are performing the administrative activity following random and non-scientific patterns. There are differences concerning the management carried out by nurses according to the nature of the institution, public or private, and the level of health assistance. As far as the steps in an administrative process go, most nurses don't plan or evaluate carefully the type of health care to be taken. They supervise the application of a plan conceived by other departments in which they may or may not have participated.